title: [The difficulty of ultrasound diagnosis of lymph node metastases of malignant melanoma in protracted tumor growth].
abstract: Lymph node ultrasound examinations are performed during the follow-up of cutaneous melanoma in order to early recognise regional metastases. The excision of regional metastases is the only way to inhibit disseminated metastasis in a certain percentage of cases. Lymph node ultrasound has a sensitivity of 95% in the diagnosis of pathological lymph node changes. Sonographic findings normally show typical features of malignancy; only in some doubtful cases are further control examinations warranted over a period of 4-6 weeks. In violation of this rule, two cases are presented with a delayed onset of metastases causing difficulties in the diagnosis of malignant transformation. Four years after the excision of a nodular melanoma with 0.8 mm tumor thickness at the right lower leg, a suspicious lymph node change in the right groin was sonographically detected which did not fulfill all criteria of malignancy. Control examinations over a period of 1 year found only a further growth of 3 mm. Excision after 1 1/2 years showed a lymph node metastasis. The second case presented 9 years after the excision of a superficial spreading melanoma with 0.76 mm tumor thickness with a suspicious lymph node in the right axilla which similarly grew very slowly. The subsequent excision showed likewise a melanoma metastasis. A protracted growth may occur in thin malignant melanomas with late development of ultrasound features of malignancy. In doubtful cases an early biopsy is recommended.
authors.affiliation: Sektion für Dermatologische Onkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen.
authors.forename: M
authors.initials: M
authors.lastname: Carl
authors.forename: W
authors.initials: W
authors.lastname: Stroebel
authors.forename: G
authors.initials: G
authors.lastname: Rassner
authors.forename: C
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography