title: Prognostic value of angiogenesis evaluated with high-frequency and color Doppler sonography for preoperative assessment of melanomas.
abstract: OBJECTIVE
  The aim of our study was to confirm the value of high-frequency and color Doppler sonography in evaluating the metastatic potential of melanomas.
  
  
  METHODS
  Sixty-nine histologically proven melanomas in 67 patients were prospectively studied before surgical resection. A morphologic study was performed with a 20-MHz probe. The maximal thickness of tumors was measured and compared with the Breslow index. A color Doppler sonographic analysis of neovascularization was performed with a 13-MHz probe to depict intratumoral vessels.
  
  
  RESULTS
  Of the 69 melanomas, 65 were depicted on sonography. Tumor thickness ranged from 0.26 to 8.0 mm as measured by sonography and from 0.15 to 8.0 mm according to the Breslow index. Sonographic measurements correlated strongly with the Breslow index (r > 0.96). Surgical reexcision was necessary in 33 tumors with a Breslow index exceeding 1 mm, but reexcision could have been avoided in 31 of these cases had the initial surgical planning been based on high-frequency sonographic measurements. Among the 62 patients studied with color Doppler sonography, intratumoral vessels were depicted on color Doppler sonography in 21 melanomas, all of which were thicker than 2 mm. The median follow-up was 40 months. Eleven patients developed metastases, and all except one had a vascularized melanoma. In the univariate analyses, neovascularization visualized with sonography and the Breslow index were both significantly linked to the occurrence of metastases (p < 0.0001). In the multivariate Cox proportional hazards regression analysis, neovascularization was the only significant parameter.
  
  
  CONCLUSIONS
  This study confirms that prognostic value of angiogenesis evaluated with color Doppler sonography could be used to identify melanomas with a high metastatic potential.
authors.affiliation: Department of Medical Imaging, Ultrasonography Unit, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lassau
authors.forename: Serge
authors.initials: S
authors.lastname: Koscielny
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Avril
authors.forename: Alvaro
authors.initials: A
authors.lastname: Margulis
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Thierry
authors.initials: T
authors.lastname: De Baere
authors.forename: Alain
authors.initials: A
authors.lastname: Roche
authors.forename: Jérome
authors.initials: J
authors.lastname: Leclère
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D011379:Prognosis; D012878:Skin Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000379:methods