title: The Tail and the String Sign: New Sonographic Features of Subcutaneous Melanoma Metastasis.
abstract: No highly specific sonographic imaging findings to evaluate melanoma spread along the lymphatic vessels have ever been described. Between January 2009 and December 2012, a consecutive group of 531 melanoma patients at their initial stage or during follow-up for nodal or extra-nodal superficial metastasis were evaluated retrospectively to assess the presence of two sonographic findings demonstrating superficial lymphatic metastasis: a "tail" sign (a thin hypoechoic prolongation from one or both poles of a superficial metastasis) and a "string" sign (multiple in-transit lesions connected to each other in a rosary image). The total number of superficial metastatic lesions was 222. The tail sign was seen in 13 of the 222 lesions (5.9%). The string sign was detected in four patients (4.5%). These signs showed a low sensitivity with a very high specificity (100%). Tail and string signs may represent an additional finding of high specificity to be employed in the differential diagnosis of melanoma patients.
authors.affiliation: Department of Advanced Medical Biosciences, University Federico II of Naples (UNINA), Biostructures and Bioimmages Institution (IBB), National Research Council (CNR), Naples, Italy; Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy. Electronic address: an.cor@hotmail.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Corvino
authors.affiliation: Department of Advanced Medical Biosciences, University Federico II of Naples (UNINA), Biostructures and Bioimmages Institution (IBB), National Research Council (CNR), Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Corvino
authors.affiliation: Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy.
authors.forename: Orlando
authors.initials: O
authors.lastname: Catalano
authors.affiliation: Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Sandomenico
authors.affiliation: Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Petrillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: High-resolution ultrasound; Lymph node metastasis; Melanoma; Metastasis; Subcutaneous tissue