Purpose: Evaluation of colour Doppler criteria to differentiate between malignant and benign skin tumours on the basis of the degree of vascularization. Material and Methods: The B-mode sonomorphology and the degree of vascularization in colour Doppler of 81 clinically potentially malignant tumours of cutaneous and subcutaneous structures were analyzed and quantified by number of intratumoral vessels per sonographic slice and percentage vessel area. Results: Of all criteria employed, counting the intratumoral vessels visible on one ultrasound slice after application of a signal-enhancing agent led to highest sensitivity (94%) of all used criteria but the specificity was poor (64%). The highest specificity (88%) and greatest diagnostic accuracy (86%) discriminating benign and malignant lesions were found using the criterion “percentage vessel area >5.0%” after all inflamed lesions had been excluded on the basis of clinical criteria. Plain colour Doppler increased the specificity up to 97%, although the sensitivity decreased simultaneously to max. 75%. Analysis of the B-mode morphology and spectral Doppler parameter of intratumoral vessels did not contribute to the differential diagnosis. Conclusion: Signal-enhanced colour Doppler sonography is a valuable tool in the pretherapeutic assessment of cutaneous lesions. This method may be relevant for therapy and prognosis.

Sir, Con®rmation of a diagnosis of skin tumour is based on histological examination after tumour excision. The initial assessment of the tumour is performed by inspection and palpation by an experienced clinician. However, tumour thickness and depth of invasion cannot always be adequately evaluated by epiluminescence microscopy. On account of the importance of these prognostic parameters for further treatment planning, high-frequency ultrasound (20 MHz, 50 MHz) has been used for a number of years. The results obtained by this procedure show a good correlation between histometry and ultrasound, but skin layer differentiation and measurement of vertical tumour height are subject to methodrelated limitations (1). The aim of the present study, therefore, was to assess the usefulness of high-resolution magnetic resonance imaging (MRI) for determining depth of invasion and thickness of skin tumours.

PURPOSE:Prospective evaluation of the diagnostic outcome of plain and signal-enhanced color Doppler sonography for the differentiation between benign and malignant cutis-involving lesions.MATERIALS AND METHODS:39 patients with 40 suspected malignant skin lesions received an preoperative ultrasound examination before and after application of 4 g Levovist i.v. Spectral Doppler, conventional color and power Doppler were performed. The images were analyzed semiquantitatively using a specially developed software. The diagnoses were confirmed by histological analysis (37 cases) or by follow up controls (3 cases).RESULTS:Whereas the B-mode criteria such as echogenoity, borderline and homogenecity, and the spectral Doppler analysis were not useful for differentiation between malignant and benign lesions, the analysis of the intratumorously visible number of vessels and of the ratio of the vascularized area using a special software, especially after injection of the signal enhancing agent, provided valuable information. In 10 of 18 benign but only in 1 of 22 malignant lesions, no intratumorous vessels were visible after application of Levovist (plain: 10/18 benign and 6/22 malignant lesions). The number of visible vessels increased strongly after signal enhancement. Using a "ratio of the vascularized area (percentage vessel area) > 5%" as a criterion of malignancy, 2 false positive and 2 false negative results were observed after application of Levovist (without/with Levovist sensitivity 73%/91%, specificity 89%/89%).CONCLUSIONS:The signal-enhanced color Doppler sonography provides useful additional information for the differentiation between benign and malignant cutis-involving lesions, especially the semiquantitative vascularization analysis. The latter is superior to B-mode ultrasound and to spectral Doppler analysis. The signal enhancer increases the sensitivity, whereas the specificity remains unchanged.

Purpose: Prospective evaluation of the diagnostic outcome of plain and signal-enhanced color Doppler sonography for the differentiation between benign and malignant cutis-involving lesions. Materials and Methods: 39 patients with 40 suspected malignant skin lesions received an preoperative ultrasound examination before and after application of 4 g Levovist(R) i.v. Spectral Doppler, conventional color and power Doppler were performed. The images were analyzed semiquantitatively using a specially developed software. The diagnoses were confirmed by histological analysis (37 cases) or by follow up controls (3 cases). Results: Whereas the B-mode criteria such as echogenoity, borderline and homogenecity, and the spectral Doppler analysis were not useful for differentiation between malignant and benign lesions, the analysis of the intratumorously visible number of vessels and of the ratio of the vascularized area using a special software, especially after injection of the signal enhancing agent, provided valuable information. In 10 of 18 benign but only in 1 of 22 malignant lesions, no intratumorous vessels were visible after application of Levovist (plain: 10/18 benign and 6/22 malignant lesions). The number of visible vessels increased strongly after signal enhancement. Using a "ratio of the vascularized area (percentage vessel area) > 5 %" as a criterion of malignancy, 2 false positive and 2 false negative results were observed after application of Levovist(R) (without/with Levovist(R) sensitivity 73 %/91 %, specificity 89 %/89 %). Conclusions: The signal-enhanced color Doppler sonography provides useful additional information for the differentiation between benign and malignant cutis-involving lesions, especially the semiquantitative vascularization analysis. The latter is superior to B-mode ultrasound and to spectral Doppler analysis. The signal enhancer increases the sensitivity, whereas the specificity remains unchanged.

RATIONALE AND OBJECTIVES:We evaluated the diagnostic potential of gadopentetate dimeglumine-enhanced, high-resolution magnetic resonance (MR) imaging to differentiate benign from malignant melanin-containing skin tumors. METHODS:Forty-five patients were prospectively examined using high-resolution MR imaging at 1.5 T using a 2.5-cm surface coil. For tumor assessment, T1-weighted and T2-weighted transverse spin-echo sequences were acquired. After intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg), the T1-weighted transverse sequence was repeated. Contrast enhancement was quantitatively determined as the percentage increase of signal intensity. Histologic findings were correlated using the Wilcoxon signed-ranks test. The quality of contrast enhancement was assessed by three independent investigators who were unaware of the patients' history and histologic data. The signal-to-noise ratio (SNR) was calculated in the T2-weighted sequence. Significance was tested using the Wilcoxon signed-ranks test. RESULTS:In all tumors, contrast enhancement was visually discernible. Half of the cases were enhanced inhomogeneously. The percentage of contrast enhancement did not correlate with histologic findings. Malignant melanomas could not be differentiated from benign melanocytic nevi with the use of gadopentetate dimeglumine. Determination of the SNR in T2-weighted sequences revealed no significant difference for histologic subgroups or tumor type. CONCLUSION:Gadopentetate dimeglumine-enhanced MR imaging does not differentiate malignant melanomas from benign melanocytic nevi. Determination of the SNR in the T2-weighted sequences revealed no significant difference for histologic subgroups.

To evaluate the use of Gd-DTPA in imaging epithelial skin tumors and tumor-like lesions, 29 benign, 8 malignant and 4 semimalignant skin tumors were prospectively examined by high-resolution MRI at 1.5 Tesla using a 2.5-cm surface coil. For tumor assessment, transverse plain and contrast-enhanced scans (0.1 mmol Gd-DTPA/kg body mass) were performed (TR 500 ms, TE 25 ms, 3 acquisitions, 256 x 256 matrix, FOV 2.5 cm). Contrast enhancement was quantitively determined as the percent enhancement of signal intensity. Histologic findings were correlated using the Mann-Whitney-test (p < 0.05). Quality of contrast enhancement was independently assessed by three investigators, who mostly described inhomogeneous enhancement, regardless of histologic findings. Malignant tumors could not be differentiated from benign lesions by contrast enhancement. MRI using Gd-DTPA does not provide differentiation of skin tumor types.

RATIONALE AND OBJECTIVES. The aim of the study was to evaluate the use of high resolution magnetic resonance imaging (MRI) for differentiation of melanin-containing skin tumors.METHODS. Twenty-seven melanocytic nevi and 18 malignant melanomas were examined by high resolution MRI, Signal intensities and signal-to-noise (SNR) and contrast-to-noise ratios (CNR) of the tumors were determined in unenhanced (T1, T2, water-suppression, and fat-suppression sequences) and contrast-enhanced images (T1 and fat-suppression sequences), The differences were tested for significance by a Wilcoxon test.RESULTS. Malignant melanomas differed from melanocytic nevi in that they displayed a higher SNR in T2-weighted and unenhanced and contrast-enhanced fat-suppression scans, Malignant melanomas exhibited a higher CNR than did benign lesions in unenhanced and contrast-enhanced fat-suppression sequences with dermis as reference tissue (P < 0.05) and in enhanced fat-suppression sequences with subcutis as reference tissue (P < 0.05),CONCLUSIONS. The usefulness of SNR and CNR analysis on MRI for the differentiation of malignant skin tumors from benign skin tumors of the melanin-containing system is limited, Clinical and histologic examinations are, further, the important step in evaluation of melanin-containing skin tumors.

A review is presented of the confusing terminology applied to the various types of neck dissection. It is recommended that the terms ''conservative'' and ''radical'' be based on clear definitions. The fourth prospective, randomized DOSAK therapy study deals with the controversial issue of radical as compared with conservative neck dissection. Patients with squamous cell carcinoma (SCC) of the oral cavity who had not been treated before were randomized and stratified according to the DOSAK treatment-dependent prognostic index (TPI). At present, 104 patients have been evaluated, of whom 48 had radical neck dissection, and 56 conservative neck dissection. Tumor location and patient age and sex are equally divided in both therapy groups. After an average follow-up time of 460 days, the relative mortality for both therapy groups is 23%. At this stage, there is no difference between the two groups in the percentage of patients with complete remission or in the percentage of patients alive. At this stage, there appears to be no difference between the two groups with regard to patient survival or recurrent disease.