The Tail and the String Sign: New Sonographic Features of Subcutaneous Melanoma Metastasis Antonio Corvino, Fabio Corvino, Orlando Catalano, Fabio Sandomenico,

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The Tail and the String Sign: New Sonographic Features of Subcutaneous Melanoma Metastasis Antonio Corvino, Fabio Corvino, Orlando Catalano, Fabio Sandomenico, Antonella Petrillo Ultrasound in Medicine and Biology Volume 43, Issue 1, Pages 370-374 (January 2017) DOI: 10.1016/j.ultrasmedbio.2016.09.008 Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 1 Drawing of loco-regional spread of cutaneous melanoma. Melanoma metastasis is described as satellite metastasis when found within 2 cm from the primary tumor (or its scar) and as in-transit metastasis if the lesion is located at a greater distance. Ultrasound in Medicine and Biology 2017 43, 370-374DOI: (10.1016/j.ultrasmedbio.2016.09.008) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 2 (a) The drawing illustrates the tail sign, seen as a small prolongation seen on one or both poles of the nodule. (b) High-resolution ultrasound image shows a melanoma in-transit metastasis in the inguinal region with the tail sign at one pole of the nodule (arrowheads). Ultrasound in Medicine and Biology 2017 43, 370-374DOI: (10.1016/j.ultrasmedbio.2016.09.008) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 3 (a) The drawing illustrates the string sign, seen as a band connecting two or multiple nodules. (b) High-resolution ultrasound image, longitudinal view, shows melanoma in-transit metastasis of the axillary region with the string sign. Ultrasound in Medicine and Biology 2017 43, 370-374DOI: (10.1016/j.ultrasmedbio.2016.09.008) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 4 High-resolution ultrasound image, longitudinal view. Left image: Melanoma in-transit metastasis in the inguinal region which shows the tail sign (arrowhead). Right image: Directional color-Doppler image rules out the possibility of a vessel (arrow). Ultrasound in Medicine and Biology 2017 43, 370-374DOI: (10.1016/j.ultrasmedbio.2016.09.008) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 5 Differential diagnosis between tail sign and lymphatic edema. High-resolution ultrasound image longitudinal view. The image shows two in-transit nodules of the thigh (between calipers) surrounded by lymphatic edema (arrowheads), due to a previous radical inguinal lymphadenectomy. The thin hypoechoic lines due to the accumulated fluid simulate the tail sign. Ultrasound in Medicine and Biology 2017 43, 370-374DOI: (10.1016/j.ultrasmedbio.2016.09.008) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 6 Differential diagnosis between the string sign and a venous thrombosis. High-resolution ultrasound, longitudinal view, with the use of extended field of view scan. The image shows an in-transit melanoma nodule (arrow) grown adjacent to an external saphenous vein filled with echoic material (arrowheads) due to thrombosis. Ultrasound in Medicine and Biology 2017 43, 370-374DOI: (10.1016/j.ultrasmedbio.2016.09.008) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions