Usefulness of real-time tissue elastography for detecting lymph-node metastases in squamous cell carcinoma

We report a case of invasive SCC arising from multiple lesions of Bowen's disease with right inguinal lymph-node metastasis. Assessment of superficial lymph-node involvement by real-time tissue elastography before surgery was found to be more useful than other noninvasive conventional methods. Histologically, the metastatic tumour cells were located asymmetrically in a small section of the cortical area of the right node, and this result was comparable with the elastographic findings. Additionally, we found that the presence of an asymmetrical cortical area with high elasticity should be included in the determination of metastatic involvement in small lymph nodes. It has high predictive values in the differentiation of benign and malignant superficial lymph nodes in patients with clinically node-negative skin cancer. More cases are needed to validate this efficiency in differentiating benign from malignant lymph-node status, but if confirmed, it may have an important role in the diagnosis of high-risk cutaneous squamous cell carcinoma.