New Frontiers of Skin Ultrasound in Precision Medicine

Ultrasound has emerged as a versatile, non-invasive imaging technique in dermatology, offering real-time, high-resolution visualization of cutaneous structures. By employing high- and ultra-high-frequency probes, skin ultrasound enables detailed assessment of the epidermis, dermis, and subcutaneous tissue, while Doppler modalities provide complementary information on vascularity. This review synthesizes current evidence on the role of ultrasound across the spectrum of dermatologic conditions, including malignant and benign tumors, inflammatory skin disorders, connective tissue diseases, and cosmetic interventions. In skin cancer, high-frequency ultrasound supports preoperative planning by estimating lesion depth, margins, and risk stratification, with particular value in basal cell carcinoma, squamous cell carcinoma, and melanoma. In benign tumors such as epidermal cysts and lipomas, sonographic features help avoid unnecessary invasive procedures. Ultrasound also refines disease staging and monitoring in chronic inflammatory dermatoses, notably hidradenitis suppurativa, psoriasis and psoriatic arthritis, while enabling quantification of fibrotic involvement in systemic sclerosis and morphea, besides assessing the degree of inflammatory activity. Beyond clinical dermatology, ultrasound provides critical guidance in aesthetic medicine, enhancing the safety and precision of filler injections and facilitating early detection and management of complications. Recent advances include integration with dermoscopy, and artificial intelligence for automated disease classification, which promise to reduce operator dependency and improve reproducibility. Taken together, these findings highlight the pivotal role of skin ultrasound as a diagnostic and therapeutic tool with a growing range of applications in dermatological and cosmetic practice.