Ultra-high-frequency ultrasound in the detection of recurrent conjunctival melanoma: A case report

Table 1 High-frequency ultrasound/ultra-high-frequency ultrasound (with Doppler) features that may help differentiate conjunctival/periocular melanoma from benign melanocytic lesions

Ultrasound feature (HFUS/UHFUS ± Doppler)	Melanoma/malignant melanocytic lesion (suggestive)	Benign melanocytic lesion (more typical)
Overall shape/symmetry	Asymmetric, irregular or multilobulated	Symmetric, round/oval
Margins	Irregular, ill-defined, infiltrative appearance	Smooth, well-defined
Echogenicity	Markedly hypoechoic relative to surrounding tissue	Mildly hypoechoic to isoechoic
Internal echotexture	Heterogeneous; disorganised echoes; possible internal hyperechoic foci	Homogeneous or finely granular; usually no marked heterogeneity
Intralesional cystic spaces (especially conjunctival nevi)	Usually absent	Often present (small anechoic cysts), particularly in conjunctival nevi
Epithelial/epidermal changes	Thickening and/or architectural disruption; possible ulceration	Epidermis/epithelium usually preserved; no disruption
Depth/thickness	Greater thickness; extension into hypodermis/subcutaneous tissue; loss of normal planes	Limited depth; confined to superficial dermis/subepithelial tissue; preserved planes
Vascularity (color/power Doppler)	Increased intra- and/or perilesional flow; tortuous vessels; higher flow signals	Absent or minimal flow; if present usually faint/peripheral
Perilesional reaction	Perilesional edema or architectural distortion may be present	No significant perilesional reaction
Multiplicity/satellites	Possible satellite or in-transit nodules; multifocality raises suspicion	Typically solitary; satellites uncommon
Change over time (if serial scans available)	Rapid growth and/or increasing vascularity	Stability over time

UHFUS: Ultra-high-frequency ultrasound; HFUS: High-frequency ultrasound.