PMC4891468_01
Right lower extremity with visible lesions inferior to the knee. [Powerpoint Slide]
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Biopsy revealed recurrent melanoma of the right lower extremity inferior to the knee surrounding the site of the previous wide local excision (Figure 1).
Gadolinium-enhanced fat-saturation T1-weighted MR images of the right lower extremity which depicts one of the in-transit metastases seen in the MRI on the left and one of the local/superficial recurrences discovered on Physical Exam (PE) seen in the MRI on the right. [Powerpoint Slide]
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A Magnetic Resonance Image (MRI) of the right lower extremity demonstrated two deep lesions in the subcutaneous tissues measuring 4 x 6 mm and 2 x 5 mm separated by a distance of 3.4 cm (Figure 2).
Sonogram of the right leg (15-MHz probe) demonstrates placement of a seed into one of the subcutaneous melanoma lesions. Arrows denote the 18 gauge spinal needle; arrowhead points to the seed prior to deployment into the lesion. [Powerpoint Slide]
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The seed is then deployed through the bone wax with a stylet (Figure 3).
AP and Lateral films of right lower extremity which displays the gross location of the radioactive seeds in relation to the palpable recurrences [Powerpoint Slide]
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Six BB's were placed on the superficial recurrences of this patient and an AP and lateral film performed (Figure 4).