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Skin Localization
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Preprocedure

    • Procedure

      TERMINOLOGY

      • Synonyms

        • Skin or dermal Ca⁺⁺ localization
      • Definitions

        • Used when group of Ca⁺⁺ superficial, possibly within skin, but not typical of dermal Ca⁺⁺
          • Tomosynthesis: Location within 1st or last slice or in tangent in skin confirms skin location; no need for further work-up
            • "Last" slice/skin opposite detector (e.g., cranial image in CC view) may be 5 mm before last image due to calibration issues
          • Grid localization: Similar to wire/seed localization, using BB on skin rather than needle insertion
        • Dermal Ca⁺⁺ benign, BI-RADS 2
          • Rarely, malignancy with Ca⁺⁺ in parenchyma can extend to overlying skin
        • Mammography ± US for skin masses
          • BB skin marker and confirmatory mammogram with BB in tangent
          • US may be needed to confirm intradermal location: Claw sign at edges of mass
        • Presurgical excision may be directed by US-guided skin BB placement or skin marking over superficial underlying lesion
          • Include depth of lesion from skin in report

      PREPROCEDURE

      • Indications

        • Getting Started

          PROCEDURE

          • Patient Position/Location

            • Equipment Preparation

              • Procedure Steps

                • Findings and Reporting

                  • Alternative Procedures/Therapies

                    POST PROCEDURE

                    • Expected Outcome

                      • Things to Do

                        OUTCOMES

                        • Complications

                          Selected References

                          1. Conant EF: Clinical implementation of digital breast tomosynthesis. Radiol Clin North Am. 52(3):499-518, 2014
                          2. Roth RG et al: Digital breast tomosynthesis: lessons learned from early clinical implementation. Radiographics. 34(4):E89-102, 2014
                          3. Sickles EA et al: Breast Imaging Reporting and Data System. 5th ed. Reston: American College of Radiology, 2013
                          4. Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: Elsevier. 402-4, 2005
                          5. Cardenosa G: Breast Imaging. Philadelphia: Lippincott Williams & Wilkins. 141-4, 2004
                          6. Diekmann F et al: Reduced-dose digital mammography of skin calcifications. AJR Am J Roentgenol. 178(2):473-4, 2002
                          7. Berkowitz JE et al: Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. 163(1):282, 1987
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Preprocedure

                            • Procedure

                              TERMINOLOGY

                              • Synonyms

                                • Skin or dermal Ca⁺⁺ localization
                              • Definitions

                                • Used when group of Ca⁺⁺ superficial, possibly within skin, but not typical of dermal Ca⁺⁺
                                  • Tomosynthesis: Location within 1st or last slice or in tangent in skin confirms skin location; no need for further work-up
                                    • "Last" slice/skin opposite detector (e.g., cranial image in CC view) may be 5 mm before last image due to calibration issues
                                  • Grid localization: Similar to wire/seed localization, using BB on skin rather than needle insertion
                                • Dermal Ca⁺⁺ benign, BI-RADS 2
                                  • Rarely, malignancy with Ca⁺⁺ in parenchyma can extend to overlying skin
                                • Mammography ± US for skin masses
                                  • BB skin marker and confirmatory mammogram with BB in tangent
                                  • US may be needed to confirm intradermal location: Claw sign at edges of mass
                                • Presurgical excision may be directed by US-guided skin BB placement or skin marking over superficial underlying lesion
                                  • Include depth of lesion from skin in report

                              PREPROCEDURE

                              • Indications

                                • Getting Started

                                  PROCEDURE

                                  • Patient Position/Location

                                    • Equipment Preparation

                                      • Procedure Steps

                                        • Findings and Reporting

                                          • Alternative Procedures/Therapies

                                            POST PROCEDURE

                                            • Expected Outcome

                                              • Things to Do

                                                OUTCOMES

                                                • Complications

                                                  Selected References

                                                  1. Conant EF: Clinical implementation of digital breast tomosynthesis. Radiol Clin North Am. 52(3):499-518, 2014
                                                  2. Roth RG et al: Digital breast tomosynthesis: lessons learned from early clinical implementation. Radiographics. 34(4):E89-102, 2014
                                                  3. Sickles EA et al: Breast Imaging Reporting and Data System. 5th ed. Reston: American College of Radiology, 2013
                                                  4. Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: Elsevier. 402-4, 2005
                                                  5. Cardenosa G: Breast Imaging. Philadelphia: Lippincott Williams & Wilkins. 141-4, 2004
                                                  6. Diekmann F et al: Reduced-dose digital mammography of skin calcifications. AJR Am J Roentgenol. 178(2):473-4, 2002
                                                  7. Berkowitz JE et al: Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. 163(1):282, 1987