Reason: stage IV melanoma with disease left leg getting systemic treatment History: reassess for treatment response. Note is made of multiple enhancing masses along the posteromedial aspect of the left leg consistent with the patient's history of melanoma. There is associated increased signal abnormality on T1 weighted images and intermediate signal abnormality T2 weighted images as well as peripheral enhancement on postcontrast sequences. For reference, the largest confluent mass measures approximately 7.2 x 3.0 cm (image 26; series 21). This mass extends to the level of the fascia of the medial head of the gastrocnemius. There is associated increased signal abnormality on fluid sensitive sequences within the gastrocnemius and soleus muscles. There is lack of enhancement of the medial aspect of the soleus as well as within the medial head gastrocnemius superiorly, which appears to correspond to foci of fatty infiltration of the musculature although this could also represent perfusion abnormalities/multiple foci of myonecrosis. There is a small amount of fluid signal surrounding the gastrocnemius. Multiple additional masses are identified along the posteromedial aspect of the leg also consistent with the patient's history of melanoma. The more anterior of these lesions also appears to abut the medial aspect of the soleus muscle. There is nonspecific skin thickening along the anterior, medial, and posterior aspect of the leg. There is diffuse nonspecific subcutaneous edema about the leg.
Multiple enhancing masses along the posteromedial aspect of the left leg consistent with the patient's history of melanoma as described above. 