What is the appropriate management for a skin surface marker on the left side of the neck identified on a coronal STIR (Short-Tau Inversion Recovery) image?

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Skin Surface Marker on Coronal STIR Image of Left Neck

Direct Answer

A skin surface marker visible on a coronal STIR image of the left neck is a deliberate external reference point placed on the patient's skin to aid in anatomical localization during imaging interpretation and does not represent pathology. This requires no clinical management beyond recognition as an imaging artifact 1.

Purpose and Function of Skin Surface Markers

Skin surface markers serve specific technical purposes in medical imaging:

  • Anatomical localization: Markers are placed on the skin surface under imaging guidance to identify specific anatomical locations, particularly for surgical planning or lymph node mapping 1
  • Surgical correlation: In sentinel lymph node procedures, markers are placed using a ⁵⁷Co-labelled pen-marker held perpendicular (90°) to the skin surface to mark lymph nodes transcutaneously, facilitating subsequent surgical harvesting 1
  • Position reference: Markers help correlate imaging findings with patient positioning, which may change between imaging and surgical procedures 1

Recognition on STIR Imaging

Coronal STIR (Short-Tau Inversion Recovery) sequences are commonly used for neck imaging:

  • High sensitivity: STIR imaging provides excellent fat suppression and high sensitivity for detecting pathology in the neck, with 100% sensitivity for metastatic lymph nodes when appropriate size criteria are used 2
  • Rapid acquisition: Coronal STIR of the entire neck can be obtained in approximately 2 minutes, making it an efficient screening technique 2
  • Surface marker appearance: Skin surface markers appear as focal signal abnormalities at the skin surface level and should be clearly distinguishable from internal pathology by their superficial location 1

Critical Distinction from Pathology

The key to proper interpretation is recognizing the marker's external location:

  • Superficial positioning: Markers are located on or immediately adjacent to the skin surface, not within deeper soft tissues 1
  • Expected appearance: In whole-body MRI protocols including STIR sequences, external markers may be intentionally placed for anatomical reference 1
  • No clinical significance: Unlike internal neck masses or lymphadenopathy, skin surface markers require no follow-up imaging or intervention 1

Common Pitfalls to Avoid

  • Misinterpretation as pathology: Do not mistake a deliberately placed external marker for an internal mass, lymph node, or soft tissue abnormality 1
  • Unnecessary workup: Recognizing the marker prevents unnecessary biopsies, additional imaging, or clinical concern 1
  • Documentation: The radiology report should clearly identify the finding as an external skin surface marker to prevent downstream confusion 1

Appropriate Documentation

When encountering a skin surface marker on imaging:

  • Clear labeling: The radiologist should explicitly state "skin surface marker" in the report to distinguish it from pathologic findings 1
  • Location specification: Document the precise anatomical location (e.g., "left lateral neck at level III") for correlation with clinical examination 1
  • No follow-up needed: Explicitly state that the marker represents an external reference point requiring no clinical action 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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