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Ultrasound lymph nodes with metastatic disease may have an irregular, hypoechoic or lobulated appearance CT imaging modality of choice to assess for nodal metastases increased regional nodal size and nodal heterogeneity have implications for metastatic disease Thoracic metastases The lungs and pleura are the second most common site of malignant melanoma metastases after lymph node involvement, with 85% of end-stage melanoma patients having evidence of lung metastases at autopsy