Exp Dermatol :类似黑色素瘤的基底细胞癌的皮肤镜特征

2022-09-08 医路坦克 MedSci原创

这项研究的目的是在选定的具有黑色素细胞特征的非典型非面部基底细胞癌队列中,与具有至少一种基底细胞癌特征的非典型非面部MMS进行比较,以确定皮肤镜特征,以制定有助于鉴别诊断的评分。

基底细胞癌(BCC)是最常见的恶性皮肤癌,其特点是浅色皮肤发病率高,生长缓慢,转移罕见。基底细胞癌最重要的危险因素是暴露在紫外线下,其在光曝光区的频繁发作证实了这一点。

除了临床检查,皮肤镜检查还显著提高了基底细胞癌的诊断准确性,其诊断标准也得到了广泛的描述,显示出高敏感性和特异性。然而,一些基底细胞癌可能表现出模棱两可的皮肤镜模式,没有典型的皮肤镜标准,类似其他恶性皮肤肿瘤,如恶性黑色素瘤(MM)。非面部基底细胞癌被描述为模拟MMS的非面部基底细胞癌,具有一系列主要特征,包括不典型的网络、蓝白相间的面纱、不规则的点/球、不规则的条纹和不典型的血管图案。

先前对未选择的、连续的面部和非面部切除的基底细胞癌的组织病理学诊断进行了回顾评估,以调查皮肤镜检查特征的变异性和意义。40.6%的基底细胞癌具有黑色素细胞病变的皮肤镜特征,在色素沉着的基底细胞癌中显著增加。然而,缺乏对具有皮肤镜黑色素细胞特征的选定的非典型非面部基底细胞癌的大型描述性研究。与皮肤镜的鉴别诊断有助于提高患者的处理水平,正确掌握切除和局部治疗的时机。

这项研究的目的是在选定的具有黑色素细胞特征的非典型非面部基底细胞癌队列中,与具有至少一种基底细胞癌特征的非典型非面部MMS进行比较,以确定皮肤镜特征,以制定有助于鉴别诊断的评分。次要目标包括确定基底细胞癌和多发性骨髓瘤的亚型,并通过研究诊断的准确性和可信度来评估这项研究的临床影响。

Mm(a-c-e)和bcc(b-d-f)皮肤镜图像:(a-b-c-d-e-f)白红色无结构区(白色星形),(a-b-c-d-e-f)不典型血管图案(黑色圆圈),(e-f)多个蓝灰色小球(黑色三角形),(C)溃疡(白色矩形),(c-d-e)回归结构(黑色矩形),(c-d)白色条纹(箭头),(e-f)枫叶状区域(白色三角形)。MM,恶性黑色素瘤;BCC,基底细胞癌

根据皮肤镜特征预测鉴别诊断MM/BCC的评分

(a-c-e)临床表现:(b-d-f)白红色无结构区(星号),(b-d-f)不典型血管模式(黑圈),(b-d-f)浅(短)细毛细血管扩张(三角形),(b-d-f)溃烂(矩形),(b-d-f)一些树枝状血管(箭头)。基底细胞癌

(b-f)枫叶状(三角形)、(b-d-f)多个蓝灰色小球(星号)、(b-d-f)回归结构(白色圆圈)、(b-f)蓝白面纱(矩形)和(b-f)一些不规则的点/球(箭头)。基底细胞癌

代表混合型的基底细胞癌病变:(a-c-e)临床表现;(b-f)浅(短)细毛细血管扩张(黑色三角),(b-d-f)多个蓝灰色小球状(星号),(b-d)不典型血管图案(白三角),(b-f)白红色无结构区(矩形),(F)不规则点/小球状(箭头),(F)白色条纹(圆形)。基底细胞癌

方法:在皮肤镜检查中,对不典型的非面部基底细胞癌(≥七点标准)和黑色素瘤(至少有一个基底细胞癌标准)进行多中心的回顾性对比研究。观察的皮肤镜特征被用来制定一个建议的评分。用层次分析方法定义病变聚集区。根据这项研究的结果,用盲法读者研究来评估临床影响。结果:共纳入146例基底细胞癌和76例黑色素瘤。血管形态不典型多见(74.5%)。提出的评分包括12个王牌特征(敏感度94.1%,特异度79.5%)。聚类分析确定了3个基底细胞癌和3个黑色素瘤聚集性。

结果:提高了总体诊断的准确性和置信度(分别为26.8%和13.8%;p<0.001)。

结论:这些发现支持非典型血管模式应被认为是黑色素瘤和非典型基底细胞癌的共同特征的观点。我们建议的评分提高了诊断的准确性和置信度。缺乏色素特征与较低的诊断准确率和置信度有关。

文献来源: Di Matteo E,  Pampena R,  Pizzichetta MA, Unusual dermoscopic patterns of basal cell carcinoma mimicking melanoma.Exp Dermatol 2022 Jun;31(6)

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    2022-12-22 sunylz
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