Dermatoscopy of basal cell carcinoma: Morphologic variability of global and local features and accuracy of diagnosis
Dermatoscopy of basal cell carcinoma: Morphologic variability of global and local features and accuracy of diagnosis
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DOI：
10.1016/j.jaad.2009.05.035
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发表时间：
2010-01-01
影响因子：
13.8
通讯作者：
Peris, Ketty
中科院分区：
文献类型：
--
作者：
Altamura, Davide;Menzies, Scott W.;Peris, Ketty
背景：基底细胞癌（BCC）的早期检测对于降低该肿瘤的发病率至关重要。
目的：我们试图研究基底细胞癌皮肤镜特征的变异性及诊断意义。
方法：我们对609例基底细胞癌以及200例黑素细胞性和非黑素细胞性病变进行了回顾性皮肤镜分析，并评估了皮肤镜下基底细胞癌诊断标准的评估者间信度。
结果：病变包括无色素（15.1%）、轻度色素沉着（33.2%）、色素沉着（42.7%）和重度色素沉着（9%）的基底细胞癌。与无色素和重度色素沉着的基底细胞癌相比，色素沉着的基底细胞癌中经典的基底细胞癌模式，包括树枝状毛细血管扩张（57.1%）、蓝/灰色卵圆形巢（47.5%）、溃疡（39.2%）、多个蓝/灰色小球（26.1%）、叶状区域（15.9%）和轮辐状区域（9%）显著增加（P = 0.0001）。在非经典的基底细胞癌模式中，我们检测到短而细的浅表毛细血管扩张（10%）和多个小糜烂（8.5%），并描述了两种新模式，名为“同心结构”（7.6%）和“多个对焦清晰的蓝/灰色点”（5.1%）。在40.6%的基底细胞癌中观察到提示黑素细胞性病变的皮肤镜特征（例如，多个棕黑色点/小球、蓝/白色面纱样结构和非树枝状血管），且在重度色素沉着的基底细胞癌中显著增加（P < 0.0001）。专家观察者对基底细胞癌做出了准确（敏感度：97%）且可靠（K值：87%）的皮肤镜诊断，尽管在特异度（P = 0.0002）和阳性预测值（P = 0.0004）方面存在显著差异。树枝状毛细血管扩张、叶状区域和大的蓝/灰色卵圆形巢是可靠且稳健的诊断参数。
局限性：本研究为回顾性研究。
结论：基底细胞癌在整体和局部皮肤镜特征上表现出广泛的多样性；重度色素沉着的基底细胞癌呈现出最具挑战性的皮肤镜特征组合。（《美国皮肤病学会杂志》2010年；62卷：67 - 75页）
Background: Early detection of basal cell carcinoma (BCC) is crucial to reduce the morbidity of this tumor. Objective: We sought to investigate the variability and diagnostic significance of dermatoscopic features of BCCs.Methods: We conducted retrospective dermatoscopic analysis of 609 BCCs and 200 melanocytic and nonmelanocytic lesions, and assessment of interrater reliability of dermatoscopic BCC criteria.Results: Lesions included nonpigmented (15.1%), lightly pigmented (33.2%), pigmented (42.7%), and heavily pigmented (9%) BCCs. Classic BCC patterns including arborizing telangiectasia (57.1%), blue/gray ovoid nests (47.5%), ulceration (39.2%), multiple blue/gray globules (26.1%), leaflike areas (15.9%), and spoke-wheel areas (9%) were significantly increased in pigmented BCCs compared with nonpigmented and heavily pigmented BCCs (P = .0001.). Among nonclassic BCC patterns, we detected short fine superficial telangiectasia (10%) and multiple small erosions (8.5%), and described two new patterns named "concentric structures" (7.6%) and "multiple in-focus blue/gray dots" (5.1%). Dermatoscopic features suggestive of melanocytic lesions (eg, multiple brown to black dots/globules, blue/white veillike structures, and nonarborizing vessels) were observed in 40.6% BCCs and significantly increased in heavily pigmented BCCs (P < .0001). Expert observers provided an accurate (sensitivity: 97%) and reliable (K: 87%) dermatoscopic diagnosis of BCC, although a significant difference in terms of specificity (P = .0002) and positive predictive value (P = .0004) was found. Arborizing telangiectasia, leaflike areas, and large blue/gray ovoid nests represented reliable and robust diagnostic parameters.Limitation: The shady was retrospective.Conclusion: BCCs show a large spectrum of global and local dermatoscopic features; heavily pigmented BCCs show the most challenging combinations of dermatoscopic features. (J Am Acad Dermatol 2010;62:67-75.)