Examination of lesions (including dermoscopy) without contact with the patient is associated with improper management in about 30% of equivocal melanomas
Examination of lesions (including dermoscopy) without contact with the patient is associated with improper management in about 30% of equivocal melanomas
复制标题
DOI：
10.1097/00042728-200502000-00009
复制
发表时间：
2005-02-01
影响因子：
2.4
通讯作者：
De Giorgi, V
中科院分区：
文献类型：
--
作者：
Carli, P;Chiarugi, A;De Giorgi, V
背景在临床实践中，关于色素性皮肤病变的处理的决定是基于形态学检查，以及记忆，情感和法医学方面。在某些情况下，“丑小鸭”的迹象可能是一个指示切除的形态学特征的黑色素瘤。因此，在不接触患者的情况下，根据临床和皮肤镜图像检查色素性皮肤病变，可能与不可忽略的病变处理不当风险相关。在这项研究中，我们试图评估在何种程度上病变的管理，纯粹的形态学检查的基础上偏离最佳管理的基础上，在体内检查与患者直接接触，病变的历史，临床和皮肤镜评价。该研究包括100个诊断可疑的色素性病变的临床和皮肤镜图像，包括20个早期黑色素瘤和5个连续转诊手术的色素性基底细胞癌;这些图像由6名专门从事黑色素瘤筛查的皮肤科医生进行审查，他们以前接受过皮肤镜检查的培训。肉眼和联合检查对黑色素瘤的正确分类率均低于50%。关于病变管理，只有大约70%的恶性肿瘤（黑色素瘤和基底细胞癌）被观察者正确地转诊进行手术。在黑色素瘤中也获得了类似的结果（72.5%）。面对色素性皮肤肿瘤诊断的困难，基于病变形态的病变管理，甚至包括皮肤镜图像，但不与患者直接接触，与面对面检查建立的金标准管理有很大差异，并且存在不可忽视的黑色素瘤未切除的风险。
BACKGROUND. In clinical practice, decisions regarding management of a pigmented skin lesion are based on morphologic examination, as well as on anamnestic, emotional, and medicolegal aspects. In some cases, the "ugly duckling" sign may be an indication for excision of a morphologically featureless melanoma. Therefore, examination of pigmented skin lesions based on clinical and dermoscopic images, without contact with the patient, may be associated with a not negligible risk of incorrect lesion management.OBJECTIVE. In this study, we tried to assess to what extent lesion management based on purely morphologic examination diverges from optimal management based on in vivo examination with direct contact with the patient, lesion history, and clinical and dermoscopic evaluation.METHODS. The study included clinical and dermoscopic images of 100 diagnostically equivocal pigmented lesions, including 20 early melanomas and 5 pigmented basal cell carcinomas consecutively referred for surgery; the images were reviewed by six dermatologists who specialize in melanoma screening and were previously trained in dermoscopy.RESULTS. The percentage of melanomas correctly classified was less than 50% both for naked eye and combined examination. Regarding lesion management, only about 70% of malignancies (melanomas and basal cell carcinomas) are correctly referred for surgery by observers. Similar results have been obtained focusing on melanoma (72.5%).CONCLUSION. Facing difficulties in diagnosing pigmented skin tumors, lesion management based on the morphology of the lesion, even including dermoscopic images, but without direct contact with the patient, diverges greatly from the gold standard management established by face-to-face examination and comports a not negligible risk of leaving a melanoma unexcised.