Perioperative confocal microscopy of the nail matrix in the management of in situ or minimally invasive subungual melanomas
Perioperative confocal microscopy of the nail matrix in the management of in situ or minimally invasive subungual melanomas
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DOI：
10.1111/j.1365-2133.2012.11013.x
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发表时间：
2012-10-01
影响因子：
10.3
通讯作者：
Thomas, L.
中科院分区：
文献类型：
--
作者：
Debarbieux, S.;Hospod, V.;Thomas, L.
背景 尽管指甲板皮肤镜检查有助于区分指甲色素沉着的良性和恶性原因，但仍存在需要进行基质活检的不明确情况。当组织病理学诊断出甲下黑色素瘤时，需进行辅助手术治疗，术后残疾持续时间相应延长。 目的 我们研究的目的是评估通过反射共聚焦显微镜 (RCM) 进行术中诊断的可行性。 患者和方法 我们的系列包括连续 9 名因获得性黑甲病（1 例良性雀斑和 8 例黑色素瘤）接受基质活检的患者。 RCM 检查是在甲板倾斜后对指甲基质进行体内检查，和/或对新鲜组织活检进行离体检查。将RCM数据与组织病理学数据进行比较。结果共聚焦和组织病理学特征之间具有良好的相关性。根据共聚焦特征，术中明确诊断了 7 例黑色素瘤病例，而根据 RCM，雀斑样痣被正确分类为良性病变。剩余病变无法通过 RCM 明确分类，并且在组织病理学上对应于需要免疫染色才能诊断的早期黑色素瘤。 结论 术中对指甲基质进行 RCM 检查是一种有效的诊断黑甲纹状体的方法，可以对恶性肿瘤进行临时诊断，从而对原位或微创黑色素瘤进行一步手术治疗，从而大大缩短术后残疾的持续时间。
Background Although dermoscopy of the nail plate is helpful to discriminate between benign and malignant causes of nail pigmentations, there remain ambiguous cases in which a matricial biopsy is required. When a subungual melanoma is diagnosed histopathologically, a complementary surgical treatment is performed secondarily, the duration of postoperative disability being accordingly prolongated.Objectives The purpose of our study was to evaluate the feasibility of an intraoperative diagnosis by reflectance confocal microscopy (RCM).Patients and methods Our series included nine consecutive patients who underwent a matricial biopsy for an acquired melanonychia (one benign lentigo and eight melanomas). RCM examination was performed in vivo on the nail matrix after reclination of the nail plate, and/or ex vivo on the fresh tissue biopsy. RCM data were compared with histopathology.Results There was a good correlation between confocal and histopathological features. Seven melanoma cases were unequivocally diagnosed intraoperatively according to the confocal features, whereas the lentigo was correctly classified as a benign lesion according to RCM. The remaining lesion could not be unequivocally classified by RCM and corresponded histopathologically to an early melanoma that required immunostaining to be diagnosed.Conclusions Intraoperative RCM examination of the nail matrix is an efficient diagnostic approach of melanonychia striata that permits an extemporaneous diagnosis of malignancy and therefore a one-step surgical treatment of in situ or minimally invasive melanoma, reducing dramatically the duration of postoperative disability.