In vivo reflectance confocal microscopy of equivocal melanocytic lesions detected by digital dermoscopy followup
In vivo reflectance confocal microscopy of equivocal melanocytic lesions detected by digital dermoscopy followup
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DOI：
10.1111/jdv.13067
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发表时间：
2015-10-01
影响因子：
9.2
通讯作者：
Puig, S.
中科院分区：
文献类型：
--
作者：
Lovatto, L.;Carrera, C.;Puig, S.
背景数字随访是检测非典型痣综合征患者黑色素瘤的一种有用方法。数字随访（DFU）和反射共聚焦显微镜（RCM）的结合可能有助于提高非典型痣综合征患者可疑病变分类的准确性。方法回顾性研究皮肤镜检查和RCM的连续可疑的非典型黑色素细胞病变表现出变化，数字皮肤镜在转诊中心。结果64个病变，从51例。13个变化的病变（20.3%）对应于8个原位黑色素瘤和5个浸润性黑色素瘤与Breslow小于1毫米。51个病变对应于黑色素细胞痣与可变的痣。无论是在基线（平均5.06和5.24; P = 0.37）还是在随访皮肤镜对照（平均5.44和5.55; P = 0.37）中，痣和黑色素瘤的皮肤镜总评分均无差异。在多变量分析中，与黑色素瘤相关的唯一显著皮肤镜特征是随访后出现条纹（P = 0.027; OR = 3.6; CI 1.50-8.70）。共聚焦显微镜评价（通过Modena和Barcelona方法）显示诊断黑色素瘤的灵敏度和特异性分别为100%和69%。根据我们的经验，RCM和DFU的组合，可以避免35 51痣excessives.Conclusions反射共聚焦显微镜评价可疑病变检测DFU提高了检测黑色素瘤的准确性。皮肤镜、DFU和共聚焦显微镜在可疑病变中的联合应用可用于显著减少非典型痣综合征患者良性病变的切除次数。
Background Digital follow-up is a useful method for the detection of melanoma in atypical mole syndrome patients. The combination of digital follow-up (DFU) and reflectance confocal microscopy (RCM) could be useful to increase the accuracy in the classification of equivocal lesions in atypical mole syndrome patients.Objectives To assess the impact of RCM analysis on sensitivity and specificity of digital follow-up in a high-risk melanoma setting.Methods Retrospective study with dermoscopy and RCM of consecutive equivocal atypical melanocytic lesions exhibiting changes in digital dermoscopy in a referral centre.Results Sixty-four lesions from 51 patients were included. Thirteen changing lesions (20.3%) corresponded to eight melanomas in situ and five invasive melanomas with Breslow less than 1 mm. Fifty-one lesions corresponded to melanocytic naevus with variable atypia. Total dermoscopy scores were not different between naevus and melanoma neither in the baseline (mean 5.06 and 5.24; P = 0.37) nor in the follow-up dermoscopic control (mean 5.44 and 5.55; P = 0.37). The only significant dermoscopic feature associated with melanoma in multivariate analysis was the presence of streaks after follow-up (P = 0.027; OR = 3.6; CI 1.50-8.70). The confocal microscopy evaluation (by means both the Modena and Barcelona methods) showed a sensitivity and specificity for the diagnosis of melanoma of 100% and 69% respectively. Based on our experience, the combination of RCM and DFU could have avoided 35 of 51 nevi excised.Conclusions Reflectance confocal microscopy evaluation of equivocal lesions detected by DFU improved the accuracy in the detection of melanoma. The combination of dermoscopy, DFU and confocal microscopy in equivocal lesions can be useful to dramatically reduce the number of excisions of benign lesions in atypical mole syndrome patients.