Frequency and morphologic characteristics of invasive melanomas lacking specific Surface microscopic features
Frequency and morphologic characteristics of invasive melanomas lacking specific Surface microscopic features
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DOI：
10.1001/archderm.132.10.1178
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发表时间：
1996-10-01
影响因子：
--
通讯作者：
McCarthy, WH
中科院分区：
文献类型：
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作者：
Menzies, SW;Ingvar, C;McCarthy, WH
目的：建立一种简便的体内皮肤表面显微镜（脱毛显微镜、皮肤镜、皮肤镜）诊断侵袭性黑色素瘤的方法，并分析手持式表面显微镜对无诊断特征的侵袭性黑色素瘤的发病率及特点。设计：使用浸泡油在体内拍摄色素沉着的皮肤病变。所有患者均被切除并复查组织学诊断。使用62个浸润性黑色素瘤和159个非典型非黑色素瘤的训练集和45个浸润性黑色素瘤和119个非典型非黑色素瘤的测试集。来自训练集的图像对72个表面微观特征进行评分。这些低敏感性（0%）和高特异性（>85%）的特征被用来建立侵袭性黑色素瘤的简单诊断模型。环境：所有患者均从悉尼（澳大利亚）黑色素瘤单位（主要病例和转诊中心）招募。患者：从较大的数据库中随机抽取病变切除的患者样本。主要观察指标：该模型诊断浸润性黑色素瘤的敏感性和特异性。结果：该模型的敏感性为92%(98/107)，特异性为71%。在该模型未能检测到的9个“无特征”黑色素瘤中，6个是着色的，薄的，有色素网络。其他3例为较厚的低黑色素病变，缺乏色素网络，一些有明显的毛细血管扩张，所有的都只有小面积的色素。患者注意到的所有无特征的黑色素瘤都有颜色、形状或大小变化的历史。结论：表面显微镜诊断浸润性黑色素瘤的灵敏度不能达到100%，因此不能作为切除的唯一指标。当诊断无特征病变时，临床病史是一个重要的考虑因素。
Objectives: To create a simple diagnostic method for invasive melanoma with in vivo cutaneous surface microscopy (epiluminescence microscopy, dermoscopy, dermatoscopy) and to analyze the incidence and characteristics of those invasive melanomas that had no diagnostic features by means of hand-held surface microscopes.Design: Pigmented skin lesions were photographed in vivo with the use of immersion oil. All were excised and reviewed for histological diagnosis. A training set of 62 invasive melanomas and 159 atypical nonmelanomas and a test set of 45 invasive melanomas and 119 atypical nonmelanomas were used. Images from the training set were scored for 72 surface microscopic features. Those features with a low sensitivity (0%) and high specificity (>85%) were used to create a simple diagnostic model for invasive melanoma.Setting: All patients were recruited from the Sydney (Australia) Melanoma Unit (a primary case and referral center).Patients: A random sample of patients whose lesions were excised, selected from a larger database.Main Outcome Measures: Sensitivity and specificity of the model for diagnosis of invasive melanona.Results: The model gave a sensitivity of 92% (98/107) and specificity of 71%. Of the 9 ''featureless'' melanomas the model failed to detect, 6 were pigmented and thin and had a pigment network. The other 3 were thicker, hypomelanotic lesions lacking a pigment network, some with prominent telangiectases, and all with only small areas of pigment. All featureless melanomas noted by the patients had a history of change in color, shape, or size.Conclusions: Surface microscopy does not allow 100% sensitivity in diagnosing invasive melanoma and therefore cannot be used as the sole indicator for excision. Clinical history is an important consideration when featureless lesions are diagnosed.