Reflectance Confocal Microscopy Criteria for Squamous Cell Carcinomas and Actinic Keratoses
Reflectance Confocal Microscopy Criteria for Squamous Cell Carcinomas and Actinic Keratoses
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DOI：
10.1001/archdermatol.2009.134
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发表时间：
2009-07-01
影响因子：
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通讯作者：
Rabinovitz, Harold S.
中科院分区：
文献类型：
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作者：
Rishpon, Ayelet;Kim, Nancy;Rabinovitz, Harold S.
目的：通过体内反射共聚焦显微镜（RCM）确定鳞状细胞癌（SCC）和光化性角化病（AK）的诊断标准。设计：对临床和/或皮肤镜下怀疑为SCC或AK的病变进行前瞻性RCM成像，然后对活检证实的SCC和AK进行RCM评估。设置：私人皮肤癌诊所，种植园，佛罗里达。患者：24例患者共38处病变进行了评估，包括7个AK，25个SCC原位，3个浸润性SCC，3个keratoacanthoma.Interventions：在进行活检之前，所有病变进行了评估由RCM。结果：镶嵌RCM图像在角质层水平显示规模在29个SCC（95%）和所有7个AK。3例SCC（10%）和1例AK（14%）可见角质层多核细胞。所有38例病例的表皮棘-颗粒层均呈不典型的蜂窝状和/或排列紊乱; 20例SCC（65%）和1例AK（14%）的棘-颗粒层中可见圆形有核细胞。真皮浅层圆形血管见于28例SCC（90%）和5例AK（72%）。结论：在角化细胞瘤谱中可以观察到异常RCM特征的频率增加。非典型蜂窝状或棘颗粒层排列紊乱、棘颗粒层圆形有核细胞和穿过真皮乳头的圆形血管是SCC的关键RCM特征。
Objective: To identify criteria for the diagnosis of squamous cell carcinoma (SCC) and actinic keratosis (AK) by in vivo reflectance confocal microscopy (RCM).Design: Prospective RCM imaging of lesions suspected clinically and/or dermoscopically to be SCC or AK, followed by RCM assessment of the biopsy-proven SCCs and AKs.Setting: Private skin cancer clinic, Plantation, Florida.Patients: A total of 38 lesions in 24 patients were assessed, including 7 AKs, 25 SCCs in situ, 3 invasive SCCs, and 3 keratoacanthomas.Interventions: Prior to undergoing biopsy, all lesions were assessed by RCM.Results: Mosaic RCM images at the stratum corneum level revealed scale in 29 SCCs (95%) and in all 7 AKs. Polygonal nucleated cells at the stratum corneum were seen in 3 SCCs (10%) and 1 AK (14%). All 38 cases displayed an atypical honeycomb and/or a disarranged pattern of the spinous-granular layer of the epidermis; round nucleated cells were seen in the spinous-granular layer in 20 SCCs (65%) and 1 AK (14%). Round blood vessels in the superficial dermis were seen in 28 SCCs (90%) and 5 AKs (72%).Conclusions: An increasing frequency of abnormal RCM features can be observed across the spectrum of keratinocytic neoplasias. The presence of an atypical honeycomb or a disarranged pattern of the spinous-granular layer, round nucleated cells at the spinous-granular layer, and round blood vessels traversing through the dermal papilla are the key RCM features of SCC.