Folliculotropism in pigmented facial macules: Differential diagnosis with reflectance confocal microscopy
Folliculotropism in pigmented facial macules: Differential diagnosis with reflectance confocal microscopy
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DOI：
10.1111/exd.13487
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发表时间：
2018-03-01
影响因子：
3.6
通讯作者：
Pellacani, Giovanni
中科院分区：
文献类型：
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作者：
Persechino, Flavia;De Carvalho, Nathalie;Pellacani, Giovanni
色素沉着的面部斑点是常见的太阳损伤的皮肤。早期恶性雀斑样痣（LM）和恶性雀斑样痣黑色素瘤（LMM）的诊断具有挑战性。反射共聚焦显微镜（RCM）已被证明可以提高面部病变的诊断准确性。回顾性收集了154个面部色素斑，对已经描述的RCM特征和描述毛囊方面的新参数的存在进行了评价。与非黑素细胞皮肤肿瘤（NMSN）相比，发现黑素细胞巢、圆形pagetoid细胞、毛囊浸润、毛囊隆起和许多明亮的树突以及毛囊浸润（即，向毛囊性）指示LM/LMM，总体灵敏度为96%，特异性为83%。对于NMSNs，日光性雀斑样痣和扁平苔藓样角化病与LM/LMM的区别更好，因为它们通常缺乏恶性特征，并提供特征性诊断参数，如表皮鹅卵石样模式和多环乳头状轮廓。另一方面，色素性光化性角化病（PAK）的区分更加困难，需要评价毛囊浸润和隆起结构，因为在表皮中经常观察到很少的明亮树突，但主要不浸润毛囊（估计PAK特异性为53%）。对促滤泡性的成分进行详细的评价有助于提高诊断的准确性。细胞的类型、分布和数量的分类，以及卵泡周围是否存在隆起，似乎是在RCM分析中区分PAK和LM/LMM的重要工具。
Pigmented facial macules are common on sun damage skin. The diagnosis of early stage lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging. Reflectance confocal microscopy (RCM) has been proven to increase diagnostic accuracy of facial lesions. A total of 154 pigmented facial macules, retrospectively collected, were evaluated for the presence of already-described RCM features and new parameters depicting aspects of the follicle. Melanocytic nests, roundish pagetoid cells, follicular infiltration, bulgings from the follicles and many bright dendrites and infiltration of the hair follicle (ie, folliculotropism) were found to be indicative of LM/LMM compared to non-melanocytic skin neoplasms (NMSNs), with an overall sensitivity of 96% and specificity of 83%. Concerning NMSNs, solar lentigo and lichen planus-like keratosis resulted better distinguishable from LM/LMM because usually lacking malignant features and presenting characteristic diagnostic parameters, such as epidermal cobblestone pattern and polycyclic papillary contours. On the other hand, distinction of pigmented actinic keratosis (PAK) resulted more difficult, and needing evaluation of hair follicle infiltration and bulging structures, due to the frequent observation of few bright dendrites in the epidermis, but predominantly not infiltrating the hair follicle (estimated specificity for PAK 53%). A detailed evaluation of the components of the folliculotropism may help to improve the diagnostic accuracy. The classification of the type, distribution and amount of cells, and the presence of bulging around the follicles seem to represent important tools for the differentiation between PAK and LM/LMM at RCM analysis.