Extensive regression in pigmented skin lesions: a dangerous confounding feature.
Extensive regression in pigmented skin lesions: a dangerous confounding feature.
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DOI：
10.5826/dpc.0202a08
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发表时间：
2012-04
影响因子：
2.8
通讯作者：
Argenziano G
中科院分区：
文献类型：
--
作者：
Lallas A;Apalla Z;Moscarella E;Zalaudek I;Tzellos T;Lefaki I;Cota C;Argenziano G
黑色素瘤的自发消退并不少见，因为在10-35%的原发皮肤病变中已经描述了这种现象。消退似乎并不预示一个更有利的病程，因为即使完全消退的黑色素瘤也可能进展为转移性疾病。一些皮肤镜检查特征与退变过程相关，包括白色疤痕样脱色素区域和灰蓝色胡椒样颗粒，这对应于真皮瘢痕形成、色素尿失禁和黑素细胞的存在。退行性不仅发生在黑色素瘤中，也可能发生在黑色素细胞痣中，同样可以在皮肤镜下显示白色区域和灰蓝色颗粒或区域。总体而言，白色区域被认为与纤维化型退行性黑素细胞肿瘤相关，灰蓝色区域与黑色素沉着型黑素细胞肿瘤退行性相关。扁平苔藓样角化病(LPLK)被认为是一种退行性日光性雀斑或脂溢性角化病。皮肤镜下的LPLK在退化过程的后期显示弥漫的灰蓝色颗粒图案，类似于在退化的黑素细胞病变中观察到的。在这种情况下，当评估表现出高度退化的皮肤损伤时，皮肤镜检查结果的解释可能是有问题的，特别是当无法识别其他皮肤镜检查线索的时候。
Spontaneous regression in melanomas is not an uncommon phenomenon, as it has been described in 10–35% of primary cutaneous lesions. Regression does not appear to predict a more favorable course, since even fully regressed melanomas may progress into metastatic disease. Several dermoscopic features have been correlated with the regression process, including white scar-like depigmented areas and gray-blue, pepper-like granules, which correspond to dermal scarring, pigment incontinence and presence of melanophages. Regression may occur not only in melanomas, but also in melanocytic nevi, which similarly may exhibit white areas and gray-blue granules or areas under dermoscopy. Overall, white areas have been proposed to be associated with the fibrosis type of regression and gray-blue areas to the melanosis type of regression of melanocytic tumors. Lichen planus like keratosis (LPLK) is considered to represent a regressed solar lentigo or seborrheic keratosis. Dermoscopy of LPLK at the late stage of the regression process reveals a diffuse gray-blue granular pattern, similar to that observed in regressed melanocytic lesions. In this context, when evaluating skin lesions that exhibit high degree of regression, interpretation of dermoscopic findings may be problematic, especially when no other dermoscopic clues can be recognized.