Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study
Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study
复制标题
DOI：
10.1111/j.1365-2133.2004.05657.x
复制
发表时间：
2004-01-01
影响因子：
10.3
通讯作者：
Ruocco, V
中科院分区：
文献类型：
--
作者：
Zalaudek, I;Argenziano, G;Ruocco, V
背景良性黑色素细胞皮肤病变在临床和皮肤镜下都很难与黑色素瘤鉴别。皮肤镜下最易混淆的特征之一，通常见于黑色素瘤，但在我们的经验中也见于黑色素细胞痣，以所谓的蓝白结构（BWS）为代表。意大利和西班牙，为期9个月。包括所有连续患者，显示一个或多个黑色素细胞病变与BWS，但没有分类为黑色素瘤皮肤镜，。对每个病变进行临床和皮肤镜拍照。由我们中的一人审查所有图像，并对每个病变的BWS的程度、类型和位置进行评价。一个由四名经验丰富的皮肤病理学家组成的小组独立审查了所有样本进行诊断，其中一人评价了黑变病和/或纤维化的存在和程度。结果158例BWS患者均表现为部分或局灶性的组织病理学消退。135处（85.4%）病变被诊断为黑色素细胞痣（观察者间完全组织病理学一致性），而23处（14.6%）被定义为可疑，因为4名病理学家中至少有一名将给定病变诊断为黑色素瘤。只有一个病灶被所有四位病理学家诊断为黑色素瘤。大多数痣表现为蓝色区域（84.4%），中心分布（57%），累及病变表面的50%（89.6%）。相比之下，78.3%的可疑病变显示白色和蓝色区域的组合，分布不规则（60.9%），并涉及> 50%的病变表面（47.8%.Conclusions使用程度和类型的BWS，构建了一个算法，可以应用于皮肤镜功能的退化病变的管理。
Background Benign melanocytic skin lesions may be difficult to differentiate from melanoma both clinically and dermoscopically. One of the most confounding dermoscopic features, commonly seen in melanoma but in our experience also in melanocytic naevi, is represented by the so-called blue-white structures (BWS).Objectives To evaluate diagnostic significance and histopathological correlates of BWS seen by dermoscopy in a series of clinically equivocal melanocytic skin lesions that were excised.Methods Patients were recruited from six specialized pigmented lesion clinics in Austria, Italy and Spain over a period of 9 months. All consecutive patients showing one or more melanocytic lesions with BWS, but not classified as melanoma dermoscopically, were included. Each lesion was photographed clinically and dermoscopically. All images were reviewed by one of us and the degree, type and location of BWS evaluated for each lesion. A panel of four experienced dermatopathologists independently reviewed all specimens for diagnosis and one of them evaluated presence and degree of melanosis and/or fibrosis. The main outcome measures were the percentage and histopathological correlates of lesions with different degree, type and location of BWS.Results All included lesions with BWS (n = 158) showed partial or focal regression histopathologically. One hundred and thirty-five (85.4%) lesions were diagnosed as melanocytic naevi (complete histopathological interobserver agreement), whereas 23 (14.6%) were defined as equivocal because at least one of four pathologists diagnosed the given lesion as melanoma. Only one lesion was diagnosed as melanoma by all four pathologists. The majority of naevi exhibited blue areas (84.4%) with a central distribution (57%) and involving < 50% of the lesion surface (89.6%). By contrast, 78.3% of equivocal lesions revealed a combination of white and blue areas with an irregular distribution (60.9%) and involving > 50% of the lesion surface (47.8%).Conclusions Using degree and type of BWS, an algorithm was constructed that can be applied for the management of lesions exhibiting dermoscopic features of regression.