基底细胞癌皮肤镜下特征分析

目的:总结基底细胞癌的皮肤镜特征,提高临床医生利用无创手段诊断该病的水平。方法:回顾分析23例经组织病理确诊为基底细胞癌的皮肤镜图像。结果:23例患者全部具备基底细胞癌的经典指征,皮肤镜下各主要指征按照出现频率的大小依次为:大的蓝灰色卵圆巢、分支状血管、短小的毛细血管扩张、蓝黑色斑片、白色无结构区、蓝白幕,一半以上的病例均出现这些特征。大的蓝灰色卵圆巢、蓝白幕和短小的毛细血管扩张在重度色素组基底细胞癌中出现频率明显高于轻中度色素组(P值均0.05)。结论:皮肤镜能明显提高基底细胞癌的早期诊断率,对临床具有一定的推广意义。     

71例基底细胞癌皮肤镜下特征分析

目的：明确基底细胞癌在皮肤镜下的特征,为临床皮肤镜鉴别色素性皮损提供参考。方法：分析71例（71 lesions)经组织病理确诊为基底细胞癌的皮损皮肤镜图像。结果：最主要的皮肤镜指征按出现频率由高到低分别为：蓝灰色卵圆形巢（78.9%）、血管模式（74.6%）、多发性蓝灰色小球（60.6%）、溃疡（57.7%）、叶状结构（21.1%）。单纯临床诊断符合率为55%,加用皮肤镜后临床准断符合率为95%,提高了40%。结论：皮肤镜可提高临床诊断基底细胞癌的符合率。     

多发性基底细胞癌6例临床与皮肤镜特征分析

目的 探讨多发性基底细胞癌的临床及皮肤镜特征.方法 回顾性分析经皮肤镜诊断且组织病理确诊为多发性基底细胞癌的6例21处皮损其临床及皮肤镜特征.结果 6例多发性基底细胞癌患者的平均年龄54.2岁,平均病程8.25年,男女比例1∶1.21处皮损中临床分型为结节溃疡型9处、色素型7处、浅表型5处.多发性基底细胞癌皮肤镜特征按...     

不同临床亚型基底细胞癌皮肤镜特征差异分析

目的比较不同临床亚型基底细胞癌(basal cell carcinoma,BCC)皮肤镜下的模式特征,为应用皮肤镜鉴别不同亚型BCC提供依据,提高临床诊断准确性。方法收集2016年3月-2018年7月在武汉市第一医院就诊的59例经组织病理确诊的BCC患者皮肤镜影像资料,比较不同亚型BCC在血管模式、色素相关模式、非血管和色素相关模式等方面的差异。结果结节溃疡型BCC中最常见的指征为溃疡(84.21%)、大的蓝灰色卵圆形巢(84.21%)、粗大分支状血管(73.68%);色素型BCC常见的皮肤镜表现为溃疡(86.67%)、大的蓝灰色卵圆形巢(100%)、粗大分支状血管(60.00%)、亮白无结构区(66.67%);而浅表型BCC最常见的表现为多发性小溃疡(80.00%)、轮辐状区域(90.00%)、浅表短细血管(80.00%)、红白背景无结构区(80.00%)。三型BCC皮肤镜指征差异主要是大的蓝灰色巢、轮辐状结构、粗大分支状血管、浅表短细血管、红白背景无结构区和亮白无结构区(P0.05)。结论不同类型BCC具有不同的皮肤镜模式特征。多发性小溃疡、轮辐状区域、浅表短细血管、红白背景无结构区等在浅表型BCC中较常见,而大溃疡、大的蓝灰色卵圆形巢、粗大分支状血管在结节型和色素型BCC中出现频率较高。通过识别这些皮肤镜特征性的结构,有助于提高诊断BCC的准确性。     

皮肤镜对基底细胞癌鉴别诊断价值的初步研究北大核心CSCD

目的探讨皮肤镜在基底细胞癌鉴别诊断中的应用价值。方法选取北京大学第一医院行皮肤镜检查并经病理确诊的基底细胞癌皮损为病例组,并随机选取色素程度和部位与基底细胞癌相似的其他色素性皮损作为对照组。以病理检查结果为金标准,用诊断试验方法评价皮肤镜诊断基底细胞癌的能力,计算提示黑素细胞性皮损的指征在基底细胞癌中的出现情况,并比较不同色素程度的基底细胞癌在皮肤镜下的差异。结果病例组86例,对照组68例。基底细胞癌皮肤镜经典诊断模式的灵敏度、特异度、阳性预测值、阴性预测值分别为98．84％、89．71％、92．39％、98．39％,Youden指数为0．88,与病理诊断的符合率94．81％。色素网、多发褐色至黑色小球或小点、毛囊口周围色素在黑素细胞性皮损中的比例显著高于基底细胞癌（P〈0．05）,蓝白幕样结构见于61．63％的基底细胞癌。蓝黑色斑片和蓝白幕样结构在重色素组基底细胞癌中出现频率显著高于低色素组（P〈0．01）。结论皮肤镜诊断色素性基底细胞癌的经典模式在中国人群也显示出良好的诊断能力,研究提出的几个指征如周边色素栅状排列、周边色素加深、毛囊口周围色素加深或减退,在鉴别诊断中的价值尚需大样本研究证实。     

基底细胞癌皮肤镜下特征分析1丁一

目的 观察分析基底细胞癌在皮肤镜下的表现,为无创诊断该病提供参考。方法 回顾分析21例经组织病理确诊为基底细胞癌的皮肤镜图像。结果 21例患者全部具备皮肤镜下基底细胞癌的经典指征表现,皮肤镜下各主要指征按照出现频率的大小依次为大的蓝灰色卵圆形巢、多发的蓝灰色小球、蓝黑色斑片、树枝状毛细血管扩张、短小的毛细血管扩张、蓝白幕。多发聚集的蓝灰色小点、周边色素栅状排列、蓝白幕在重度色素组基底细胞癌中出现频率明显高于轻中度色素组(P 0.05)。结论 皮肤镜能明显提高基底细胞癌的早期诊断率,对临床具有一定的推广意义。     

基底细胞癌皮肤镜下特征分析

目的观察分析基底细胞癌在皮肤镜下的表现,为无创诊断该病提供参考。方法回顾分析21例经组织病理确诊为基底细胞癌的皮肤镜图像。结果 21例患者全部具备皮肤镜下基底细胞癌的经典指征表现,皮肤镜下各主要指征按照出现频率的大小依次为大的蓝灰色卵圆形巢、多发的蓝灰色小球、蓝黑色斑片、树枝状毛细血管扩张、短小的毛细血管扩张、蓝白幕。多发聚集的蓝灰色小点、周边色素栅状排列、蓝白幕在重度色素组基底细胞癌中出现频率明显高于轻中度色素组(P 0.05)。结论皮肤镜能明显提高基底细胞癌的早期诊断率,对临床具有一定的推广意义。     

足底基底细胞癌1例

报告1例足底基底细胞癌.患者男,70岁,右足底皮肤黑色斑片2年.皮肤专科检查:右足底见一 2 cm×3 cm大小的黑色斑片,边界尚清,皮损表面可见一表浅性溃疡,病灶无红肿、渗液,无流血、流脓,无触痛及压痛.皮肤镜检查可见黄白色结构伴少许蓝灰色结构,见个别不典型溃疡伴少许点状血管.皮损组织病理检查可见真皮浅层的基底样细胞...     

反射式共聚焦显微镜在多发性基底细胞癌诊断及治疗随访中的应用

目的：观察多发性基底细胞癌反射式共聚焦显微镜（RCM）影像特征,探讨RCM在多发性基底细胞癌诊断及治疗随访中的价值。方法：对在我科就诊的6例疑似多发性基底细胞癌患者64处皮损行RCM检查,62处皮损诊断为基底细胞癌,其中39处行手术切除并行组织病理检查,23处皮损外涂5%咪喹莫特乳膏治疗,治疗后RCM随访。对基底细胞癌的RCM特征进行归纳总结。结果：手术切除行组织病理检查的39处皮损均符合基底细胞癌,与RCM符合率100%,手术切除后3个月、6个月RCM随访,均未发现基底细胞癌RCM特征。外用5%咪喹莫特乳膏的 23处皮损,治疗后3个月、6个月、12个月,分别有12处、8处、4处仍有基底细胞癌RCM特征。 RCM诊断为基底细胞癌的62处皮损特征：异形角质形成细胞96.8%,与表皮相连90.3%,肿瘤细胞巢96.8%,肿瘤巢周围裂隙样暗区54.8%,肿瘤巢周边细胞栅栏状排列51.6%,肿瘤巢内高折光树枝状结构77.4%,肿瘤间质内血管增生扩张充血95.2%,肿瘤巢内及周围高折光颗粒77.4%。结论：基底细胞癌在RCM下有特征性表现,RCM可作为多发性基底细胞癌诊断及治疗随访的有效手段。     

【开放获取】儿童外阴硬化性苔藓79例皮肤镜特征分析

【摘要】 目的 探讨儿童外阴硬化性苔藓的皮肤镜特征。方法 回顾2019年1月至2021年5月昆明市儿童医院79例外阴硬化性苔藓初诊及复诊时的皮肤镜特征。结果 外阴硬化性苔藓女性患儿79例，年龄2.4 ~ 12岁，发病年龄（5.6 ± 2.12）岁，病程（14.23 ± 12.36）个月，其中30例规律复诊及治疗。初诊329处皮损中，149处（45.3％）可见特征性血管形态，包括线状血管（129处）、点状血管（25处）、盘绕状血管（19处）、发夹样血管（12处）等；207处（62.92%）可见退行性结构及色素异常，包括蓝灰色色素结构（136处）、褐色色素结构（51处）、胡椒粉样模式（15处）等；280处（85.1％）见黄白色无结构区，97处（29.5％）毛囊角栓，66处（20％）紫红色小球、斑片等。复诊238处皮损中，100处（42％）可见特征性血管形态，其中线状血管87处、树枝状血管21处、点状血管4处，未见发夹样血管；154（64.70%）处见退行性结构及色素异常，其中褐色色素结构93处、蓝灰色色素结构57处、胡椒粉样模式4处；165处（69.3％）见黄白色无结构区，62处（26.1％）毛囊角栓，8处（3.4％）紫红色小球、斑片。复诊皮损中观察到的蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及点状血管、发夹样血管、盘绕状血管比例均低于初诊（均P < 0.05），而褐色色素结构高于初诊（均P < 0.05）。结论 儿童硬化性苔藓皮肤镜下黄白色无结构区具较高特异性，监测镜下褐色色素结构及蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及血管结构等特征可反映疗效，在辅助诊断及随访观察中有一定应用价值。     

Evaluation of dermoscopic and histopathologic features and their correlations in pigmented basal cell carcinomas

BACKGROUND: Because of their clinical similarities, pigmented basal cell carcinomas (BCCs) can be confused with melanocytic pigmented lesions especially with melanoma. Since special dermoscopic features have been described for pigmented BCCs, dermoscopy is accepted as a useful tool for the diagnosis of pigmented BCCs. OBJECTIVE: To investigate dermoscopic and corresponding histopathologic features of BCCs and to evaluate their correlations in pigmented BCCs. METHODS: In this study, 32 pigmented BCCs in 30 patients whose diagnoses were confirmed with clinical and histopathologic features were included. Before the histopathologic evaluation, the lesions were analysed for dermoscopic features. Histopathologic correlations of dermoscopic features of BCCs and the localization of pigment accumulation in tumour mass were investigated. RESULTS: In addition to ulceration, large grey-blue ovoid nests, multiple grey-blue globules, maple leaf areas and arborizing telangiectasia; dermoscopically yellow-brown, whitish-yellow, and black-dark brown colour showed statistically significant correlation with their histopathologic counterparts (P < 0.05). Whitish veil, which is among dermoscopic features of BCCs, did not show significant correlation with its histopathologic counterpart (P > 0.05). It was histopathologically determined that pigmentation is found within the tumour mass as well as in the tumour stroma and in the hyperplastic epidermal melanocytes. CONCLUSIONS: Ulceration, large grey-blue ovoid nests, multiple grey-blue globules, maple leaf-like areas and arborizing telangiectasia, which are specific dermoscopic features for the diagnosis of pigmented BCC, were found to correlate with their histopathologic counterparts. In conclusion, dermoscopy can be described as a valuable tool for the diagnosis of pigmented basal cell carcinomas.     

Dermoscopic patterns of superficial basal cell carcinoma

Background Superficial basal cell carcinoma (BCC) presents as a scaly, pink to red–brown patch and is predominantly located on the trunk. Clinical diagnosis may not be always easy and implicates a variety of differential diagnoses; in this situation dermoscopy has been reported improving the diagnostic accuracy. This study investigated dermoscopic patterns of superficial BCC focalizing the most specific and frequent structures in order to improve the diagnostic accuracy. Limitations Study population referred to skin lesion clinic. Methods Dermoscopic patterns of 42 superficial BCCs were analyzed and photographed. These cases represented the 8% of all BCCs excised in our Department between 2005 and 2006. Results Dermoscopic structures observed in the 42 superficial BCCs consisted of shiny white to red areas (100%), “erosions” (78.6%), short fine telangiectasias (SFTs) (66.6%), leaf‐like areas (16.6%), arborizing telangiectasias (14.3%), blue–gray globules (14.3%) and large blue–gray ovoid nests (4.7%). Conclusions Our study identifies the presence of shiny white to red areas, SFTs and “erosions” as main dermoscopic criteria of superficial BCC. Other dermoscopic features, such as leaf‐like areas, arborizing telangiectasias, blue–gray globules and large blue–gray ovoid nests, are not strongly associated with the diagnosis of superficial BCC but they are useful in the differential diagnosis from other pigmented and nonpigmented skin lesions.     

The relation between dermoscopy and histopathology of basal cell carcinoma

BACKGROUND:

Basal cell carcinoma is the most frequent cancer in fair-skinned populations and dermoscopy is an important, non-invasive technique that aids in the diagnosis of Basal cell carcinoma.

OBJECTIVES:

The aim of this study was to evaluate the relationship between histopathological subtypes and dermoscopic features of Basal cell carcinoma.

METHODS:

This study included 98 patients with clinically and histopathologically confirmed Basal cell carcinomas. The dermoscopic features of the lesions from each patient were analyzed before the histopathological findings were evaluated.

RESULTS:

Dermoscopic structures were observed in all 98 patients and irregular vascularity was identified in 78 patients (79.6%). The most common vascular pattern was the presence of arborizing vessels (42 patients, 42.9%) followed by arborizing microvessels (21 patients, 21.4%) and short fine telangiectasias (SFTs; 15 patients, 15.3%). White streaks (38 patients, 38.8%), translucency (31 patients, 31.6%), a milky-pink to red background (42 patients, 42.9%), and erosion/ulceration (29 patients, 29.6%) were also observed. Pigmented islands were seen as blue-gray globules (7 patients, 7.1%) and blue-gray ovoid nests (42 patients, 42.9%). The pigment distribution pattern was maple leaf-like areas in 9 patients (9.2 %) and spoke wheel-like areas in 6 patients (6.1%).

CONCLUSIONS:

Basal cell carcinomas show a wide spectrum of dermoscopic features. Arborizing vessels were the most common dermoscopic findings in Basal cell carcinomas, while superficial Basal cell carcinomas displayed mainly milky-pink to red areas, and arborizing microvessels. The most common dermoscopic features of pigmented types were islands of pigment (blue-gray globules, blue-gray ovoid nests). In conclusion, dermoscopy can be used as a valuable tool for the diagnosis of Basal cell carcinomas and prediction of their histopathological subtypes.     

Dermoscopic features of actinic keratosis

Actinic keratosis (AK) is a keratinocytic neoplasm that typically develops on sun‐damaged skin of elderly individuals. Only a few reports so far have described the dermoscopic diagnostic features of AK, mainly focusing on facial non‐pigmented AKs. A typical feature of facial non‐pigmented AK is a composite pattern named “strawberry pattern”, characterized by a background erythema/red pseudonetwork consisting of unfocused, large vessels located between the hair follicles, associated with prominent follicular openings surrounded by a white halo. Dermoscopic characteristics of pigmented AK on the face include multiple slate‐gray to dark‐brown dots and globules around the follicular ostia, annular‐granular pattern and brown to gray pseudonetwork. Recognizing specific dermoscopic features of AK can be useful in guiding the clinician in the differential diagnosis of AK with melanocytic skin lesions such as LM and non‐melanocytic lesions. Histopathologic examination should be performed whenever clinical and/or dermoscopic differential diagnosis is inconclusive.     

毛母细胞瘤皮肤镜特征初步探究

【摘要】 目的 初步探究毛母细胞瘤皮肤镜结构特征，为临床诊断毛母细胞瘤提供思路。方法 收集2018年11月至2021年7月在武汉市第一医院就诊的5例经组织病理确诊的毛母细胞瘤患者皮肤镜数据资料，分析其镜下结构特征。结果 根据肉眼观察有无色素，将毛母细胞瘤分为色素型（3例）和无色素型（2例）两类。在3例色素型毛母细胞瘤中，皮肤镜下可见蓝灰色卵圆形巢（3例）、分支状血管（2例）、蓝灰色小球（2例）、亮白色无结构区（2例）、同心性结构（1例）、溃疡（1例），均无黄白色均质结构。 2例无色素型毛母细胞瘤中，皮肤镜下可见分支状血管2例、黄白色均质结构2例、亮白色无结构区2例，蓝灰色小球1例，均未见溃疡及蓝灰色卵圆形巢。结论 色素型与无色素型毛母细胞瘤具有不同的皮肤镜特征，皮肤镜可以为毛母细胞瘤提供初步的诊断线索。     

Usefulness of Dermatoscopy for the Preoperative Assessment of the Histopathologic Aggressiveness of Basal Cell Carcinoma

BackgroundLimited information is available regarding dermatoscopic differences between non-aggressive and aggressive types of basal cell carcinoma (BCC).ObjectiveTo investigate dermatoscopic differences between non-aggressive and aggressive types.MethodsWe evaluated 145 histopathologically confirmed BCCs from 141 patients. Histopathologic types and aggressiveness from 4 mm punch biopsy and their dermatoscopic findings were evaluated. We assessed the statistical significance of dermatoscopic differences between non-aggressive and aggressive types. To objectively predict aggressiveness, we created a "dermatoscopic index of BCC aggressiveness" in which 1 point was added and subtracted for each dermatoscopic finding significantly higher in aggressive and non-aggressive types, respectively.ResultsLarge blue-gray ovoid nests were found more frequently in non-aggressive type than aggressive one (85/105 [80.9%] vs. 21/40 [52.5%], p=0.001). Compared to non-aggressive type, aggressive type had more multiple blue-gray globules (29/40 [72.5%] vs. 57/105 [54.3%], p=0.046), arborizing telangiectasia (29/40 [72.5%] vs. 48/105 [45.7%], p=0.004), and concentric structure (11/40 [27.5%] vs. 12/105 [11.4%], p=0.018). Regarding dermatoscopic index, cases of aggressive type with a score of 1 were most common (n=18, 45.0%), followed by a score of 2 (n=14, 35.0%). Limited number of aggressive type of BCCs and the effect of width on the determination of histopathologic aggressiveness.ConclusionAggressive type BCCs more often exhibited multiple blue-gray globules, arborizing telangiectasia, and concentric structure, while the non-aggressive type exhibited large blue-gray ovoid nests more frequently. Score exceeding 2 on the dermoscopic index can be screening criteria for aggressiveness. These dermatoscopic features and dermoscopic index could be useful for assessing aggressiveness of BCCs before surgery.     

Key points in dermoscopic diagnosis of basal cell carcinoma and seborrheic keratosis in Japanese

Basal cell carcinoma (BCC) and seborrheic keratosis (SK) are representative pigmented skin tumors, and they are differentiated as non-melanocytic lesions in the two-step dermoscopy algorithm proposed by the Consensus Net Meeting on Dermoscopy. Because most BCC in Japanese patients are pigmented clinically, dermoscopy plays an important role in their differential diagnosis. The dermoscopic criteria for BCC include the lack of a pigment network and the presence of at least one positive feature for BCC, such as large blue-gray ovoid nests, multiple blue-gray globules, leaf-like areas, spoke wheel areas, arborizing vessels and ulceration. Whereas various dermoscopic features are seen in SK, comedo-like openings, milia-like cysts, and fissures and ridges are especially important features. It is necessary for clinicians to consider the pathological conditions causing the dermoscopic features of BCC and SK. In addition, the sensitivity and specificity of each feature should be taken into consideration to ensure an accurate dermoscopic diagnosis.     

Dermoscopy of Bowen's disease

BACKGROUND: Dermoscopy improves the diagnostic accuracy in pigmented skin lesions, but it is also useful in the evaluation of nonpigmented skin tumours as it allows the recognition of vascular structures that are not visible to the naked eye. Bowen's disease (BD) or squamous cell carcinoma in situ is usually nonpigmented, but may also rarely be pigmented. Objective To describe the dermoscopic features in a series of pigmented and nonpigmented BD. METHODS: Dermoscopic images of 21 histopathologically proven BD were evaluated for the presence of various dermoscopic features. Each lesion was photographed using the Dermaphot (Heine Optotechnik, Herrsching, Germany), at 10-fold magnification, and the colour slides were scanned to digital format using a Kodak Photo CD system. RESULTS: The majority of cases of BD revealed a peculiar dermoscopic pattern characterized by glomerular vessels (90%) and a scaly surface (90%). In addition, in pigmented BD small brown globules regularly packed in a patchy distribution (90%), and structureless grey to brown pigmentation (80%) were observed. CONCLUSIONS: Dermoscopy can be helpful for diagnosing BD because of the presence of repetitive morphological findings such as glomerular vessels and a scaly surface. In pigmented BD, small brown globules and/or homogeneous pigmentation can be seen as well.