皮肤镜在色素性肿瘤诊断中的应用价值

目的分析皮肤镜在色素性肿瘤诊断中的应用价值。方法选取544例色素性肿瘤患者,经临床医生肉眼诊断、皮肤镜检查诊断和病理学诊断后,比较肉眼诊断、皮肤镜诊断与病理学诊断结果的符合率。结果 544例患者中,经皮肤镜诊断与病理学诊断后,色素痣、蓝痣、脂溢性角化、日光性角化、基底细胞癌、甲母痣、恶性黑素瘤的符合率分别为97.2%、91.3%、92.2%、89.3%、90.0%、91.5%、86.8%,所有病例的总符合率为92.0%。皮肤镜诊断的符合率高于肉眼诊断,差异有统计学意义(P<0.05)。结论皮肤镜在色素性肿瘤的诊断中具有较高的符合率,值得推广应用。     

皮肤发光显微镜用于识别良恶性混合瘤

在同一皮损中出现两种不同的肿瘤在临床上很少见,以往文献报道为碰撞瘤或混合瘤。对于恶性肿瘤伴良性损害的患者,做出正确的诊断对指导治疗非常重要。皮肤发光显微镜是一种体内无创技术,可提高黑色素瘤及其他色素性皮肤病的临床诊断准确度。作者描述了多种良恶性混合瘤的皮肤发光显微镜的镜下特征:2例脂溢性角化病伴基底细胞癌,2例黑色素细胞痣伴基底细胞癌,1例皮肤纤维瘤伴基底细胞癌。最终作者得出结论:皮肤发光显微镜是鉴别此类肿瘤的一种有用工具。皮肤发光显微镜用于识别良恶性混合瘤@Zaballos Diego P.$Dermatology Department, Ho…     

外阴部色素沉着性脂溢性角化病临床表现似恶性黑素瘤:对1例患者进行临床、表皮发光显微镜病理学研究

脂溢性角化病通常从临床上即可诊断,但色素沉着性脂溢性角化病有时和恶性黑素瘤难以区分。表皮发光显微镜可提高外阴黑素瘤的早期诊断率,从而在此类色素沉着性疾病外科手术前分级中占一定地位,作者报道了1例外阴部色素沉着性脂溢性角化病患者,其临床表现似恶性黑素瘤,对其表皮发光显微镜特征及病理学相关性进行研究,结果表皮发光显微镜显示患者没有黑头粉刺样开口而呈现假网状结构。因此,表皮发光显微镜在区分色素性疾病中是有用的,即便皮损在外阴部。外阴部色素沉着性脂溢性角化病临床表现似恶性黑素瘤:对1例患者进行临床、表皮发光显微镜…     

电子皮肤镜对脂溢性角化病皮损的观察

目的了解电子皮肤镜在诊断脂溢性角化病中的价值.方法利用电子皮肤镜观察诊断32例脂溢性角化病,临床肉眼观察诊断38例脂溢性角化病,经皮肤组织病理确诊,比较电子皮肤镜与临床肉眼观察诊断脂溢性角化病的正确诊断率.结果电子皮肤镜对脂溢性角化病的正确诊断率为93.8%,明显高于临床肉眼观察诊断组(71.1%).脂溢性角化病的皮损在电子皮肤镜下可分为4种类型.结论电子皮肤镜可以为诊断脂溢性角化病的诊断及鉴别诊断提供重要依据,具有重要意义.     

皮肤镜联合反射式共聚焦显微镜对色素痣良恶性、脂溢性角化病的诊断价值

目的:探讨皮肤镜联合反射式共聚焦显微镜(RCM)在诊断脂溢性角化病、色素痣良恶性方面是否优于单一影像技术。方法:收集中日友好医院皮肤性病科门诊2016年3月~2017年11月期间拟诊为色素痣、脂溢性角化病患者,皮损数量分别为112例、168例,经皮肤镜、RCM诊断后进行组织病理学检查确诊。分别计算皮肤镜、RCM、皮肤镜+RCM的诊断效能。结果:对于脂溢性角化病,皮肤镜诊断的正确率、灵敏度和特异度为96.42%、96.93%和80%,RCM为80.35%、80.98%和100%,皮肤镜+RCM为97.62%、98.16%和100%;皮肤镜显著优于RCM(P<0.05)。诊断色素痣良恶性,皮肤镜的正确率、灵敏度和特异度为77.68%,76.85%和100%,单用RCM和皮肤镜+RCM的正确率、灵敏度和特异度均为98.21%、98.14%和100%;RCM显著优于皮肤镜(P<0.05)。2种疾病采用3种检查的正确率与病理学诊断均无统计学差异(均P>0.05)。结论 :皮肤镜联合RCM的诊断效能优于单一影像技术。鉴别色素痣良恶性、脂溢性角化病首选检查分别为RCM、皮肤镜。     

皮肤镜在黑人中的应用

背景:关于皮肤镜在非白种人皮肤的应用以及能否对诊断产生影响知之甚少。目的:首次评价在黑人人群中应用皮肤镜诊断色素性皮肤病的实用性和有效性。方法:共计100例临床上可疑或难确定的黑人色素性皮肤病患者接收了皮肤镜检查。由两组皮肤科医师用皮肤镜进行观察,一组为巴西(体内),另一组为意大利(幻灯图像)。除作出诊断外,还需在相同的表格中记录皮肤镜观察到的特征。结果:100例临床可疑病例中,有79例Clark痣、15例脂溢性角化、4例蓝痣、1例皮肤纤维瘤和1例黑素瘤。除少数皮损(3例Clark痣)需外科切除来证实诊断外,两组观察者均成功的对所有…     

皮肤肿瘤病症40例临床诊断与分析

目的：分析皮肤肿瘤病症的临床诊断及临床表现。方法收集40例皮肤肿瘤患者的临床病理资料加以回顾探究。结果本组40例皮肤肿瘤患者中,上皮细胞肿瘤合并角化棘皮瘤者10例,脂溢性角化病者12例,基底细胞癌者10例,鳞状细胞癌者2例,黑色素细胞瘤合并黑色素细胞痣者4例,附属器肿瘤合并增生性外毛根鞘肿瘤者2例。结论皮肤肿瘤病理学存在较多类型,临床诊断符合率较低。组织病理检查对皮肤肿瘤的临床诊治具有重要意义。     

早期脂溢性角化病与扁平疣皮肤镜特征分析

目的总结分析早期脂溢性角化病与扁平疣的皮肤镜图像特征,为皮肤镜鉴别早期脂溢性角化病与扁平疣提供依据,减少扁平疣误诊率。方法对从2016年12月至2017年8月在山西医科大学第一医院皮肤科门诊经皮肤镜检查,且临床确诊为早期脂溢性角化病与扁平疣的皮损皮肤镜图像进行分析。结果共分析早期脂溢性角化病患者50例,89个皮损,最主要的皮肤镜特征(灵敏度50%)为裂缝和脊(75.2%)、匀质假网结构(57.3%)、虫蚀状边缘(51.7%),其它特征为粉刺样开口(37.1%)、发夹样血管(32.6%)、粟粒样囊肿(27.0%)、乳头增生样结构(12.4%)、胡椒粉样结构(10.1%)。扁平疣患者50例,84个皮损,最主要的皮肤镜特征(灵敏度50%)为粉红色背景(79.8%)、点状出血结构(73.8%),其它特征为环状色沉结构(27.4%)、洋葱皮状脱屑结构(33.3%)、皮色背景(20.2%)。结论根据早期脂溢性角化病与扁平疣各自皮肤镜图像特征,应用皮肤镜检查有助于两者的鉴别诊断。     

生存蛋白基因及其在皮肤肿瘤中表达的研究进展

生存蛋白(survivin)基因是凋亡抑制蛋白家族的新成员,也是目前发现的功能最强大的凋亡抑制蛋白。过去有关survivin的研究主要集中在皮肤恶性肿瘤领域(如恶性黑素瘤、基底细胞瘤、鳞状细胞癌、皮肤瘢痕癌、鲍温病),近期研究表明,其在皮肤良性肿瘤中(如色素痣、光化性角化病、脂溢性角化病、乳头状瘤、尖锐湿疣、鲍温样丘疹病)同样也有阳性表达。目前,这方面的研究已取得了明显进展,未来,survivin将有可能成为皮肤肿瘤新的临床诊断标准与治疗靶点。     

FOXP3在正常人皮肤和表皮肿瘤中的表达及意义

目的   探讨叉头状转录因子P3（forkhead box protein-3,FOXP3）在正常人皮肤和不同表皮肿瘤皮损中的表达及意义。方法   应用免疫组织化学EnVision法检测20例脂溢性角化、19例日光性角化、21例鲍恩病、13例鳞状细胞癌及13例正常人皮肤中FOXP3的表达。结果   脂溢性角化、日光性角化、鲍恩病、鳞状细胞癌皮损中FOXP3+淋巴细胞阳性率均高于正常皮肤（P＜0.01）;脂溢性角化、日光性角化、鲍恩病、鳞状细胞癌间FOXP3+淋巴细胞阳性率差异有统计学意义（P＜0.01）;日光性角化FOXP3+淋巴细胞阳性率高于脂溢性角化（P＜0.05）;鲍恩病、鳞状细胞癌FOXP3+淋巴细胞阳性率均高于日光性角化（P＜0.05）,而其在鲍恩病与鳞状细胞癌间表达差异无统计学意义（P＞0.05）。结论   FOXP3+淋巴细胞在表皮良性肿瘤、癌前病变、恶性肿瘤中的表达呈逐渐增高趋势,在表皮肿瘤的免疫逃逸中发挥重要作用,促进了其发生发展。     

AgNORs在皮肤良恶性病变研究中的应用

目的：探讨银染核仁组成区蛋白（ＡｇＮＯＲｓ）在皮肤良恶性病变、皮肤癌之间的临别鳞癌的分级诊断中的意义。方法：采用银染一步法。结果：银染一步法方法简便、迅速，适用于石蜡切片，可做回顾性研究，ＡｇＮＯＲｓ技术结合图像分析技术右避免光镜下和的弊端。ＡｇＮＯＲｓ作为一项定量指标在皮肤肿瘤研究中已显示其潜在价值。对良性痣细胞痣及恶性黑素瘤、恶性淋巴瘤及假性淋巴瘤、尖锐湿疣及假性湿疠基阍细胞癌及其他皮肤癌、鳞     

眼睑肿物77例临床分析

目的:探讨眼睑肿物的临床、病理学分类及手术方法。方法:回顾性分析1993年~2005年收治77例眼睑肿物患者年龄分布及病理分类:结合病例讨论肿物切除及整形术应注意的问题。结果:恶性肿瘤中居前两位者为基底细胞癌、睑板腺癌,良性肿瘤中居前两位者为色素痣和皮样囊肿。75例手术切除,2例肿瘤转移未行手术。结论:对眼睑肿物进行分析有利于指导临床诊断及其治疗。     

Preliminary results of skin cancer screening in West Virginia

Although skin cancer screening is theoretically of value, its effectiveness has not been firmly established because few studies have systematically followed persons with a positive screen to obtain pathologically confirmed diagnoses. From the 799 persons screened at Charleston Area Medical Center in 1988 and 1989, 153 screenees with suspected skin cancer, dysplastic nevi, and congenital nevi were followed to determine their final diagnosis. Follow-up was done by letter and telephone calls to both the individuals who screened positive and their treating physicians. Eighty-four (54 percent) then sought medical attention as a result of letters and calls. Thirty-one basal cell carcinomas, three squamous cell carcinomas, three dysplastic nevi, two melanomas, and one congenital nevus were pathologically confirmed. The predictive value positive of the screenings was 32 percent to 60 percent for non-melanoma skin cancer, 9 percent to 25 percent for dysplastic nevi, and 15 percent for melanoma. This study suggests that post-screening follow-up of those with suspected premalignant and malignant skin lesions is feasible and should be encouraged so that more definitive evaluation and treatment can potentially be performed and skin cancer screenings more accurately assessed.     

皮肤肿瘤Ag—NOR定量研究

应用银胶染色技术对46例皮肤肿瘤石蜡切片进行Ag-NOR定量观察。结果表明,皮肤乳头状瘤Ag-NOR计数平均为1.3个/核;基底细胞癌Ag-NOR计数平均为5.6个/核;高分化鳞癌Ag-NOR计数平均为2.4个/核;低分化鳞癌Ag-NOR计数平均为5.3个/核。     

Squamous cell carcinoma of the skin. Accuracy of clinical diagnosis and outcome of follow-up in Australia

The accuracy of the clinical diagnosis of 1292 non-melanotic skin tumours that were submitted to a private pathology service in 1980-1981 was determined. The clinical diagnosis that was written on the pathology slip which was submitted with the tumour was correlated with the histological diagnosis and the type of medical practitioner submitting the lesion. The clinical diagnosis was most accurate in the case of basal cell carcinoma; dermatologists most often reached this diagnosis correctly. For squamous cell carcinoma, although most frequently the lesions were diagnosed correctly clinically by dermatologists, their clinical diagnosis was confirmed in only 51% of cases. On average, 36% of squamous cell carcinomas were diagnosed clinically as basal cell carcinomas. The clinical course of 299 patients with a total of 305 squamous cell carcinomas that were selected from the squamous cell carcinomas that were submitted in 1980-1981 was traced. Four tumours (1.6%) which occurred in sun-exposed areas of the body metastasized, and 18 (7.5%) recurred locally. We conclude that those non-melanotic skin tumours which have the most potential to metastasize (squamous cell carcinomas) are those which are most poorly diagnosed clinically. It is recommended that patients with non-melanotic skin cancers should undergo biopsy as a routine to confirm the clinical diagnosis. Those who have a squamous cell carcinoma removed should be followed up for at least two years after the initial treatment.     

Treatment of Basal Cell Carcinoma by Curettage and Electrosurgery

One hundred and forty-eight basal cell carcinomas were treated by curettage and electrosurgery. Twenty-six recurrent carcinomas were treated and 24 did not recur during a minimum two-year follow-up. Seventy-two newly diagnosed carcinomas were treated by the same method, and a two-year recurrence-free rate of 97.4% was obtained. About 50 new and recurrent lesions were treated in three patients in whom extensive cutaneous changes from actinic atrophy and previous therapy made the distinction between new and recurrent lesions difficult or impossible. This technique has a particular place in the management of multiple lesions. Patient acceptance is good. Lesions at some sites, e.g. on the nose, where closure of a wound is difficult, are better managed by this method than by surgical excision. Secondary infection is rare and the cosmetic results are excellent.     

3例毛母细胞瘤临床病理分析

目的：研究毛母细胞瘤（TB）的病理形态特征、诊断及鉴别诊断。方法回顾性分析3例 TB 临床病理特点、形态学及免疫表型特征,以及与多种疾病的鉴别诊断;另选择5例基底细胞癌行免疫表型检测并重点与 TB 相鉴别诊断。结果镜下可见,3例中肿瘤均位于皮下,不与表皮相连,单一的基底样细胞构成肿瘤主体,肿瘤周边细胞呈栅栏状排列。例1可见大小不等的囊腔及色素沉积,诊断为色素性 TB;例2可见原始毛乳头样结构,诊断为 TB;例3肿瘤中的基底样细胞核呈栅栏状排列,形成波纹状结构,诊断为波纹状 TB。3例雄激素受体（AR）及2例 B 淋巴细胞2（Bcl-2）阴性表达,1例细胞角蛋白（CK）20散在阳性,3例 CD10间质及毛乳头样结构阳性;5例基底细胞癌周边栅栏状排列的肿瘤细胞 CD10阳性,4例 AR 阳性,3例 Bcl-2阳性,5例CK20阴性。结论 TB 是来源于毛囊生发上皮的良性肿瘤,完整切除预后良好,需重点与基底细胞癌相鉴别。     

乳腺良、恶性疾病中的基质改变

对84例良、恶性乳腺病变的基质作超微结构对比分析。结果表明存在两型基板/基质相互关系:良性疾患和非侵袭性乳腺癌的基板完整,基质全由成纤维细胞(fibroblast,FB)组成,无肌成纤维细胞(myofibroblast,MFB)存在;在侵袭性癌中,基板大多有缺陷或完全消失,基质中均可存在单个或成群的MFB。原位癌周围的MFB增生是癌性浸润的早期信号,对精确诊断非浸润性癌有价值。对MFB增生程度与肿瘤类型的关系、诱发浸润癌中MFB增生的可能原因及其意义等问题进行了讨论。     

基于卷积神经网络的基底细胞癌和色素痣的临床图像鉴别

目的：利用卷积神经网络(convolutional neural network,CNN)算法构建基于临床图像的基底细胞癌和 色素痣的智能辅助诊断模型。方法：首先,基于湘雅医学大数据平台构建一个大规模的以中国人种为主的皮肤疾 病临床图像数据集——湘雅皮肤疾病数据集;在此数据集的基底细胞癌和色素痣的子集上评估5种主流CNN模型 (ResNet50,InceptionV3,InceptionResNetV2,DenseNet121,Xception)的分类性能;以热力图的形式分析模型诊断结果 的依据;将最优的CNN分类模型与30名专业的皮肤科医生对100例患者临床图像鉴别进行对比。结果：湘雅皮肤疾病 数据集包含150 223幅带有病变区域标记的临床图像,涵盖543类皮肤疾病,且数据集内每幅图片都包含病理金标准的 支持和患者的病史资料。在由349幅基底细胞癌和497幅色素痣的测试集上,最优的CNN模型为Xception,其分类正确 率可以达到93.5%,其中基底细胞癌和色素痣曲线下面积(area under curve,AUC)分别为97.4%和96.9%。热力图的结果 表明CNN模型能学习到与疾病鉴别相关的特征。Xception模型在鉴别基底细胞癌和色素痣的临床图像的能力与专业皮 肤科医生基本相当。结论：本研究属于首次基于中国人种临床数据集的皮肤肿瘤的辅助诊断研究,证明了CNN模型 具有对于中国人种基底细胞癌和色素痣的鉴别能力,为后续人工智能在皮肤肿瘤中的诊疗应用奠定了扎实基础。     

STUDY ON THE GENETICS OF BASAL CELL NEVUS SYNDROME IN ONE FAMILY

Cytogenetic data on the basal cell nevus syndrome (BCNS) arc scanty. So far, we have not seen any reports on the cytogenetic study of this syndrome using G-banding and sister chromatid ex change (SCE) techniques either in China or abroad. This article presents the results of a systematic genetic study of BCNS in a single family. No abnor- malities in chromosome number or structure was found. However, the SCE frequenncy in an affected individual who developed cancerous changes was significantly higher than that of an unaffected person, or an affected person without malignant changes of the nevi. This can be used as an indicator of malignant change in pigmented nevi.