皮肤镜在微小色素型基底细胞癌诊断中的初步研究

目的 评价皮肤镜在微小色素型基底细胞癌诊断中的价值.方法 体表疑似微小(皮损直径＜5 mm)色素型基底细胞癌患者58例,男19例,女39例;年龄16～82岁;病程3个月至25年.对每例皮损进行皮肤镜检查,留皮肤镜照片.由两名医生参照色素型基底细胞癌皮肤镜特点,仅根据照片盲法独立进行诊断.以病理诊断为金标准,通过诊断性试验的研究方法,研究皮肤镜在微小色素型基底细胞癌诊断中的敏感度、特异度及一致性.结果 58例患者中36例经组织病理学诊断为基底细胞癌,医生A皮肤镜诊断为色素型基底细胞癌41例,不是色素型基底细胞癌17例;医生B皮肤镜诊断为色素型基底细胞癌40例,不是色素型基底细胞癌18例.与病理诊断相比,两名医生皮肤镜诊断色素型基底细胞癌的灵敏度、特异度、Youden指数及Kappa值分别为97.22％、72.73％、69.95％、0.732 (P＞ 0.05)和97.22％、77.27％、74.49％、0.772(P＞0.05).结论 皮肤镜对微小色素型基底细胞癌诊断与组织病理学检查结果有较好的一致性.     

高频超声和剪切波弹性成像在基底细胞癌术前评估中的应用

【摘要】 目的 探讨高频超声和剪切波弹性成像在基底细胞癌（BCC）术前评估中的价值。方法 回顾性分析2017年1月至2020年12月于广东省中山市中医院皮肤科就诊并经手术病理确诊的95例皮肤BCC病例的临床资料。所有病例术前均行常规超声和剪切波弹性成像检查，记录病变的常规超声测量指标（最大直径、最大浸润深度、最大血流速度及阻力指数）以及剪切波弹性成像测量指标（杨氏模量平均值Eave、杨氏模量标准差Esd及杨氏模量平均值比值Eratio）。以病理亚型为参考依据，进一步将病例分成高风险和低风险BCC组，通过配对t检验比较两组常规超声测量以及剪切波弹性成像测量结果。结果 高风险BCC组15例，低风险组80例，两组间皮损最大浸润深度［（8.5 ± 4.6） mm比（4.5 ± 1.6） mm，t = 6.150，P < 0.001］、杨氏模量平均值Eave［（32.7 ± 11.2）比（20.6 ± 5.1） kPa，t = 4.065，P = 0.001］以及杨氏模量标准差Esd［（7.0 ± 4.1）比（4.2 ± 2.1） kPa，t = 2.632，P = 0.018］差异有统计学意义，其他测量指标差异无统计学意义（均P > 0.05）。以最大浸润深度、Eave以及Esd诊断高风险BCC的受试者工作特征曲线下面积分别为0.775、0.909及0.822，其中以Eave的诊断效能最佳。以25.7 kPa作为截断值，使用Eave诊断高风险BCC的敏感度、特异度分别为86.7%、85.0%。结论 应用高频超声和剪切波弹性成像有助于鉴别高风险与低风险BCC。     

多发性基底细胞癌的皮肤镜特点

目的:明确多发性基底细胞癌的皮肤镜特点。方法:回顾性分析行皮肤镜检查并经组织病理确诊为基底细胞癌的7例多发性基底细胞癌患者的25处皮损。结果:皮损表现为散在血管模式20处,无血管模式5处;蓝灰色卵圆巢21处,多发性蓝灰色点及小球16处,不典型血管15处,无结构区13处,色素减退12处,线性毛细血管扩张11处,出血/溃疡11处,枫叶状结构10处,螺旋状血管10处,分支状血管7处,乳红色小球7处,红白背景下无结构区7处,逗号样血管5处,乳红色小点4处,轮幅样结构2处。结论:多发性基底细胞癌皮肤镜常见表现为散在血管模式,蓝灰色卵圆巢及多发性蓝灰色点及小球。     

107例基底细胞癌的高频超声特点

回顾性分析经病理证实的107例BCC患者的声像图(其中结节溃疡型63例、色素型22例、表浅型20例、纤维上皮瘤型1例、硬斑病型1例)。BCC的圆度系数值为1.43~17.75,平均值8.53,中位数3;22例探及血流信号,收缩期峰值流速(PSV)平均值为14.23±4.77 cm/s,阻力指数(RI)平均值为0.44±0.13。结节溃疡型、色素型和纤维上皮瘤型皮损回声形态表现为椭圆形或类圆形68例,扁平形18例,位于真皮层内62例;表浅型、硬斑病型皮损回声形态表现为椭圆形或类圆形2例,扁平形19例、位于真皮层内2例。     

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。     

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...     

皮肤基底细胞癌和皮肤鳞状细胞癌270例回顾性分析

 目的:总结我院皮肤基底细胞癌(BCC)和皮肤鳞状细胞癌(SCC)临床与组织病理资料,以期提高BCC与SCC的诊断率。方法：回顾性分析2014年1月1日-2018年12月31日间我院皮肤科门诊经组织病理切片确诊的170例BCC与100例SCC患者的临床与病理资料。结果：BCC与SCC年度发病整体均呈逐渐上升趋势。BCC、SCC男女患病比例分别为0.8∶1、1∶1，好发部位均为曝光部位(头面颈部和四肢)，临床诊断与组织病理诊断符合率分别为62.4%与30.0%。临床诊断上，BCC易与脂溢性角化病(SK)、色素痣混淆；SCC易与BCC、鲍温病、光线性角化病(AK)混淆。结论：BCC和SCC为临床常见的非黑素性皮肤肿瘤，但易误诊和漏诊。临床医生对于可疑病灶应尽早行皮损组织病理检查。     

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。     

高频超声鉴别侵袭性与非侵袭性皮肤基底细胞癌的应用价值

目的 探讨高频超声鉴别侵袭性与非侵袭性皮肤基底细胞癌（BCC）的应用价值。方法 分析经病理确诊的95例皮肤BCC患者的病理切片,进一步对其病理亚型进行划分,根据病理亚型的侵袭性将患者分为侵袭性和非侵袭性,比较侵袭性和非侵袭性超声征象的差异,无相关性分析结果。结果 在BCC的超声征象中,侵袭性BCC比非侵袭性更容易浸润至皮下组织（χ2=5.189,P=0.023）,病灶内部更容易出现液性暗区（χ2=10.672,P=0.001）;而在病灶形态、最大直径、平均高回声点计数、后方回声变化以及Alder血流分级方面,侵袭性与非侵袭性BCC间差异无统计学意义。结论 侵袭性与非侵袭性皮肤BCC的高频超声表现间有一定差异,这些差异或许能在术前鉴别二者及制定治疗方案中发挥主要作用。     

皮肤鳞状细胞癌和基底细胞癌中p53和C-myc突变基因及蛋白的检测

目的 研究和探讨ｐ５３和Ｃ－ｍｙｃ基因突变在皮肤鳞状细胞癌（ＳＣＣ）和基底细胞癌（ＢＣＣ）的发生,发展中的作用。方法 采用多聚酶链反应－单链构象多态性分析（ＰＣＲ－ＳＳＣＰ）技术检测石蜡标本中ｐ５３与Ｃ－ｍｙｃ基因突变及免疫组化方法检测Ｃ－ｍｙｃ蛋白及突变型ｐ５３基因产物的表达。结果 ３０例ＳＣＣ中１２例ｐ５３基因突变（４０％）和１例Ｃ－ｍｙｃ基因突变,Ｐ５３蛋白表达占５０％（１５／３０）,Ｃ－ｍ     

High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma

The recent development of high-frequency ultrasound, associated with the improved sensitivity in color Doppler, enabled the identification of various skin structures and layers. In basal cell carcinoma, the 22 MHz frequency ultrasound permits the delimitation of tumor margins, while color Doppler, determines its vascularization. We present two cases in which the association of both exams allowed an in vivo analysis of the tumor''s morphology, size, thickness and vascularization, thus contributing to a better pre-operative evaluation.     

Wide area digital dermoscopy applied to basal cell carcinoma

In situations in when a dermoscopic record of a large lesion is desirable, the resulting images are usually restricted to a small field of view due to the limited diameter of dermatoscope lenses. This limitation often produces several photographs separately, thus losing the possibility of a single-image global evaluation. In these case reports, we show examples of a recently published image montage technique called Wide Area Digital Dermoscopy, in this case, applied to basal cell carcinomas.     

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.     

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

BackgroundBasal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking.ObjectivesTo evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts.MethodsA retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence.ResultsOf the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types.Study limitationsRetrospective nature of the study.ConclusionThe present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.     

Basal cell carcinoma with compromised margins: retrospective study of management,evolution, and prognosis

BackgroundNon-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial.ObjectivesTo compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma.MethodsSelection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013.ResultsA total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery.Study limitationsMean follow-up time of less than five years and sample size.ConclusionsThe presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.     

基底细胞癌的治疗

基底细胞癌是最常见的皮肤恶性肿瘤,该病几乎不发生转移,如不治疗,肿瘤会发生局部浸润性生长而破坏邻近组织,影响功能和美观,严重时危及生命.基底细胞癌的治疗方法很多,主要分为手术疗法和非手术疗法.手术疗法是首选的治疗手段,包括常规手术切除和Mohs显微外科手术切除,较大的缺损可以通过多种治疗手段进行创面修复.非手术疗法包括光动力学疗法、放射治疗、局部化疗、免疫调节剂治疗以及分子靶向治疗等.     

Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery

BackgroundThe treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy.Objectivesa) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery.MethodsRetrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery.ResultsThe agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases.Study limitationsRetrospective nature, sample size, and biopsies performed by different professionals.ConclusionsThe agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.     

高频超声弹性成像对基底细胞癌的诊断

目的：探讨高频超声剪切波弹性成像在皮肤基底细胞癌中的应用价值。方法：收集我院2017年3月至2018年12月于本院临床皮肤科因皮肤黑色占位性皮损就诊，同意接受超声检查及手术治疗的患者。结果：共收集患者108例，病理确诊基底细胞癌62例，良性对照病例46例，高频超声弹性成像对基底细胞癌诊断符合率为98.15%。高频超声弹性成像主要表现为基底细胞癌皮损表皮增厚、毛糙或不同程度的表皮缺损改变，可见多发的点状强回声，点状强回声后方无声影，后方有轻微声衰减，内血流信号多少不一，平均杨氏模量为（36.3±8.3）kpa，与周围正常组织弹性应变比约7.4±3.2。结论：高频超声剪切波弹性成像对皮肤基底细胞癌有较高的诊断能力。