脂溢性角化病的皮肤高频超声及皮肤镜特征分析

目的 描述脂溢性角化病（SK）的常见皮肤高频超声及皮肤镜特征。方法 收集2017年8 - 12月在北京协和医院皮肤科门诊就诊的46例SK患者,对其50处SK皮损行50 MHz和20 MHz皮肤高频超声和皮肤镜检查。对SK皮肤高频超声和皮肤镜特征进行总结分析。采用χ2检验比较50 MHz和20 MHz超声对SK的评估结果差异,并对SK皮肤高频超声和皮肤镜下特征的对应关系通过简单匹配系数进行分析。结果 SK皮损特征自上而下50 MHz和20 MHz超声表现分别为增强高回声（48处和39处,P = 0.007）、角质层块状或点状增强高回声（22处和11处,P = 0.019）、伴后方声影（34处和13处,P < 0.001）、皮损形态规则且边界清晰（46处和41处,P = 0.137）、皮损内不均质低回声（50处和47处,P = 0.079）和点状高回声（25处和2处,P < 0.001）、基底位于同一水平面（40处和36处,P = 0.349）、皮损下方真皮回声减低（50处和28处,P < 0.001）。50 MHz超声对SK皮损的8个皮肤高频超声特征整体评价显著优于20 MHz超声（P = 0.002）。50处SK皮损常见皮肤镜下特征为边界清楚（50处）,粉刺样开口（45处）,沟嵴/脑回状模式（31处）,发卡样血管（30处）,多发粟粒样囊肿（24处）,虫蚀状边缘（21处）和亮白色条纹（3处）。50 MHz和20 MHz超声下,SK皮损角质层块状或点状增强高回声与皮肤镜下粉刺样开口的简单匹配系数分别为42%（21处）和20%（10处）,皮损内点状高回声与皮肤镜下多发粟粒样囊肿（> 3个）的简单匹配系数分别为58%（29处）和48%（24处）。结论 皮肤高频超声和皮肤镜对SK皮损评估具有较好的应用价值,且50 MHz超声比20 MHz超声对SK的皮损成像更具优势。     

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。     

浅表型基底细胞癌34例临床表现、皮肤镜及组织病理特征分析

目的:总结34例浅表型基底细胞癌(BCC)患者的临床表现、皮肤镜及组织病理特点。方法:对2009年1月—2017年12月该院皮肤科门诊确诊的34例浅表型BCC患者临床表现、皮肤镜与皮损组织病理资料进行回顾性分析。结果:34例患者中男14例,女20例,以老年人居多,皮损最好发于躯干。32例皮损表现为单发性红斑、斑片及糜烂,2例为多发皮损。皮肤镜下皮损部位主要表现为枫叶样结构及轮辐状区域。皮损组织病理表现为真皮内芽蕾样嗜碱性细胞团块,与表皮相连,沿水平方向延伸、生长;边缘细胞呈栅栏状排列,可见周边裂隙。大部分患者真皮浅层可见淋巴细胞浸润(85.3%)、肿瘤团块内色素沉积(67.6%)及周边纤维组织增生(76.5%)。结论:浅表型BCC的临床表现、皮肤镜及组织病理特点均与经典型BCC相异,临床医生需提高对该病的认识以减少误诊。     

日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病皮肤镜特征专家共识

【摘要】 日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病是常见的良性表皮增生性疾病,其皮肤镜特征对于明确诊断、与其他皮肤肿瘤相鉴别、避免不必要的活检和手术以及动态监测皮损变化等都有一定帮助。本共识对这3种疾病的皮肤镜特征进行了总结。日光性雀斑样痣的皮肤镜特征主要为皮损边界清晰、虫蚀状边缘、模糊的色素网、指纹模式、棕色均质模式、假性网络。脂溢性角化病的皮肤镜特征主要为皮损边界清晰、粟粒样囊肿、粉刺样开口、脑回状模式、发夹样血管、摇晃试验中皮损整体移动。扁平苔藓样角化病的皮肤镜特征主要为胡椒粉样或颗粒模式以及周围可见日光性雀斑样痣、脂溢性角化病或光线性角化病的皮肤镜特征。     

原发性皮肤淀粉样变皮肤镜特征分析

目的 描述原发性皮肤淀粉样变的常见皮肤镜特征,探讨皮肤镜在原发性皮肤淀粉样变辅助诊断中的应用价值.方法 收集2014年4月至2016年12月在北京协和医院皮肤科门诊就诊并行皮肤镜检查的原发性皮肤淀粉样变患者17例,分析45处皮损的皮肤镜特征.结果 原发性皮肤淀粉样变常见的皮肤镜特征为存在中心区域(可为白色、棕色或瘢痕样结构)和多种形态的色素结构及亮白色条纹.45处皮损(100％)皮肤镜下均观察到中心区域.14处(31％)苔藓样皮损仅有白色中心区域,5处(11％)苔藓样皮损同时具有白色中心区域和瘢痕样结构.8处(18％)斑状皮损仅有棕色中心区域,6处(13％)苔藓样皮损和17处(38％)斑状皮损同时具有白色及棕色中心区域.所有皮损均有多种形态的色素结构.4处(9％)苔藓样皮损有亮白色条纹.结论 皮肤镜在原发性皮肤淀粉样变的辅助诊断中具有良好的应用价值.     

术前无创检测方法界定基底细胞癌边界的临床应用比较

目的探究皮肤镜、5-氨基酮戊酸(5-aminolevulinic acid,ALA)荧光定位、反射光共聚焦显微镜(reflectance confocal microscopy,RCM)及高频超声无创检测方法检测基底细胞癌边界的可行性,为临床手术范围评估提供参考。方法选取32例病理诊断为基底细胞癌(BCC)的患者,术前在无影灯下肉眼观察皮损大小,结合患者皮损情况及患者意愿使用皮肤镜、ALA荧光定位、RCM对病损及其边界进行观察并测量大小,高频B超测量浸润深度,后行手术切除,比较几种方法检测的肿瘤边界与肉眼观察边界、安全边界、切除肿瘤大小的差异,并进行统计学分析。结果无影灯下肉眼观察、皮肤镜、ALA荧光定位、RCM检测的安全边界、手术切除大小两两相比,除皮肤镜与ALA荧光定位检测的大小差异无统计学意义外,其他差异均有统计学意义;将皮肤镜、ALA荧光定位、RCM检测大小与切除肿瘤大小进行对比,其相关系数Pearson值分别为0.948、0.901、0.934;手术切除大小分别在皮肤镜、ALA荧光定位、RCM检测大小基础上平均外扩2.93 mm、2.89 mm、1.41 mm;术前经50 MHz高频超声测量浸润深度的4例BCC患者,手术切除后底壁均呈阴性。结论对于BCC患者,术前根据患者不同皮损特点、病理类型及病损部位等恰当选择皮肤镜、ALA荧光或RCM观察和检测BCC的边界,以及使用50 MHz高频超声测量浸润深度能有效减少根据单纯手术扩切的盲目性,提高单次手术切净率,提高临床手术效率,降低手术风险。     

皮肤基底细胞癌的高频超声表现

目的 总结皮肤基底细胞癌的高频超声表现。方法 回顾性分析我院35例病理证实为皮肤基底细胞癌患者的临床和超声检查资料。结果 35例患者均为单发,病变最常见于头面部(33例,94.3%)。30例(85.7%)患者肿物表面有出血史。所有病例病变表面均有不同程度表皮缺损,病变边缘清楚,以椭圆形及不规则形为主,内部以低回声为主,并见多发的点状强回声(34例,97.1%),32例(91.4%)病变内可见丰富血流信号。结论 皮肤基底细胞癌多位于头面部,超声特征表现为不规则形的低回声结节,病变内部见点状强回声。结合病变表面有出血史,可与其他皮肤肿瘤相鉴别。     

47例扁平疣的皮肤镜特征分析

目的应用皮肤镜对扁平疣的图像特征进行归纳总结,为扁平疣的皮肤镜诊断总结相对明确的诊断特征。方法对2014年9月—2015年3月来天津市中医药研究院附属医院门诊皮肤科就诊患者47例,217余处皮损进行皮肤镜检查,获得特征性图像资料。结果扁平疣皮损图像显示为3种形态,即环状结构围绕着点状血管,颗粒状凸起内可见点状血管,及扁平均质样结构内散在分布点状血管。结论皮肤镜有助于快速无创的诊断扁平疣。     

色素性扁平苔藓皮肤镜下特征分析

目的明确色素性扁平苔藓在皮肤镜下图像特征。方法分析45例经组织病理确诊为色素性扁平苔癣的患者,共选取144处皮损皮肤镜下图像特征进行整理分析。结果皮肤镜下18处(12.5%)皮损可见Wickham纹,Wickham纹呈现白色。117处(81.25%)可见尘灰样色素颗粒改变,27处(18.75%)可见色素球、弥漫的色素改变;皮肤镜下共129处(89.58%)可见血管构型变化,其变化为点状或线状。结论皮肤镜可以提高色素性扁平苔藓的临床诊断率,可作为色素性扁平苔藓的辅助诊断手段。     

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。     

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.     

Computerized digital dermoscopy

Within the past 15 years, dermoscopy has become a widely used non-invasive technique for physicians to better visualize pigmented lesions. Dermoscopy has helped trained physicians to better diagnose pigmented lesions. Now, the digital revolution is beginning to enhance standard dermoscopic procedures. Using digital dermoscopy, physicians are better able to document pigmented lesions for patient follow-up and to get second opinions, either through teledermoscopy with an expert colleague or by using computer-assisted diagnosis. As the market for digital dermoscopy products begins to grow, so do the number of decisions physicians need to make when choosing a system to fit their needs. The current market for digital dermoscopy includes two varieties of relatively simple and cheap attachments which can convert a consumer digital camera into a digital dermoscope. A coupling adapter acts as a fastener between the camera and an ordinary dermoscope, whereas a dermoscopy attachment includes the dermoscope optics and light source and can be attached directly to the camera. Other options for digital dermoscopy include complete dermoscopy systems that use a hand-held video camera linked directly to a computer. These systems differ from each other in whether or not they are calibrated as well as the quality of the camera and software interface. Another option in digital skin imaging involves spectral analysis rather than dermoscopy. This article serves as a guide to the current systems available and their capabilities.     

Dermatoscopia del carcinoma basocelular: revisión actualizada

Dermoscopy is a noninvasive technique that has been demonstrated to improve diagnostic accuracy in basal cell carcinoma (BCC). The first dermoscopic model for the diagnosis of BCC, based mainly on the identification of pigmented structures, was described by Menzies et al., and since then dermoscopy has generated an abundance of literature useful to routine clinical practice. From a practical perspective, dermoscopic structures associated with BCC can be classified as pigmented, vascular, or nonpigmented/nonvascular. One of the most recent applications of dermoscopy in BCC is as an aid to predicting histologic subtype and essentially differentiating between superficial and nonsuperficial BCC. It can also, however, help raise suspicion of more aggressive variants with a higher risk of recurrence. A thorough dermoscopic examination during follow-up of patients with actinic damage or a history of multiple BCCs can facilitate the detection of very incipient lesions and significantly impact treatment and prognosis.     

Dermoscopy

First, a brief introduction about types of dermoscope and an explanation on the theory of dermoscopy are provided. Second, some introduction on the difference of dermoscopic pictures between benign and malignant neoplasm is given. Basically, benign lesions tend to show symmetrical dermoscopic structures and colors, whereas malignant lesions have a tendency to present irregular and atypical dermoscopic structures. Third, the relationship between dermoscopic images and anatomical structures will be shown. Acral melanocytic lesions have site-specific dermoscopic patterns, namely parallel furrow pattern or parallel ridge pattern. These parallel patterns are due to different distribution of benign and malignant melanocytes. Benign melanocytes (nevus cells) are mainly found on the tips of crista profunda limitans and supply melanin granules to the furrows of stratum corneum, making a parallel furrow pattern. To the contrary, melanoma cells proliferate mainly on the tips of crista profunda intermedia or rather diffusely and randomly, and supply melanin granules irregularly and diffusely to the ridges of stratum corneum, having parallel ridge pattern. Fourth, the global features of dermoscopic findings are described respectively with definitions of the technical terms. To analyze dermoscopic structures, it is easier to look at global features first and local features next. Basic global features include reticular, globular, cobblestone, homogeneous, starburst and parallel patterns. If a given dermoscopy image has two patterns, the more prominent pattern might be chosen. If it has more than three dermoscopic patterns, then multi-component pattern is the reasonable selection. If there are no particular dermoscopic structures, then the unspecific pattern will be selected. Finally, some comments on the relationship between dermoscopy and dermatopathology are given briefly. It is always useful to imagine dermatopathological features when examining a dermoscopic image. There are considerable relations between dermoscopy and dermatopathology.     

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。     

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。     

A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face

Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.     

Dermoscopy of skin lesions in two patients with xeroderma pigmentosum

BACKGROUND: Xeroderma pigmentosum (XP) is a rare disorder produced by a genetic defect in the repair of DNA damage caused by ultraviolet radiation. The early diagnosis of malignant skin tumours is crucial in the survival of patients with XP, but this is not easy even for experienced dermatologists due to the presence of a high number of actinic lesions. Dermoscopy is a new diagnostic method that increases the diagnostic accuracy for skin tumours. OBJECTIVES: To describe the clinical and dermoscopic features of different benign and malignant lesions [focusing on malignant melanoma, basal cell carcinoma (BCC) and benign melanocytic naevi] in two patients with XP. METHODS: Three dermatologists with experience in pigmented skin lesions and dermoscopy examined two siblings with XP over a period of 54 months. Diagnosis of skin tumours was obtained using clinical examination and dermoscopy with 10-fold magnification and digital images. All the tumours with criteria of malignancy were excised for further histopathological analyses. RESULTS: Multiple skin tumours showing some degree of pigmentation were detected in the patients. Clinical and dermoscopic examination allowed the discrimination of four melanomas (three of them in situ), 26 BCCs and five dysplastic naevi from other pigmented skin lesions. The features and parameters previously described for dermoscopy were shown to be appropriate for the recognition of tumours in our patients with XP. Generalized actinic lentigos were distinguished from BCCs by the presence of a delicate brown pigmented network. Fine vessels from poikiloderma were differentiated from the arborizing telangiectasia of BCC. CONCLUSIONS: The dermoscopic findings in the tumours were similar to those previously described in patients not affected by XP. Diagnosis by dermoscopic pattern analyses allowed a correct classification of malignant tumours in these cases.     

Clinical selection of melanocytic lesions for dermoscopy decreases the identification of suspicious lesions in comparison with dermoscopy without clinical preselection

BACKGROUND: In most cases dermoscopy is performed only on lesions selected by clinical inspection which present worrying clinical features or appear to deviate from the patient's average type of naevus. Thus, possible early malignant melanomas (MMs) or MM precursors, lacking typical clinical characteristics, may elude the dermoscopic examination. OBJECTIVES: To perform a comparison between two different approaches to the patient's examination, one based on a clinical preselection of lesions to be examined by dermoscopy, and the other consisting of the dermoscopic scrutiny of all melanocytic lesions with a diameter>or=2 mm (total dermoscopy). METHODS: Sixty-three consecutive patients with MM, undergoing periodic dermoscopic examinations of their naevi, were enrolled in the study. The patients first underwent an assessment of the entire skin with the unaided eye for the identification of lesions for dermoscopy. Subsequently, the patients underwent dermoscopic examination of all melanocytic lesions. Images of naevi identified by clinical examination or by total dermoscopy as having dermoscopic aspects characteristic of a suspicious lesion, i.e. necessitating either surgical excision or follow-up examinations, were separately recorded, classified and described employing the ABCD rule of dermoscopy and the seven-point checklist. RESULTS: Five hundred and fifty-one lesions were chosen by clinical inspection for subsequent dermoscopic examination; among these, 117 were considered for excision or follow-up. Ninety-two further lesions were identified for excision or follow-up by employing only total dermoscopy. Dermoscopy scores of lesions selected by clinical inspection plus dermoscopy were similar to those identified by dermoscopy alone. In the former group, 13 lesions showed either an ABCD or a seven-point score corresponding to a suspicious lesion, whereas eight such lesions were identified only by total dermoscopy. Thus, by clinical selection plus dermoscopy we were able to identify only 62% of dermoscopically suspicious lesions. CONCLUSIONS: Clinical selection of melanocytic lesions for dermoscopic examination is associated with the 'loss' of a conspicuous number of lesions which deserve surgical excision or follow-up examinations. Total dermoscopy, enabling the detection of suspicious lesions, together with storage, retrieval and sequential comparison of their images, could enhance MM diagnosis by follow-up, in comparison with clinical preselection for dermoscopy.