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。     

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...     

基底细胞癌的皮肤镜图像轮廓特征分析

目的研究分析色素型基底细胞癌和其他色素性皮损的轮廓规则性特征。方法选取30例色素型基底细胞癌和50例其他色素性皮损患者的皮肤镜图像,应用计算机图像处理方法分别对皮损轮廓的曲率分布、矩形度和偏心度特征进行研究分析。结果 83.30%的色素型基底细胞癌病例轮廓曲率标准差大于0.001,而100%的其他色素性皮损的轮廓曲率标准差均小于0.001,差异有统计学意义(P0.05);统计涉及的80例色素性皮损病例,色素性皮损的矩形度平均值(0.637 5)明显小于色素型基底细胞癌(0.881 6),差异有统计学意义(P0.05);体现偏心度的半径方差、半径极差和半径变异系数平均值分别为3 235.80、207.264、24.149和158.435、65.704、7.232,差异均有统计学意义(P均0.05)。结论基于皮肤镜图像,色素型基底细胞癌和其他色素性皮损的轮廓规则性特征存在显著差异,可为临床鉴别诊断提供参考依据。     

皮肤镜在脂溢性角化、日光性角化和基底细胞癌诊断中的应用

目的:探讨皮肤镜在脂溢性角化、日光性角化及基底细胞癌中的诊断价值。方法:收集临床上拟诊为脂溢性角化(108例)、日光性角化(46例)和基底细胞癌(71例)的病例,以病理学检查为“金标准”,研究皮肤镜诊断三种疾病的敏感性、特异度及一致性。结果:与病理诊断比较:①A、B两位医生使用皮肤镜诊断脂溢性角化的一致率分别为93.52%、93.52%,灵敏度为94.67%、93.33%,特异度为90.91%、93.94%,误诊率为9.09%、6.06%,漏诊率为5.33%、6.67%,Youden指数为85.58%、87.27%,Kappa值为0.8484、0.8511。②A、B两位医生使用皮肤镜诊断日光性角化的一致率分别为89.13%、89.13%,灵敏度为88.89%、85.19%,特异度为89.47%、94.74%,误诊率为10.53%、5.26%,漏诊率为11.11%、14.81%,Youden指数为78.36%、79.93%,Kappa值为0.7776、0.7809。③A、B两位医生使用皮肤镜诊断基底细胞癌的一致率分别为91.55%、91.55%,灵敏度为89.74%、92.31%,特异度为93.75%、90.63%,误诊率为6.25%、9.37%,漏诊率为10.26%、7.69%,Youden指数为83.49%、74.84%,Kappa值为0.8304、0.8293。结论:皮肤镜诊断脂溢性角化、日光性角化和基底细胞癌灵敏度、特异度均较好,值得临床推广应用。     

反射式共聚焦显微镜联合皮肤镜对黑素细胞痣的诊断价值评估

目的 评估皮肤镜与反射式共聚焦显微镜(RCM)单独或联合对黑素细胞痣的诊断价值.方法 收集临床拟诊黑素细胞痣的患者37例,对皮损先进行皮肤镜、RCM检查,再经组织病理学检查确诊.总结黑素细胞痣的影像学特征,计算不同检查诊断黑素细胞痣的敏感度、特异度、阳性预测值、阴性预测值、正确率,分析皮肤影像技术与组织病理学诊断的一致性.结果 皮肤镜和RCM检查结果示真皮内痣细胞的形态结构可分为两种:(a)真皮乳头层不融合、高折光、圆形的痣细胞,皮肤镜下表现为褐色或浅褐色均质模式,见于5处皮损;(b)真皮乳头内不规则、高折光的痣细胞团块,皮肤镜表现为鹅卵石模式或球状模式,见于31处皮损.在诊断黑素细胞痣方面,RCM结合皮肤镜的敏感度、特异度、正确率、阳性预测值、阴性预测值分别为91.7％、87.5％ 、90.9％ 、97.1％ 、70％,RCM为86.1％ 、75％ 、84％ 、93.9％ 、54.5％,皮肤镜为77.8％ 、87.5％ 、75％ 、96.3％ 、41.2％.除特异度与皮肤镜相同外,RCM结合皮肤镜的其他指标均高于二者单独应用;RCM敏感度、正确率、阴性预测值高于皮肤镜,特异度、阳性预测值低于皮肤镜.RCM结合皮肤镜或单用RCM与组织病理诊断结果之间差异无统计学意义(x2值分别为0.25、0.57,P值分别为0.63、0.45),Kappa值分别为0.72、0.53;皮肤镜与病理诊断结果之间差异有统计学意义(x2=5.81,P=0.012).结论 RCM联合皮肤镜较二者单独使用能更准确地诊断黑素细胞痣.     

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。     

儿童色素减退型线状苔藓反射式共聚焦显微镜图像特征分析

目的 分析儿童色素减退型线状苔藓皮肤反射式共聚焦显微镜(RCM)影像学特征.方法 RCM检查11例临床诊断为色素减退型线状苔藓的患儿皮损及皮损附近正常皮肤,再与该处皮损组织病理学检查进行对比.结果 色素减退型线状苔藓皮损组织病理学检查显示,表皮细胞间或细胞内轻度水肿,伴不同程度棘层增厚,基底细胞灶性液化变性,真皮浅层血管周围较多淋巴细胞及少数噬黑素细胞浸润.RCM水平扫描皮损显示,多灶性基底细胞液化变性,导致表真皮界面模糊,色素环不完整或不清晰,真皮乳头及真皮浅层较多高折光的噬黑素细胞及中、低折光的炎症细胞浸润.结论 RCM影像学特征可为儿童色素减退型线状苔藓的诊断及鉴别诊断提供有力依据.     

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。     

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。     

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。     

皮肤镜诊断面部光线性角化病的初步研究

目的 评价皮肤镜在面部光线性角化病诊断中的价值.方法 面部疑似光线性角化病患者40例,其中男27例,女13例;年龄46～88岁;病程2～20年.分别对其行皮肤镜检查及组织病理学检查;以病理诊断为"金标准",通过诊断性试验的研究方法,研究皮肤镜诊断面部非色素性光线性角化病的敏感性、特异性及一致性.结果 与病理诊断比较,两位医生皮肤镜诊断面部非色素性光线性角化病的灵敏度、特异度、Youden指数及Kappa值分别为90.91%、88.89%、79.80%、0.798(χ2=0.25,P>0.05)和86.36%、94.44%、80.80%、0.800(χ2=0.25,P>0.05).结论 皮肤镜检查对面部非色素性光线性角化病诊断与病理组织检查结果存在较好的一致性.     

皮肤镜在尖锐湿疣诊断中的价值评估

目的 探讨皮肤镜在男性生殖器部位尖锐湿疣诊断中的应用价值.方法 对66例男性生殖器部位临床疑似尖锐湿疣的122个疣体,由临床经验丰富的皮肤科医师根据皮损形态特征结合临床病史进行临床诊断,然后采用皮肤镜进行诊断,并与组织病理检查结果比较.结果 122个疑似疣体中,采用肉眼观察确诊100个为尖锐湿疣,皮肤镜检查确诊112个,病理检查确诊114个.以病理检查为金标准,皮肤镜检查的灵敏度是97.4％,特异度是87.5％;肉眼观察的灵敏度是87.7％,特异度是100％.在皮肤镜下男性生殖器部位尖锐湿疣颜色主要呈粉红色(98/114,86.0％),形态以乳头状多见(98/114,86.0％),有明显的血管特征(107/114,93.9％),其中多形血管(102/114,89.5％)和点状血管(98/114,86.0％)多见.结论 皮肤镜下尖锐湿疣疣体具有特征性结构,皮肤镜能够用于男性生殖器尖锐湿疣诊断.     

Correlation between dermoscopic and histopathological diagnoses of atypical nevi in a dermatology outpatient clinic of the Medical School of S?o José do Rio Preto,SP, Brazil

BACKGROUND

The incidence of cutaneous melanoma is increasing worldwide. Since it is an aggressive neoplasm, it is difficult to treat in advanced stages; early diagnosis is important to heal the patient. Melanocytic nevi are benign pigmented skin lesions while atypical nevi are associated with the risk of developing melanoma because they have a different histological pattern than common nevi. Thus, the clinical diagnosis of pigmented lesions is of great importance to differentiate benign, atypical and malignant lesions. Dermoscopy appeared as an auxiliary test in vivo, playing an important role in the diagnosis of pigmented lesions, because it allows the visualization of structures located below the stratum corneum. It shows a new morphological dimension of these lesions to the dermatologist and allows greater diagnostic accuracy. However, histopathology is considered the gold standard for the diagnosis.

OBJECTIVES

To establish the sensitivity and specificity of dermoscopy in the diagnosis of pigmented lesions suspected of malignancy (atypical nevi), comparing both the dermatoscopic with the histopathological diagnosis, at the Dermatology Service of the outpatient clinic of Hospital de Base, São José do Rio Preto, SP.

METHODS

Analysis of melanocytic nevi by dermoscopy and subsequent biopsy on suspicion of atypia or if the patient so desires, for subsequent histopathological diagnosis.

RESULTS

Sensitivity: 93%. Specificity: 42%.

CONCLUSIONS

Dermoscopy is a highly sensitive method for the diagnosis of atypical melanocytic nevi. Despite the low specificity with many false positive diagnoses, the method is effective for scanning lesions with suspected features of malignancy.     

Dermoscopic diagnosis by a trained clinician vs. a clinician with minimal dermoscopy training vs. computer-aided diagnosis of 341 pigmented skin lesions: a comparative study

BACKGROUND: In the last few years digital dermoscopy has been introduced as an additional tool to improve the clinical diagnosis of pigmented skin lesions. OBJECTIVE: To evaluate the validity of digital dermoscopy by comparing the diagnoses of a dermatologist experienced in dermoscopy (5 years of experience) with those of a clinician with minimal training in this field, and then comparing these results with those obtained using computer-aided diagnoses. METHODS: Three hundred and forty-one pigmented melanocytic and non-melanocytic skin lesions were included. All lesions were surgically excised and histopathologically examined. Digital dermoscopic images of all lesions were framed and analysed using software based on a trained artificial neural network. Cohen's kappa statistic was calculated to assess the validity with regard to the correct diagnoses of melanoma and non-melanoma. RESULTS: Sensitivity was high for the experienced dermatologist and the computer (92%) and lower for the inexperienced clinician (69%). Specificity of the diagnosis by the experienced dermatologist was higher (99%) than that of the inexperienced clinician (94%) and the computer assessment (74%). Notably, computer analysis gave a higher number of false positives (26%) compared with the experienced dermatologist (0.6%) and the inexperienced clinician (5.5%). CONCLUSIONS: Our results indicate that analysis either by a trained dermatologist or an artificial neural network-trained computer can improve the diagnostic accuracy of melanoma compared with that of an inexperienced clinician and that the computer diagnosis might represent a useful tool for the screening of melanoma, particularly at centres not experienced in dermoscopy.     

Diagnostic accuracy of dermoscopy for 934 basal cell carcinomas: A single-center retrospective study

Although the efficacy of dermoscopic diagnosis of basal cell carcinoma (BCC) has already been established, most studies have been conducted in Western countries. However, there are racial differences in the clinicopathological characteristics of BCC, highlighting the need for a survey among Asians. Herein, we aimed to investigate the diagnostic accuracy of dermoscopy in 934 Japanese patients with BCC and statistically analyze the clinicopathological factors affecting diagnostic accuracy. We analyzed 5093 skin lesions, including 934 BCCs that were diagnosed consecutively from 1998 to 2018. The sensitivity and specificity of dermoscopic diagnosis for BCC were calculated. The sensitivity and specificity of dermoscopic diagnosis were 92.2% and 96.0%, respectively. There were 73 false-negative cases of BCCs that were clinically diagnosed with other diseases. The most common incorrect clinical diagnosis was seborrheic keratosis (n = 18), followed by melanocytic nevus (n = 15). Multiple logistic regression analysis showed that sensitivity was significantly lower in BCCs located on the trunk and extremities, which showed low pigmentation (less than 10% of the lesion surface) and were diagnosed by a resident dermatologist. Experience of 3–6 months of 12 resident dermatologists revealed increased sensitivity. Dermoscopy is a reliable tool for the accurate diagnosis of BCC in Japanese individuals. Care should be taken when diagnosing BCCs of the trunk and extremities, and the less-pigmented subtype because of lower sensitivity. A certain amount of experience is required to improve the skills for dermoscopy.     

Surface microscopy of pigmented basal cell carcinoma

OBJECTIVES: To describe the relevant morphologic features and to create a simple diagnostic method for pigmented basal cell carcinoma (BCC) using in vivo cutaneous surface microscopy (ie, dermoscopy, dermatoscopy, or oil epiluminescence microscopy). DESIGN: Pigmented skin lesions were photographed in vivo using immersion oil (surface microscopy). All pigmented skin lesions were excised and reviewed for histological diagnosis. Photographs of 142 pigmented BCCs, 142 invasive melanomas, and 142 benign pigmented skin lesions were randomly divided into 2 equally sized training and test sets. Images from the training set were scored for 45 surface microscopy features. From this a model was derived and tested on the independent test set. SETTING: All patients were recruited from the primary case and referral centers of the Sydney Melanoma Unit, Sydney, Australia, and the Skin and Cancer Unit, Skin and Cancer Associates, Plantation, Fla. PATIENTS: A random sample (selected from a larger database) of patients whose lesions were excised. MAIN OUTCOME MEASURES: Sensitivity and specificity of the model for diagnosis of pigmented BCCs. RESULTS: The following model was created. For a pigmented BCC to be diagnosed it must not have the negative feature of a pigment network and must have 1 or more of the following 6 positive features: large gray-blue ovoid nests, multiple gray-blue globules, maple leaflike areas, spoke wheel areas, ulceration, and arborizing "treelike" telangiectasia. On an independent test set the model had a sensitivity of 97% for the diagnosis of pigmented BCCs and a specificity of 93% for the invasive melanoma set and 92% for the benign pigmented skin lesion set. CONCLUSION: A robust surface microscopy method is described that allows the diagnosis of pigmented BCCs from invasive melanomas and benign pigmented skin lesions. Arch Dermatol. 2000;136:1012-1016     

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.     

丘疹结节型色素性基底细胞癌的电子皮镜所见

目的　探讨丘疹结节型色素性基底细胞癌的电子皮镜所见及其在临床诊断中的意义。方法　利用电子皮镜观察丘疹结节型色素性基底细胞癌 6例 8个病灶 ,术后做组织病理确认。结果　丘疹结节型色素性基底细胞癌在电子皮镜下所见具有特征性 ,术后病理均诊断为基底细胞癌。结论　电子皮镜检查可以为丘疹结节型色素性基底细胞癌的诊断及鉴别诊断提供依据 ,具有重要意义。     

Suspected skin malignancy: a comparison of diagnoses of family practitioners and dermatologists in 493 patients

BACKGROUND: In the Irish health system, dermatology patients present to their family practitioner for diagnosis and treatment, and are referred to a dermatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably. AIM: To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer. METHODS: Four hundred and ninety-three patients were seen by one of two dermatologists over a 1-year period at a rapid referral clinic for patients suspected by their family practitioners of having unstable or possibly malignant skin lesions; 213 of these patients had a diagnosis made on clinical examination by the dermatologist, while 264 had diagnostic or therapeutic biopsies performed; 16 patients defaulted on surgery. RESULTS: The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Thirty-eight patients had histologically proven skin malignancy. These were diagnosed accurately by the referring family practitioner in 22% of patients, while the dermatologists made the correct diagnosis prior to biopsy in 87%. CONCLUSIONS: In over 50% of cases diagnosed clinically, the dermatologist and family practitioner agreed. Histologically proven skin cancers were diagnosed accurately in only 22% of cases by family practitioners, compared to 87% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic keratoses, squamous cell carcinoma, and melanoma. Postgraduate education for family practitioners should be directed towards these areas of deficiency. Dermatologists had difficulty distinguishing pigmented actinic keratoses from melanoma.