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。

Application of the reflectance confocal microscopy in the diagnosis and follow-up of multiple basal cell carcinoma

Objective: To investigate the image features of multiple basal cell carcinoma (BCC) under reflectance confocal microscopy (RCM), and further assess the application value of RCM in the diagnosis and follow-up of multiple BCC. Methods: Among 6 patients (64 lesions) clinically diagnosed as BCC, 62 lesions were diagnosed as BCC by RCM. Of 62 lesions, 39 were taken surgical treatment and histopathologic examination, 23 were treated with 5% imiquimod cream. 62 lesions were re-assessed by RCM during follow-up. The RCM image characteristics of BCC were summarized. Results: The histological features of 39 lesions treated with excision were in accordance with BCC and the coincidence rate of diagnosis was 100％. No RCM evidence of BCC was identified at 3-month and 6-month follow-up. Of 23 lesions treated with 5% imiquimod cream,  there were RCM evidence of BCC in 12 lesions, 8 lesions and 4 lesions respectively at 3-month, 6-month and 12-month follow-up. The RCM characteristics of 62 lesions were keratinocyte atypia (96.8%), tumor islands (96.8%), cords connected to the epidermis (90.3%), bright particles inside and around tumor island (77.4%), peripheral palisading (51.6%), peri-tumoral clefting (54.8%), increased vascularization (95.2%), dendritic cells inside tumor islands (77.4%). Conclusion: There are characteristic RCM features of BCC, and RCM play an important role in follow-up diagnosis.