Carli Paolo, Mannone Francesca, De Giorgi Vincenzo, Nardini Paolo, Chiarugi Alessandra, Giannotti Benvenuto
Department of Dermatology, University of Florence, Florence, Italy.
Melanoma Res. 2003 Apr;13(2):179-82. doi: 10.1097/00008390-200304000-00011.
The predictive value of melanoma diagnosis made by visual examination during pigmented lesion screening is low. This creates the problem of false-positive diagnoses, which lead to unnecessary treatment and scarring. The purpose of this study was to evaluate the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) on the false-positive rate in the routine melanoma screening activity of a pigmented lesion clinic (PLC). In a series of 133 subjects consecutively referred to the PLC, lesions defined as suspicious or equivocal on visual examination were examined by dermoscopy. Only lesions also defined as suspicious on dermoscopy were excised; other lesions were observed at follow-up examinations. Among the 2542 pigmented lesions observed, clinical examination led to identification of 43 suspicious lesions, 13 of which were also suspicious on dermoscopy and were subsequently excised. Histopathological examination revealed three malignant melanomas. Compared with visual examination alone, the addition of dermoscopy to the subgroup of clinically equivocal lesions resulted in an increase in specificity from 98.4% to 99.6% and in positive predictive value from 6.9% to 23%. The specificity of the visit outcome 'subject to be referred for surgical excision' increased from 69.2% to 92.3%. No false-negative melanoma diagnoses on dermoscopy were observed during a follow-up period of 4 years. The addition of dermoscopy to routine PLC activity as a second-level examination led to a reduction in the number of false-positive diagnoses, thus producing an overall increase in the specificity and positive predictive value of melanoma diagnosis.
在色素沉着病变筛查中，通过视觉检查进行黑色素瘤诊断的预测价值较低。这就产生了假阳性诊断的问题，会导致不必要的治疗和瘢痕形成。本研究的目的是评估皮肤镜检查（落射荧光显微镜检查、皮肤镜检查）对色素沉着病变诊所（PLC）常规黑色素瘤筛查活动中假阳性率的影响。在连续转诊至PLC的133名受试者中，对视觉检查定义为可疑或不明确的病变进行了皮肤镜检查。仅对皮肤镜检查也定义为可疑的病变进行切除；其他病变在随访检查中观察。在观察的2542个色素沉着病变中，临床检查发现43个可疑病变，其中13个在皮肤镜检查中也可疑，随后进行了切除。组织病理学检查发现3例恶性黑色素瘤。与仅进行视觉检查相比，对临床不明确病变亚组增加皮肤镜检查后，特异性从98.4%提高到99.6%，阳性预测值从6.9%提高到23%。“需转诊进行手术切除”的就诊结果特异性从69.2%提高到92.3%。在4年的随访期内，未观察到皮肤镜检查出现假阴性黑色素瘤诊断。在PLC常规活动中增加皮肤镜检查作为二级检查可减少假阳性诊断的数量，从而总体提高黑色素瘤诊断的特异性和阳性预测值。
