黑素细胞痣的长期皮肤镜随访：临床结果与患者依从性

Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance.

作者信息

Schiffner R, Schiffner-Rohe J, Landthaler M, Stolz W

机构信息

Clinic of Dermatology and Allergology, Hospital Munich Schwabing, 80804, Munich, Germany.

出版信息

Br J Dermatol. 2003 Jul;149(1):79-86. doi: 10.1046/j.1365-2133.2003.05409.x.

DOI:10.1046/j.1365-2133.2003.05409.x

PMID:12890198

Abstract

BACKGROUND

Digital dermoscopy for the follow-up of melanocytic naevi (MN) is becoming more common in dermatological private practice.

OBJECTIVES

To evaluate the clinical outcome, including the patient's compliance, in a long-term follow-up of single MN.

METHODS

Criteria for the selection of MN for follow-up: clinically suspicious without dermoscopically atypical features, or typical for the patient. Clinical outcome measures: number of detected malignant melanomas (MM) and/or atypical MN; quantity, quality, and differences in morphological changes between 'low-risk' patients (no MM in history and < 50 MN) and 'high-risk' patients (MM in history and/or > 50 MN). Compliance: the number of patients who joined a recommended follow-up scheme.

RESULTS

No MM was found in 145 consecutive patients (mean age 28 years, 54% female) during a 4-year period (median follow-up per patient: 24 months; ranging 4-45; at least three visits). In five patients (3%), seven histologically proven atypical MN were shown on whole body examination at sites other than those documented. A total of 1968 images in 177 'low-risk' and 95 'high-risk' MN were analysed: 37% (n = 65) of 'low-risk' and 32% (n = 30) of 'high-risk' MN showed dermoscopic changes (difference not statistically significant), none were suspicious for MM. Compliance, evaluated within a separate database of 303 consecutive patients (mean age 32 years, 52% female) over a 6-month period, was only 46%, although recall letters were used.

CONCLUSIONS

(i) In our setting of daily routines in dermatological private practices long-term follow-up of a single MN seems not to be helpful for the detection of MM. (ii) A whole body examination must be done at each visit. (iii) The clinician's experience of the type and number of possible morphological changes in MN is crucial in order to avoid unnecessary excisions. (iv) The patient's compliance might be an important problem. (v) Cost-effectiveness has yet to be analysed.

摘要

背景

在皮肤科私人诊所中，利用数字皮肤镜对黑素细胞痣（MN）进行随访正变得越来越普遍。

目的

在对单个MN的长期随访中评估临床结果，包括患者的依从性。

方法

选择MN进行随访的标准：临床上可疑但皮肤镜检查无非典型特征，或对患者来说是典型的。临床结果指标：检测到的恶性黑色素瘤（MM）和/或非典型MN的数量；“低风险”患者（既往无MM且MN＜50个）和“高风险”患者（既往有MM和/或MN＞50个）之间形态学变化的数量、质量及差异。依从性：加入推荐随访方案的患者数量。

结果

在4年期间（每位患者的中位随访时间：24个月；范围4 - 45个月；至少3次就诊），145例连续患者（平均年龄28岁，54%为女性）未发现MM。5例患者（3%）在全身检查时，在记录部位以外的其他部位发现7个经组织学证实的非典型MN。共分析了177个“低风险”MN和95个“高风险”MN的1968张图像：37%（n = 65）的“低风险”MN和32%（n = 30）的“高风险”MN出现皮肤镜变化（差异无统计学意义），均无MM可疑表现。在一个单独数据库中，对303例连续患者（平均年龄32岁，52%为女性）进行6个月的评估，尽管使用了召回信，但依从性仅为46%。