Feit N E, Dusza S W, Marghoob A A
Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 160 East 53rd St, New York, NY 10022, USA.
Br J Dermatol. 2004 Apr;150(4):706-14. doi: 10.1111/j.0007-0963.2004.05892.x.
Early detection of melanoma results in excision of thinner melanomas, which are associated with better prognosis. Total cutaneous photography provides a temporal comparison of lesions, which allows clinicians and patients to recognize new and subtly changing lesions.
We examined the utility of total cutaneous photography in detecting melanoma, identified the reason for biopsy of suspicious lesions and determined who detected new melanomas, the physician on follow-up examination or the patient on self-examination.
PATIENTS/METHODS: The charts of the 576 patients in the total cutaneous photography database were reviewed. Twelve patients were identified who had melanoma diagnosed with photographic assistance. Baseline and prebiopsy photographs, dermatology clinic notes (115 patient visits) and pathology reports for each biopsied lesion were reviewed. Histological diagnosis, cause for biopsy, and whether the lesion was detected by the patient or physician, was recorded for each of the biopsied lesions. Also noted were all the lesions that concerned patients, the cause for concern, and whether these lesions were biopsied.
A total of 93 lesions were biopsied in these patients. Twenty-seven (35%) of 77 melanocytic lesions were histologically diagnosed as melanoma. The thickest melanoma found measured 1.1 mm, indicating a favourable prognosis in our patients. Seventy-four per cent of the melanomas were biopsied due to changes from baseline and 19% were biopsied because they were new lesions. The changes noted were subtle and the lesions that proved to be melanoma did not satisfy the classical clinical criteria for melanoma. Eight (30%) of the melanomas were identified by patients on skin self-examination. Twenty-six per cent of the lesions that concerned patients were not biopsied after evaluation by a physician.
We found that photographically assisted follow-up helped detect new and subtly changing melanomas, which did not satisfy the classical clinical features of melanoma. In addition, photographically assisted follow-up helped detect nonmelanoma skin cancers. Patient skin self-examination proved to be valuable, in that it complemented physician follow-up examination in detecting melanomas. Photographic follow-up was also valuable in avoiding unnecessary biopsy in suspicious, but stable lesions. Total cutaneous photography therefore may be an effective way to increase the sensitivity and specificity for detecting melanoma.
黑色素瘤的早期检测可实现更薄黑色素瘤的切除，而更薄的黑色素瘤预后更佳。全身皮肤摄影可对皮损进行时间上的对比，这有助于临床医生和患者识别新出现的以及有细微变化的皮损。
我们研究了全身皮肤摄影在检测黑色素瘤方面的效用，确定了对可疑皮损进行活检的原因，并确定是谁发现了新的黑色素瘤，是随访检查的医生还是自我检查的患者。
患者/方法：回顾了全身皮肤摄影数据库中576例患者的病历。确定了12例在摄影辅助下诊断为黑色素瘤的患者。查阅了每个活检皮损的基线照片和活检前照片、皮肤科门诊记录（115次患者就诊记录）以及病理报告。记录每个活检皮损的组织学诊断、活检原因以及皮损是由患者还是医生发现的。还记录了所有引起患者关注的皮损、关注原因以及这些皮损是否进行了活检。
这些患者共进行了93次皮损活检。77个黑素细胞性皮损中有27个（35%）经组织学诊断为黑色素瘤。发现的最厚的黑色素瘤为1.1毫米，表明我们的患者预后良好。74%的黑色素瘤因与基线相比有变化而进行活检，19%因是新出现的皮损而进行活检。所观察到的变化很细微，被证实为黑色素瘤的皮损并不符合黑色素瘤的经典临床标准。8例（30%）黑色素瘤是患者在皮肤自我检查时发现的。26%引起患者关注的皮损在医生评估后未进行活检。
我们发现摄影辅助随访有助于发现新的以及有细微变化的黑色素瘤，这些黑色素瘤并不符合黑色素瘤的经典临床特征。此外，摄影辅助随访有助于发现非黑色素瘤皮肤癌。患者的皮肤自我检查被证明是有价值的，因为它在发现黑色素瘤方面补充了医生的随访检查。摄影随访在避免对可疑但稳定的皮损进行不必要的活检方面也很有价值。因此，全身皮肤摄影可能是提高黑色素瘤检测敏感性和特异性的有效方法。
