Rezze Gisele Gargantini, Scramim Ana Paula, Neves Rogério Izar, Landman Gilles
Department of Cutaneous Oncology of Hospital do Câncer A. C. Camargo São Paulo, Brazil.
Am J Dermatopathol. 2006 Feb;28(1):13-20. doi: 10.1097/01.dad.0000181545.89077.8c.
Interpretation of dermoscopic features of cutaneous melanoma is based on histologic description of perpendicular sections of the lesions that does not reflect the overview achieved by epiluminescence. We describe the utilization of transverse sections as a tool to define the histopathology of features that are the dermoscopic hallmarks of cutaneous melanoma. From a collection of 23 pigmented lesions with the dermoscopic diagnosis of cutaneous melanoma submitted for surgical excision we selected, from each specimen, one dermoscopic feature (black dots and globules, brown dots, blues dots and globules, depigmentation, broadened network, radial streams or pseudopods) that was sampled with a 4-mm punch (specimen) to obtain perpendicular and transverse sections. Using this strategy, it was possible to correlate the histopathology of all features that are often used as criteria for diagnostic dermoscopy. The black dots were pigmented neoplastic cells at the dermal-epidermal junction (DEJ) and within the epidermis in heavily pigmented columns. Similar findings were seen in brown dots, however there was slightly less pigment. No statistical difference was observed between brown dots and black dots regarding size, area and number of atypical cellnests. Blue dots correlated to melanophages, surrounding the superficial vascular plexus. Depigmentation was characterized by intense fibrosis of the papillary dermis. The pigmented network showed atypical pigmented or non-pigmented melanocytes at the DEJ and epidermis as well as heavily pigmented keratinocytes in the basal cell layer. The radial streaming and pseudopods had neoplastic cells in nests, a stratified growth pattern arranged in centrifugal linear extensions, resembling a arborescent branching. The results represented herein, are an important tool for understanding histopathological alterations responsible for dermoscopic features and for improving the efficacy of this diagnostic method.
皮肤黑色素瘤的皮肤镜特征解读基于病变垂直切片的组织学描述，而这并不能反映表皮透光所获得的整体情况。我们描述了利用横切面作为一种工具来界定那些作为皮肤黑色素瘤皮肤镜特征的组织病理学特征。从23例经皮肤镜诊断为皮肤黑色素瘤并接受手术切除的色素性病变样本中，我们从每个标本中选取一种皮肤镜特征（黑点和小球、棕色点、蓝点和小球、色素脱失、增宽的网状结构、放射状条纹或伪足），用4毫米打孔器取样（标本）以获得垂直和横切面。采用这种方法，有可能将所有常被用作诊断性皮肤镜标准的特征的组织病理学联系起来。黑点是位于真皮 - 表皮交界处（DEJ）以及表皮内色素沉着严重的柱状结构中的色素性肿瘤细胞。棕色点也有类似发现，但色素略少。棕色点和黑点在非典型细胞巢的大小、面积和数量方面未观察到统计学差异。蓝点与围绕浅表血管丛的噬黑素细胞相关。色素脱失的特征是乳头真皮层的强烈纤维化。色素性网状结构在DEJ和表皮处显示非典型色素性或非色素性黑素细胞，以及基底细胞层中色素沉着严重的角质形成细胞。放射状条纹和伪足有巢状肿瘤细胞，呈分层生长模式，排列成离心线性延伸，类似树枝状分支。本文呈现的结果是理解导致皮肤镜特征的组织病理学改变以及提高这种诊断方法效能的重要工具。
