Malvehy Josep, Puig Susana, Argenziano Giuseppe, Marghoob Ashfaq A, Soyer H Peter
Dermatology Department, Melanoma Unit, Hospital Clinic, Barcelona, Spain.
J Am Acad Dermatol. 2007 Jul;57(1):84-95. doi: 10.1016/j.jaad.2006.02.051. Epub 2007 May 4.
Dermoscopy can assist clinicians in the evaluation and diagnosis of skin tumors. Since dermoscopy is becoming widely accepted and used in the medical community, there is now the need for a standardized method for documenting dermoscopic findings so as to be able to effectively communicate such information among colleagues.
Toward this end, the International Dermoscopy Society embarked on creating a consensus document for the standardization and recommended criteria necessary to be able to effectively convey dermoscopic findings to consulting physicians and colleagues.
The Dermoscopy Report Steering Committee created an extensive list of dermoscopic criteria obtained from an exhaustive search of the literature. A preliminary document listing all the dermoscopic criteria that could potentially be included in a standardized dermoscopy report was elaborated and presented to the members of the International Dermoscopy Society Board in two meetings of the Society and subsequently discussed via Internet communications between members and the Steering Committee.
A consensus document including 10 points categorized as either recommended or optional and a template of the dermoscopy report were obtained. The final items included in the document are as follows: (1) patient's age, relevant history pertaining to the lesion, pertinent personal and family history (recommended); (2) clinical description of the lesion (recommended); (3) the two-step method of dermoscopy differentiating melanocytic from nonmelanocytic tumors (recommended); (4) the use of standardized terms to describe structures as defined by the Dermoscopy Consensus Report published in 2003. For new terms it would be helpful to provide a working definition (recommended); (5) the dermoscopic algorithm used should be mentioned (optional); (6) information on the imaging equipment and magnification (recommended); (7) clinical and dermoscopic images of the tumor (recommended); (8) a diagnosis or differential diagnosis (recommended); (9) decision concerning the management (recommended); (10) specific comments for the pathologist when excision and histopathologic examination are recommended (optional).
The limitations of this study are those that are intrinsic of a consensus document obtained from critical review of the literature and discussion by opinion leaders in the field.
Although it may be acceptable for a consulting physician to only state the dermoscopic diagnosis, the proposed standardized reporting system, if accepted and utilized, will make it easier for consultants to communicate with each other more effectively.
皮肤镜检查可协助临床医生评估和诊断皮肤肿瘤。由于皮肤镜检查在医学界正被广泛接受和使用,现在需要一种标准化方法来记录皮肤镜检查结果,以便能够在同事之间有效地交流此类信息。
为此,国际皮肤镜检查协会着手制定一份共识文件,以确定将皮肤镜检查结果有效传达给会诊医生和同事所需的标准化和推荐标准。
皮肤镜检查报告指导委员会通过对文献的详尽检索,制定了一份广泛的皮肤镜检查标准清单。一份初步文件列出了可能纳入标准化皮肤镜检查报告的所有皮肤镜检查标准,并在协会的两次会议上提交给国际皮肤镜检查协会理事会成员,随后通过成员与指导委员会之间的互联网通信进行了讨论。
获得了一份包括10项内容的共识文件,分为推荐项或可选项,并形成了皮肤镜检查报告模板。文件中最终纳入的项目如下:(1)患者年龄、与病变相关的病史、相关个人和家族史(推荐);(2)病变的临床描述(推荐);(3)区分黑素细胞性肿瘤和非黑素细胞性肿瘤的皮肤镜检查两步法(推荐);(4)使用标准化术语描述2003年发表的《皮肤镜检查共识报告》所定义的结构。对于新术语,提供一个实用定义会有所帮助(推荐);(5)应提及所使用的皮肤镜检查算法(可选项);(6)有关成像设备和放大倍数的信息(推荐);(7)肿瘤的临床和皮肤镜检查图像(推荐);(8)诊断或鉴别诊断(推荐);(9)关于治疗的决定(推荐);(10)当建议进行切除和组织病理学检查时,给病理学家的具体说明(可选项)。
本研究的局限性在于从对文献的批判性综述以及该领域意见领袖的讨论中获得的共识文件所固有的局限性。
虽然会诊医生仅陈述皮肤镜检查诊断可能是可以接受的,但如果所提议的标准化报告系统被接受并采用,将使会诊医生之间更有效地相互沟通变得更加容易。