Pellacani Giovanni, Longo Caterina, Malvehy Josep, Puig Susana, Carrera Cristina, Segura Sonia, Bassoli Sara, Seidenari Stefania
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
Arch Dermatol. 2008 Dec;144(12):1597-608. doi: 10.1001/archderm.144.12.1597.
To identify in vivo microscopic substrates of the dermoscopic patterns of melanocytic lesions and to correlate them with histopathologic features.
Before excision, lesion areas that showed characteristic dermoscopic patterns were imaged by dermoscopy and confocal microscopy and directly correlated with histopathologic features.
Departments of Dermatology of the University of Modena and Reggio Emilia and Hospital Clínico of Barcelona, between July 2006 and March 2007. Patients Patients with 202 melanocytic lesions, corresponding to 76 melanomas, 114 nevi, and 12 Spitz or Reed nevi.
Correlation of dermoscopic patterns in melanocytic lesions with confocal microscopic findings and conventional histopathologic findings.
Characteristic architectural and cytologic substrates were identified in vivo with the use of confocal microscopy and correlated with histopathologic features. Pigment network atypia was evidenced through confocal microscopy as a disarrangement of dermoepidermal junction architecture and cellular atypia. Pigmented globules consisted of cell clusters, corresponding to melanocytic nests identified on histopathologic analysis. Black dots correlated with intraepidermal reflective spots or with large pagetoid cells in nevi and melanoma, respectively. Blue structures usually consisted of numerous pleomorphic cells, corresponding to malignant melanocytes and inflammatory cells in melanomas, whereas plump bright cells, corresponding to melanophages on histopathologic analysis, characterized benign lesions. Within regression, a retiform distribution of collagen fibers, which sometimes intermingled with melanophages and rarely with nucleated cells, was observable.
The knowledge of the cytologic and architectural aspects of the different dermoscopic patterns, as they appear by in vivo confocal microscopy, may guide the user to the identification of specific substrates in melanocytic lesions and consequently the interpretation of the dermoscopic features.
识别黑素细胞性皮损皮肤镜模式的体内微观基质，并将其与组织病理学特征相关联。
在切除前，对显示特征性皮肤镜模式的皮损区域进行皮肤镜和共聚焦显微镜成像，并直接与组织病理学特征相关联。
2006年7月至2007年3月期间，摩德纳大学和雷焦艾米利亚大学皮肤科以及巴塞罗那临床医院。患者202例黑素细胞性皮损患者，包括76例黑色素瘤、114例痣以及12例Spitz痣或Reed痣。
黑素细胞性皮损的皮肤镜模式与共聚焦显微镜检查结果及传统组织病理学检查结果的相关性。
通过共聚焦显微镜在体内识别出特征性的结构和细胞学基质，并与组织病理学特征相关联。色素网异型性通过共聚焦显微镜显示为真皮表皮交界处结构紊乱和细胞异型性。色素小球由细胞簇组成，对应于组织病理学分析中识别出的黑素细胞巢。黑点分别与痣和黑色素瘤中的表皮内反射点或大的派杰样细胞相关。蓝色结构通常由大量多形性细胞组成，对应于黑色素瘤中的恶性黑素细胞和炎性细胞，而丰满明亮的细胞，在组织病理学分析中对应于噬黑素细胞，是良性皮损的特征。在消退区域内，可观察到胶原纤维呈网状分布，有时与噬黑素细胞混合，很少与有核细胞混合。
通过体内共聚焦显微镜观察到的不同皮肤镜模式的细胞学和结构方面的知识，可能会指导使用者识别黑素细胞性皮损中的特定基质，从而解读皮肤镜特征。
