Guitera-Rovel P, Vestergaard M-E
The Sydney Melanoma Diagnostic Centre and Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australie.
Ann Dermatol Venereol. 2008 Dec;135(12):828-34. doi: 10.1016/j.annder.2008.10.002. Epub 2008 Nov 25.
A number of new tools have been developed in the last ten years to improve the diagnosis of cutaneous melanoma.
To review the value of diagnostic tools for cutaneous melanoma in a clinical setting.
Review of multiple databases from 1987 to 2007 and classification of publications in terms of level of evidence according to "The Australian Cancer Network".
Dermoscopy has superior specificity and sensitivity to naked-eye examination according to a meta-analysis of nine level-2 studies. Sequential digital dermoscopic imaging allowed detection of melanoma in the absence of dermoscopic evidence of melanoma in four level-2 studies. Total body photography, generally performed for high-risk patients, seems to be equally valuable but has the additional advantage of allowing self-examination by patients themselves. Dermographic photographs with computer-assisted diagnosis of primary melanoma appear to have equivalent diagnostic capacity to experts but very few studies have been performed in a clinical setting. Optical methods still under development yield in vivo information that is closely correlated with histopathology data and may avoid unnecessary excision while providing improved control of excision margins. They will doubtless be used as a second-line method after clinical detection of suspect lesions and history-taking, which will continue to be primordial regardless of the other tools available.
在过去十年中，已开发出多种新工具以改善皮肤黑色素瘤的诊断。
在临床环境中评估皮肤黑色素瘤诊断工具的价值。
检索1987年至2007年的多个数据库，并根据“澳大利亚癌症网络”对出版物按证据水平进行分类。
根据对9项二级研究的荟萃分析，皮肤镜检查对肉眼检查具有更高的特异性和敏感性。在4项二级研究中，连续数字皮肤镜成像能够在没有皮肤镜下黑色素瘤证据的情况下检测到黑色素瘤。全身摄影通常用于高危患者，似乎同样有价值，而且还有患者可自行检查的额外优势。具有计算机辅助诊断原发性黑色素瘤功能的皮肤照片似乎与专家具有同等的诊断能力，但在临床环境中进行的研究很少。仍在开发中的光学方法可提供与组织病理学数据密切相关的体内信息，可能避免不必要的切除，同时更好地控制切除边缘。在临床检测到可疑病变并进行病史采集后，无论是否有其他可用工具，病史采集无疑仍将是首要的，光学方法无疑将用作二线方法。
