Gerger A, Hofmann-Wellenhof R, Samonigg H, Smolle J
Division of Oncology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
Br J Dermatol. 2009 Mar;160(3):475-81. doi: 10.1111/j.1365-2133.2008.08995.x. Epub 2009 Jan 10.
Melanoma of the skin represents one of the greatest challenges in early or preventive detection. Whereas surgical excision in early stages of melanoma development is almost always curative, delayed recognition puts the patient at risk for destructive growth and death from disease once the tumour has progressed to competence for metastasis. The worldwide introduction of dermoscopy has led to improved diagnostic accuracy for melanocytic skin tumours. Whereas dermoscopy has probably reached the method's inherent potential diagnostic accuracy because of the lack of cellular level evaluation, further improvements could be expected by in vivo confocal laser scanning microscopy. In vivo confocal microscopy represents a novel imaging tool that allows the noninvasive examination of skin cancer morphology in real time at a 'quasihistopathological' resolution viewing microanatomical structures and individual cells. Numerous morphological confocal features of melanocytic skin tumours have been described and histopathological correlates of confocal structures have been previously elucidated. Recently, several studies have evaluated the diagnostic accuracy of in vivo confocal microscopy for melanocytic skin tumours, investigating approximately 50,000 tumour images. Remarkably, sensitivity superior to the diagnostic accuracy achieved with dermoscopy could be reached by this imaging modality. These studies represent a significant contribution to the body of research necessary for the evaluation and implementation of in vivo confocal microscopy in clinical practice to avoid many currently unnecessary biopsies. In vivo confocal microscopy probably augurs a sea change in the way we evaluate melanocytic skin tumours in the future and will ultimately move the art of histological diagnosis closer to the bedside.
皮肤黑色素瘤是早期或预防性检测中最大的挑战之一。虽然黑色素瘤发展早期的手术切除几乎总能治愈，但一旦肿瘤发展到具有转移能力，延迟诊断会使患者面临疾病破坏性生长和死亡的风险。皮肤镜在全球范围内的应用提高了黑素细胞性皮肤肿瘤的诊断准确性。由于缺乏细胞水平的评估，皮肤镜可能已达到该方法固有的潜在诊断准确性，而体内共聚焦激光扫描显微镜有望带来进一步的改进。体内共聚焦显微镜是一种新型成像工具，能够以“准组织病理学”分辨率实时无创检查皮肤癌形态，观察微观解剖结构和单个细胞。黑素细胞性皮肤肿瘤的许多形态学共聚焦特征已被描述，共聚焦结构的组织病理学相关性也已得到阐明。最近，几项研究评估了体内共聚焦显微镜对黑素细胞性皮肤肿瘤的诊断准确性，研究了约50000张肿瘤图像。值得注意的是，这种成像方式能够达到优于皮肤镜诊断准确性的灵敏度。这些研究对评估和实施体内共聚焦显微镜在临床实践中的应用所需的研究做出了重大贡献，以避免许多目前不必要的活检。体内共聚焦显微镜可能预示着我们未来评估黑素细胞性皮肤肿瘤方式的巨大变革，并最终使组织学诊断技术更接近床边诊断。
