Segura Sonia, Puig Susana, Carrera Cristina, Palou Josep, Malvehy Josep
Department of Dermatology, Hospital del Mar, Barcelona, Passeig Marítim 25-29, Barcelona 08003, Spain.
J Am Acad Dermatol. 2009 Aug;61(2):216-29. doi: 10.1016/j.jaad.2009.02.014. Epub 2009 Apr 29.
Reflectance confocal microscopy (RCM) has been shown to improve accuracy in the differentiation of nevus from melanoma, but only a few studies have evaluated both melanocytic lesions (ML) and non-ML.
We sought to develop an algorithm for the in vivo diagnosis of skin tumors by RCM.
In 143 patients we evaluated 154 skin tumors (100 melanocytic, 54 nonmelanocytic) by RCM before their excision. We analyzed RCM features on stored images and performed univariate and multivariate analyses to determine the association of RCM features with tumor types.
Four confocal features differentiated ML from non-ML: cobblestone pattern of epidermal layers, pagetoid spread, mesh appearance of the dermoepidermal junction, and the presence of dermal nests. Within ML, the presence of roundish suprabasal cells and atypical nucleated cells in the dermis was associated with melanoma, and the presence of edged papillae and typical basal cells was associated with nevi. Based on the correlation of RCM features with dermatoscopy and histology, we developed a two-step algorithm for the diagnosis of skin tumors by RCM.
This is a preliminary study, and the results must be validated in further studies with a larger number of cases.
RCM appears to be helpful in improving the presurgical diagnosis of difficult skin tumors.
反射式共聚焦显微镜（RCM）已被证明可提高痣与黑色素瘤鉴别的准确性，但仅有少数研究对黑素细胞性病变（ML）和非黑素细胞性病变均进行了评估。
我们试图开发一种通过RCM对皮肤肿瘤进行活体诊断的算法。
我们在143例患者切除皮肤肿瘤前，通过RCM对154个皮肤肿瘤（100个黑素细胞性、54个非黑素细胞性）进行了评估。我们分析了存储图像上的RCM特征，并进行单变量和多变量分析以确定RCM特征与肿瘤类型的相关性。
四个共聚焦特征可区分ML与非ML：表皮层的鹅卵石样模式、派杰样扩散、真皮表皮交界处的网格外观以及真皮巢的存在。在ML中，真皮内圆形的基底层上细胞和非典型有核细胞的存在与黑色素瘤相关，边缘乳头和典型基底细胞的存在与痣相关。基于RCM特征与皮肤镜检查和组织学的相关性，我们开发了一种通过RCM诊断皮肤肿瘤的两步算法。
这是一项初步研究，结果必须在更多病例的进一步研究中得到验证。
RCM似乎有助于改善疑难皮肤肿瘤的术前诊断。
