Barnhill R L, Roush G C
Dermatopathology Division, Massachusetts Hospital, Boston, MA.
Cancer. 1991 Jun 15;67(12):3157-64. doi: 10.1002/1097-0142(19910615)67:12<3157::aid-cncr2820671237>3.0.co;2-6.
To define better the evolving entity of dysplastic melanocytic nevus (DMN), studies correlating clinical with histologic features of DMN are essential. However, based on a literature search, no previous quantitative analysis was found of the relationship between gross morphologic features and histologic features of DMN. The authors correlated individual clinical features with histopathologic features and histologic diagnosis of the clinically most atypical nevus in 153 melanoma patients. This nevus was identified, evaluated clinically, and removed for histologic evaluation from each patient. Gross morphologic features assessed for nevi included: size (in mm), the presence of a macular component, irregular border, ill-defined border, haphazard coloration, distortion of skin cleavage lines on tangential lighting, asymmetry, and number of colors present (12 features in all). Nineteen histologic features were assessed in each nevus by a single dermatopathologist. These included architectural, nuclear, and cytoplasmic parameters ascribed to dysplastic nevi. Each of these histologic features was correlated with the 12 individual clinical features. Seventeen percent of the nevi fulfilled the criteria for the histologic diagnosis of DMN. Among individual nevus parameters, size (in mm), irregular border, ill-defined border, macular component, and pink color were associated significantly with histologic DMN. Nevus size (in mm) and irregular borders correlated with the greatest number of individual histologic parameters. A comparison of clinicopathologic correlations for two different examiners revealed that certain clinical features are probably more important than others for the recognition of dysplastic nevi and that individual examiners have different thresholds for the perception of some gross morphologic features. These observations are relevant to the development of clinical criteria for dysplastic nevi.
为了更准确地定义发育异常性黑素细胞痣（DMN）这一不断演变的实体，将DMN的临床特征与组织学特征相关联的研究至关重要。然而，通过文献检索发现，之前尚未有对DMN大体形态学特征与组织学特征之间关系的定量分析。作者将153例黑色素瘤患者临床上最不典型痣的个体临床特征与组织病理学特征及组织学诊断进行了关联。从每位患者身上识别出该痣，进行临床评估，然后切除用于组织学评估。对痣评估的大体形态学特征包括：大小（以毫米为单位）、斑片状成分的存在、边界不规则、边界不清、颜色杂乱、切线照明下皮肤纹理的扭曲、不对称以及颜色数量（共12项特征）。由一名皮肤病理学家对每个痣评估19项组织学特征。这些特征包括归因于发育异常痣的结构、核和细胞质参数。将这些组织学特征中的每一项与12项个体临床特征进行关联。17%的痣符合DMN的组织学诊断标准。在个体痣参数中，大小（以毫米为单位）、边界不规则、边界不清、斑片状成分和粉色与组织学上的DMN显著相关。痣的大小（以毫米为单位）和边界不规则与最多的个体组织学参数相关。对两位不同检查者的临床病理相关性比较显示，对于发育异常痣的识别，某些临床特征可能比其他特征更重要，并且个体检查者对某些大体形态学特征的感知阈值不同。这些观察结果与发育异常痣临床标准的制定相关。
