Université François Rabelais, Tours, France.
Br J Dermatol. 2010 Sep;163(3):550-6. doi: 10.1111/j.1365-2133.2010.09903.x. Epub 2010 Jul 26.
Metastases of cutaneous melanoma may simulate benign blue naevi clinically.
To investigate the value of ultrasonography in the differential diagnosis of lesions that look similar clinically, i.e. blue naevi and cutaneous metastases of melanoma.
Participants were invited for inclusion in the study if they had a cutaneous blue lesion clinically suggestive of a blue naevus or cutaneous metastasis of melanoma. After obtaining signed consent, the lesion was photographed and studied using dermoscopy and high-resolution ultrasonography before being removed for histological examination. Clinical, dermoscopic and ultrasonographic images were reviewed anonymously by four dermatologists to assign the diagnosis of blue naevus or metastasis of melanoma. The diagnostic performance of clinical examination, dermoscopy and sonography was assessed for the ability of each to differentiate between metastases of melanoma and blue naevi with reference to the histological diagnosis. Moreover, experts undertook a semeiological description of each ultrasonographic image according to seven items: location of the lesion, echogenicity, homogeneity, shape of the lesion, definition of margins, posterior acoustic shadow and increased posterior echogenicity.
Twenty-eight patients were included with a total of 39 blue skin lesions, and 17 of the 28 patients had a previous history of melanoma. Interobserver agreement in the semeiological description of the sonographic images was good (κ≥0·6) for five of seven items. Sonography was more specific (94%) than clinical examination (77%) and dermoscopy (74%). The sonographic features contributing to the differential diagnosis were: location of the lesion (P=0·027), shape of the lesion (P<0·001), homogeneity (P=0·001) and increased posterior echogenicity (P=0·007).
Ultrasonography is a reproducible and specific tool that can assist the differential diagnosis between blue naevi and metastases of melanoma. A blue naevus is a homogeneous, hypoechoic, 'dish-shaped' lesion, located in the superficial dermis, whereas metastases of melanoma are 'potato-shaped', hypoechoic, heterogeneous lesions, located in the hypodermis.
皮肤黑色素瘤转移可能在临床上模拟为良性蓝色痣。
探讨超声在鉴别临床上相似的病变（即蓝色痣和皮肤黑色素瘤转移）中的价值。
邀请临床疑似蓝色痣或皮肤黑色素瘤转移的患者参加本研究。在获得书面同意后，对病变进行拍照，并使用皮肤镜和高分辨率超声进行研究，然后切除进行组织学检查。四位皮肤科医生匿名回顾临床、皮肤镜和超声图像，以分配蓝色痣或黑色素瘤转移的诊断。评估临床检查、皮肤镜和超声检查区分黑色素瘤转移和蓝色痣的能力，以组织学诊断为参考。此外，专家根据七个项目对每个超声图像进行半定量描述：病变位置、回声、均匀性、病变形状、边缘定义、后方声影和后方回声增强。
共纳入 28 例患者，共 39 个蓝色皮肤病变，其中 28 例患者中有 17 例有黑色素瘤病史。对超声图像半定量描述的观察者间一致性在五个项目中为良好（κ≥0.6）。超声比临床检查（77%）和皮肤镜（74%）更具特异性。有助于鉴别诊断的超声特征包括：病变位置（P=0.027）、病变形状（P<0.001）、均匀性（P=0.001）和后方回声增强（P=0.007）。
超声是一种可重复使用的特异性工具，可辅助蓝色痣和黑色素瘤转移之间的鉴别诊断。蓝色痣是一种均匀、低回声、“盘状”病变，位于真皮浅层，而黑色素瘤转移是“土豆状”、低回声、不均匀病变，位于皮下组织。
