结节性黑素瘤的皮肤镜评估。

Dermoscopic evaluation of nodular melanoma.

机构信息

Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.

出版信息

JAMA Dermatol. 2013 Jun;149(6):699-709. doi: 10.1001/jamadermatol.2013.2466.

DOI:10.1001/jamadermatol.2013.2466

PMID:23553375

Abstract

IMPORTANCE

Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical.

OBJECTIVE

To determine the dermoscopy features of NM.

DESIGN

Eighty-three cases of NM, 134 of invasive non-NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/hypomelanotic or pigmented to assess outcomes.

SETTING

Predominantly hospital-based clinics from 5 continents.

MAIN OUTCOME MEASURES

Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma.

RESULTS

Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, blue-white veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (>98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/hypomelanotic NM (84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM.

CONCLUSIONS AND RELEVANCE

When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.

摘要

重要性

结节性黑色素瘤 (NM) 是一种快速进展、具有潜在致命性的皮肤肿瘤，早期诊断至关重要。

目的

确定 NM 的皮肤镜特征。

设计

使用改良和先前描述的方法对 83 例 NM、134 例侵袭性非 NM、115 例结节性良性黑色素细胞瘤和 135 例结节性非黑色素细胞瘤进行皮肤镜特征评分。将病变分为无色素/低色素或色素沉着，以评估结果。

地点

来自五大洲的主要基于医院的诊所。

主要观察指标

用于诊断黑色素瘤的特征/模型的敏感性、特异性和优势比。

结果

与侵袭性非 NM（7.5%）相比，无色素/低色素的 NM 更为常见（37.3%）。与侵袭性非 NM 相比（按优势比降序排列），色素性 NM 更常出现（5.8% 比 0.8%）对称色素模式、大直径血管、均匀蓝色色素区域、对称形状、主要外围血管、蓝白面纱、粉红色、黑色和乳白色/粉红色区域。色素性 NM 较少显示不典型扩大的网络、色素网络或伪网络、多个蓝灰色点、瘢痕样脱色素、不规则分布和大小的棕色斑点和颗粒、棕褐色、不规则形状的脱色素、以及任何颜色的不规则分布和大小的斑点和颗粒。与结节性非黑色素瘤相比，色素性 NM 最重要的正相关特征是外围黑色斑点/颗粒、多个棕色斑点、不规则黑色斑点/颗粒、蓝白面纱、均匀蓝色色素沉着、5 至 6 种颜色和黑色。一种将病变分类为黑色素瘤的模型对结节性色素性和非结节性色素性黑色素瘤具有很高的敏感性（>98.0%），但对无色素/低色素的 NM 敏感性较低（84%）。一种诊断无色素/低色素恶性病变（包括基底细胞癌）的方法对 NM 的敏感性为 93%，特异性为 70%。