Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Br J Dermatol. 2015 Jul;173(1):31-41. doi: 10.1111/bjd.13689. Epub 2015 Apr 27.
Reflectance confocal microscopy (RCM) is a noninvasive tool that can be helpful in the diagnosis of nonpigmented skin tumours. As RCM enables visualization of architectural and cytological structures at near-histological resolution, it can improve the diagnostic accuracy of dermoscopically equivocal solitary pink neoplasms. For management decisions, it is important to identify specific morphological clues that allow bedside classification of nonpigmented skin neoplasms into benign vs. malignant and melanocytic vs. nonmelanocytic. More specifically, the presence of a nested melanocytic proliferation at the dermoepidermal junction or dermis level permits the clinician to ascribe a given lesion as melanocytic; the identification of basaloid bright tumour islands is a key RCM feature for the diagnosis of basal cell carcinoma; and the presence of disarrayed epidermis along with small demarcated papillae is suggestive for the diagnosis of squamous cell carcinoma. The present review offers a comprehensive description of the main RCM diagnostic clues for solitary pink neoplasms that direct clinicians to the correct diagnosis and that may serve as groundwork for future prospective studies.
反射式共聚焦显微镜（RCM）是一种非侵入性工具，可有助于诊断非色素性皮肤肿瘤。由于 RCM 能够以接近组织学的分辨率可视化结构和细胞学结构，因此可以提高皮肤科不确定的单一粉红色肿瘤的诊断准确性。对于管理决策，重要的是要确定特定的形态学线索，以便能够在床边将非色素性皮肤肿瘤分类为良性与恶性、黑素细胞性与非黑素细胞性。更具体地说，在表皮与真皮交界处或真皮水平存在巢状黑素细胞增生，可使临床医生将特定病变归因于黑素细胞性；基底样明亮肿瘤岛的识别是基底细胞癌诊断的关键 RCM 特征；以及排列紊乱的表皮和小界限分明的乳头的存在提示鳞状细胞癌的诊断。本综述全面描述了指导临床医生进行正确诊断的单一粉红色肿瘤的主要 RCM 诊断线索，并可能为未来的前瞻性研究奠定基础。
