Division of Medical Oncology - Preventive Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, Italy.
Department of Dermatology, University of Vienna, Vienna, Austria.
Br J Dermatol. 2015 Jul;173(1):106-14. doi: 10.1111/bjd.13861. Epub 2015 Jun 2.
Nodular melanoma (NM), representing 10-30% of all melanomas, plays a major role in global mortality related to melanoma. Nonetheless, the literature on dermoscopy of NM is scanty.
To assess odds ratios (ORs) to quantify dermoscopic features of pigmented NM vs. pigmented superficial spreading melanoma (SSM), and pigmented nodular nonmelanocytic and benign melanocytic lesions.
To assess the presence or absence of global patterns and dermoscopic criteria, digitized images of 457 pigmented skin lesions from patients with a histopathological diagnosis of NM (n = 75), SSM (n = 93), and nodular nonmelanocytic and benign melanocytic lesions (n = 289; namely, 39 basal cell carcinomas, 85 seborrhoeic keratoses, 81 blue naevi, and 84 compound/dermal naevi) were retrospectively collected and blindly evaluated by three observers.
Multivariate analysis showed that ulceration (OR 4.07), homogeneous disorganized pattern (OR 10.76), and homogeneous blue pigmented structureless areas (OR 2.37) were significantly independent prognostic factors for NM vs. SSM. Multivariate analysis of dermoscopic features of NM vs. nonmelanocytic and benign melanocytic lesions showed that the positive correlating features leading to a significantly increased risk of NM were asymmetric pigmentation (OR 6.70), blue-black pigmented areas (OR 7.15), homogeneous disorganized pattern (OR 9.62), a combination of polymorphous vessels and milky-red globules/areas (OR 23.65), and polymorphous vessels combined with homogeneous red areas (OR 33.88).
Dermoscopy may be helpful in improving the recognition of pigmented NM by revealing asymmetric pigmentation, blue-black pigmented areas, homogeneous disorganized pattern and abnormal vascular structures, including polymorphous vessels, milky-red globules/areas and homogeneous red areas.
结节性黑素瘤（NM）占所有黑素瘤的 10-30%，是导致全球黑素瘤相关死亡率的主要原因。然而，关于 NM 的皮肤镜检查的文献却很少。
评估比值比（OR）来量化 NM 与色素性浅表扩散性黑素瘤（SSM）、色素性结节性非黑素细胞性和良性黑素细胞性病变的皮肤镜特征。
为了评估全局模式和皮肤镜标准的存在或缺失，回顾性地收集了 457 个有组织病理学诊断为 NM（n=75）、SSM（n=93）和结节性非黑素细胞性和良性黑素细胞性病变（n=289；即 39 个基底细胞癌、85 个脂溢性角化病、81 个蓝色痣和 84 个复合/真皮痣）的患者的数字化图像，并由三位观察者进行盲法评估。
多变量分析显示，溃疡（OR 4.07）、均匀杂乱模式（OR 10.76）和均匀蓝色色素无结构区域（OR 2.37）是 NM 与 SSM 相比的显著独立预后因素。NM 与非黑素细胞性和良性黑素细胞性病变的皮肤镜特征的多变量分析显示，导致 NM 风险显著增加的正相关特征是不对称色素沉着（OR 6.70）、蓝黑色色素沉着区（OR 7.15）、均匀杂乱模式（OR 9.62）、多形血管与乳白色红色球/区的组合（OR 23.65）和多形血管与均匀红色区的组合（OR 33.88）。
皮肤镜检查可能有助于通过揭示不对称性色素沉着、蓝黑色色素沉着区、均匀杂乱模式和异常血管结构（包括多形血管、乳白色红色球/区和均匀红色区）来提高对色素性 NM 的识别。
