Cinotti E, Couzan C, Perrot J L, Habougit C, Labeille B, Cambazard F, Moscarella E, Kyrgidis A, Argenziano G, Pellacani G, Longo C
Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France.
Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France.
J Eur Acad Dermatol Venereol. 2015 Dec;29(12):2458-62. doi: 10.1111/jdv.13394. Epub 2015 Sep 25.
Melanosis is the most common cause of mucosal pigmentation and can be clinically difficult to differentiate from early melanoma (MM). Dermoscopy can help in the distinction between melanosis and MM, but in some instances, melanoses may exhibit overlapping features with MM such as the presence of grey colour.
We sought to evaluate whether reflectance confocal microscopy (RCM) can help to better understand the dermoscopic features of melanoses in order to assist clinicians in their diagnosis.
All melanoses diagnosed between June 2011 and December 2014 in the Departments of Dermatology of the University of Saint-Etienne (France) and of Modena and Reggio Emilia (Italy), for which dermoscopic and RCM images were available, were included. Twenty-two lesions were biopsied to confirm the clinical diagnosis, whereas the others did not present any change at a follow-up of at least 6 months. The correlation between dermoscopic and RCM features were evaluated by the Spearman's rho correlation coefficient.
55 melanoses were studied: 31 of the oral mucosa and 24 of the genital mucosa. 49% (n = 27) of melanoses exhibited a grey colour under dermoscopy. The grey colour correlated with the presence of melanophages under RCM (ρ = 0.424, P = 0.002).
Our findings highlight that the presence of the grey colour on dermoscopy, considered as an alerting feature, is common in melanoses and it is related to the presence of melanin-laden inflammatory cells in the papillary dermis on RCM. When it is present as a 'pure' feature not associated to other colours than brown or to atypical dermoscopical structures, it could be related to the diagnosis of melanosis.
黑变病是黏膜色素沉着最常见的原因，临床上可能难以与早期黑色素瘤（MM）相鉴别。皮肤镜检查有助于区分黑变病和MM，但在某些情况下，黑变病可能表现出与MM重叠的特征，如出现灰色。
我们试图评估反射式共聚焦显微镜（RCM）是否有助于更好地理解黑变病的皮肤镜特征，以协助临床医生进行诊断。
纳入2011年6月至2014年12月在法国圣艾蒂安大学和意大利摩德纳及雷焦艾米利亚大学皮肤科诊断的所有黑变病病例，这些病例均有皮肤镜和RCM图像。22个病变进行了活检以确诊临床诊断，而其他病变在至少6个月的随访中未出现任何变化。通过Spearman等级相关系数评估皮肤镜和RCM特征之间的相关性。
共研究了55例黑变病：口腔黏膜31例，生殖器黏膜24例。49%（n = 27）的黑变病在皮肤镜检查下呈现灰色。灰色与RCM下噬黑素细胞的存在相关（ρ = 0.424，P = 0.002）。
我们的研究结果表明，皮肤镜检查中出现的灰色作为一个警示特征，在黑变病中很常见，并且与RCM下乳头真皮层中含黑色素的炎症细胞的存在有关。当它作为一种“纯粹”的特征出现，不与棕色以外的其他颜色或非典型皮肤镜结构相关时，可能与黑变病的诊断有关。
