Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
Pathology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
Br J Dermatol. 2016 Mar;174(3):610-6. doi: 10.1111/bjd.14286. Epub 2015 Dec 26.
Differentiating Spitz naevi from melanomas can be difficult both clinically and dermoscopically. Previous studies have reported the potential role of in vivo reflectance confocal microscopy (RCM) in increasing diagnostic accuracy.
To define RCM criteria that can differentiate 'false twins', namely Spitz naevi and melanomas sharing similar dermoscopic appearance.
Lesions histopathologically diagnosed as Spitz naevi or melanomas were retrospectively retrieved. They were selected to cover all dermoscopic types and were put into couples sharing similar aspects. Lesions were classified into three main dermoscopic categories: globular and starburst pattern, spitzoid with dotted vessels, and multicomponent or aspecific pattern.
RCM findings revealed that striking cell pleomorphism within the epidermis, widespread atypical cells at the dermoepidermal junction and marked pleomorphism within nests were significantly associated with the diagnosis of melanoma, while spindled cells and peripheral clefting were found exclusively with and pathognomonic of Spitz naevi. Furthermore, the analysis of a dermoscopic subgroup highlights the importance of striking pleomorphism and spindled cells as clues to differentiate 'false twins' with globular or starburst patterns.
The current study highlights the role of RCM in discriminating 'false twins' of Spitz naevi and melanomas for lesions showing starburst and globular patterns on dermoscopy, whereas RCM is not useful in the other dermoscopic subgroups.
Spitz 痣和黑色素瘤在临床和皮肤镜下都很难区分。先前的研究报告了体内反射共聚焦显微镜（RCM）在提高诊断准确性方面的潜在作用。
确定 RCM 标准，以区分“假性双胞胎”，即具有相似皮肤镜表现的 Spitz 痣和黑色素瘤。
回顾性检索组织病理学诊断为 Spitz 痣或黑色素瘤的病变。选择它们以涵盖所有皮肤镜类型，并将它们分为具有相似方面的夫妇。病变分为三个主要皮肤镜类别：球形和星爆模式、点状血管的 Spitz 样、多成分或非特异性模式。
RCM 结果显示，表皮内明显的细胞多形性、表皮下不典型细胞广泛存在以及巢内明显的多形性与黑色素瘤的诊断显著相关，而梭形细胞和周围裂则仅存在于 Spitz 痣中，具有特征性。此外，对皮肤镜亚组的分析强调了明显的多形性和梭形细胞作为区分具有球形或星爆模式的“假性双胞胎”的线索的重要性。
本研究强调了 RCM 在区分具有皮肤镜下星爆和球形模式的 Spitz 痣和黑色素瘤“假性双胞胎”中的作用，而 RCM 在其他皮肤镜亚组中没有用处。
