Maher Nigel G, Solinas Annalisa, Scolyer Richard A, Guitera Pascale
The Melanoma Institute Australia, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.
Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jan;123(1):84-94. doi: 10.1016/j.oooo.2016.08.011. Epub 2016 Aug 24.
To improve prebiopsy diagnostic accuracy and surgical management of pigmented appearing lesions on the lips, particularly melanoma, using in vivo reflectance confocal microscopy (RCM).
Prospective case series over a 12-month period between 2015 and 2016. The setting was two specialist dermatology referral centers with expertise in confocal microscopy. The study population was a consecutive sample of patients with pigmentation of the lip for which the cause was uncertain clinically, whose differential diagnosis included melanoma, and who had undergone both in vivo RCM and subsequent biopsy. The outcome measures were RCM features, dermoscopy features, and histopathological diagnosis. Results were reported by descriptive analysis and correlations made between RCM features and histopathology.
Eight patients were recruited for the study. In vivo RCM facilitated the targeting of small biopsies to identify two in situ oral melanoma recurrences and successfully mapped an in situ oral melanoma before wide excision. Suprabasal dendritic pagetoid cells and epidermal disarray on RCM were useful indicators for in situ melanoma of the lip. Previously described dermoscopy features for mucosal melanoma were not very helpful in diagnosing melanoma in our series. Challenges included evaluating inflamed lesions with pigment incontinence.
RCM can assist in the diagnosis and management of pigmented lip lesions, but additional studies are required to further evaluate these initial observations.
利用活体反射式共聚焦显微镜（RCM）提高唇部色素沉着性病变（尤其是黑色素瘤）活检前的诊断准确性及手术管理水平。
2015年至2016年为期12个月的前瞻性病例系列研究。研究地点为两个具备共聚焦显微镜专业知识的皮肤科专科转诊中心。研究对象为唇部色素沉着且临床病因不明、鉴别诊断包括黑色素瘤、并接受了活体RCM检查及后续活检的连续样本患者。观察指标为RCM特征、皮肤镜特征及组织病理学诊断。结果通过描述性分析报告，并对RCM特征与组织病理学进行相关性分析。
8名患者纳入本研究。活体RCM有助于对小活检进行靶向定位，以识别2例原位口腔黑色素瘤复发，并在广泛切除前成功绘制出1例原位口腔黑色素瘤。RCM上的基底上层树突状佩吉特样细胞和表皮紊乱是唇部原位黑色素瘤的有用指标。在我们的系列研究中，先前描述的黏膜黑色素瘤的皮肤镜特征对黑色素瘤的诊断帮助不大。挑战包括评估伴有色素失禁的炎症性病变。
RCM可协助诊断和管理唇部色素沉着性病变，但需要进一步研究以进一步评估这些初步观察结果。
