“双病灶”：哪一个是恶性的？反射式共聚焦显微镜改善临床诊断
"Twin lesions": Which one is the bad one? Improvement of clinical diagnosis with reflectance confocal microscopy.
作者信息
Saral Secil, Hartmann Daniela, Letulè Valerie, Ruzicka Thomas, Ruini Cristel, von Braunmühl Tanja
机构信息
Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Department of Dermatology and Venereology, Ankara University, Ankara, Turkey.
Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany.
出版信息
Dermatol Pract Concept. 2017 Jan 31;7(1):11-17. doi: 10.5826/dpc.0701a02. eCollection 2017 Jan.
BACKGROUND
In vivo reflectance confocal microscopy (RCM) is a novel non-invasive diagnostic tool, which is used to differentiate skin lesions. Even in lesions with similar dermatoscopic images, RCM may improve diagnostic accuracy.
METHODS
Three sets of false "twin lesions" with similar macroscopic and dermatoscopic images are matched. All lesions are evaluated with RCM and lesions are excised for further evaluation. Corresponding features in confocal images, dermatoscopy and histopathology are discussed.
RESULTS
In all matched pairs, one of the lesions was diagnosed as melanoma with the observation of melanoma findings such as: epidermal disarray, pagetoid cells in epidermis and cellular atypia at the junction. Benign lesions were differentiated easily with RCM imaging.
CONCLUSION
Examining dermatoscopically difficult and/or similar lesions with RCM facilitates diagnostic and therapeutic decision making. Using RCM in daily practice may contribute to a decrease in unnecessary excisions.
背景
体内反射式共聚焦显微镜（RCM）是一种新型的非侵入性诊断工具，用于鉴别皮肤病变。即使在皮肤镜图像相似的病变中，RCM也可能提高诊断准确性。
方法
匹配三组具有相似宏观和皮肤镜图像的假“孪生病变”。所有病变均采用RCM进行评估，并切除病变以进行进一步评估。讨论了共聚焦图像、皮肤镜检查和组织病理学中的相应特征。
结果
在所有匹配的病变对中，通过观察黑色素瘤的表现，如表皮紊乱、表皮中的派杰样细胞和交界处的细胞异型性，其中一个病变被诊断为黑色素瘤。良性病变通过RCM成像很容易鉴别。
结论
用RCM检查皮肤镜检查困难和/或相似的病变有助于诊断和治疗决策。在日常实践中使用RCM可能有助于减少不必要的切除。
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