Laimer Martin, Arzberger Edith, Kirchner Clara-Anna, Prodinger Christine, Hofmann-Wellenhof Rainer, Ahlgrimm-Siess Verena
*Department of Dermatology, Paracelsus Medical University of Salzburg, Salzburg, Austria; †Department of Dermatology, Medical University of Graz, Graz, Austria, Europe.
Dermatol Surg. 2017 Jul;43(7):911-919. doi: 10.1097/DSS.0000000000001110.
Differentiation of melanotic macules from melanocytic lesions, most importantly of melanoma, is a common problem on clinical-dermoscopic examination.
To assess the value of noninvasive reflectance confocal microscopy (RCM) in the differential diagnosis of melanotic macules and melanocytic lesions.
Reflectance confocal microscopy images of 42 pigmented macules on mucocutaneous junctions of genitalia and lips, including 31 melanotic macules, 6 nevi, and 5 melanomas, were retrospectively and independently assessed in a blinded manner by one expert observer and 2 less experienced observers together.
The authors differentiated 3 subtypes of melanotic macules; 2 subtypes ("solar lentigo type" and regular subtype of "dendritic type" melanotic macules) could be classified with confidence as benign by all RCM investigators, comprising 64% of melanotic macules. The third subtype (irregular subtype of "dendritic type" melanotic macules; 36%) displaying RCM features overlapping with melanoma was difficult to differentiate and should be biopsied not to miss a melanoma. The RCM differentiation between melanotic macules and nevi was easily performed.
RCM has the potential to increase the diagnostic accuracy in the noninvasive differentiation of pigmented macules on mucocutaneous junctions.
在临床皮肤镜检查中，区分黑素性斑疹与黑素细胞性病变，尤其是与黑色素瘤的区分，是一个常见问题。
评估无创反射式共聚焦显微镜（RCM）在黑素性斑疹和黑素细胞性病变鉴别诊断中的价值。
对42例位于生殖器和唇部黏膜皮肤交界处的色素沉着斑的反射式共聚焦显微镜图像进行回顾性分析，这些病例包括31例黑素性斑疹、6例痣和5例黑色素瘤，由一名专家观察者和2名经验较少的观察者共同以盲法独立评估。
作者区分出黑素性斑疹的3种亚型；所有RCM研究者均可自信地将2种亚型（“日光性雀斑样型”和“树枝状型”黑素性斑疹的规则亚型）归类为良性，占黑素性斑疹的64%。第三种亚型（“树枝状型”黑素性斑疹的不规则亚型；36%）显示出与黑色素瘤重叠的RCM特征，难以鉴别，应进行活检以免漏诊黑色素瘤。黑素性斑疹与痣之间的RCM鉴别很容易进行。
RCM有可能提高黏膜皮肤交界处色素沉着斑无创鉴别诊断的准确性。
