Dika Emi, Chessa Marco Adriano, Ribero Simone, Fanti Pier A, Gurioli Carlotta, Lambertini Martina, Baraldi Carlotta, Patrizi Annalisa
Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarnti 1, IT-40138 Bologna, Italy.
Acta Derm Venereol. 2017 Oct 2;97(9):1100-1107. doi: 10.2340/00015555-2705.
The introduction of dermoscopy has improved the accuracy of diagnosis of melanoma. However, early stage melanoma can be difficult to diagnose. Eighty-nine cases of thin melanoma with a Breslow thickness ≤1 mm located on the lower limb and diagnosed between 2008 and 2016 were assessed using 4 dermoscopic algorithms: (i) modified pattern analysis; (ii) ABCD rule of dermoscopy; (iii) 7-point checklist; and (iv) Menzies' method. Two groups of early stage melanomas of the legs were identified: "difficult to diagnose melanomas" (DDM) and "non-difficult to diagnose melanomas" (NDDM). In our series the dermoscopic features of DDM were difficult to differentiate from melanocytic naevi, and the reticular pattern was the most frequently observed. "Depigmentation" was the only specific criterion associated with DDM. The sensitivity of diagnostic systems for thin melanomas of the lower limbs was lower than in previous studies. This result could be related to the lower mean Breslow thickness of the invasive melanomas in our sample and the high number of melanomas in situ. In conclusion, early stage melanoma of the legs may be difficult to detect at clinical examination or with dermoscopic examination alone. Focusing on depigmentation in dermoscopy associated with anamnestic features could be a useful tool to detect difficult thin melanomas. In addition, sequential dermoscopy is recommended for high-risk patients with previous melanomas or atypical mole syndrome.
皮肤镜的引入提高了黑色素瘤诊断的准确性。然而，早期黑色素瘤可能难以诊断。对2008年至2016年间诊断出的89例位于下肢、Breslow厚度≤1mm的薄型黑色素瘤病例，使用4种皮肤镜算法进行评估：（i）改良模式分析；（ii）皮肤镜ABCD规则；（iii）7分检查表；以及（iv）孟席斯方法。确定了两组腿部早期黑色素瘤：“难以诊断的黑色素瘤”（DDM）和“非难以诊断的黑色素瘤”（NDDM）。在我们的系列研究中，DDM的皮肤镜特征难以与黑素细胞痣区分，网状模式是最常观察到的。“色素脱失”是与DDM相关的唯一特定标准。下肢薄型黑色素瘤诊断系统的敏感性低于先前研究。这一结果可能与我们样本中侵袭性黑色素瘤较低的平均Breslow厚度以及原位黑色素瘤的高数量有关。总之，腿部早期黑色素瘤在临床检查或仅通过皮肤镜检查时可能难以检测到。关注皮肤镜检查中与既往史特征相关的色素脱失可能是检测难以诊断的薄型黑色素瘤的有用工具。此外，对于有既往黑色素瘤或非典型痣综合征的高危患者，建议进行连续皮肤镜检查。
