Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Histopathology. 2018 Jan;72(2):294-304. doi: 10.1111/his.13342. Epub 2017 Oct 17.
Early recognition and accurate diagnosis underpins melanoma survival. Identifying early melanomas arising in association with pre-existing lesions is often challenging. Clinically suspicious foci, however small, must be identified and examined histologically. This study assessed the accuracy of punch biopsy 'scoring' of suspicious foci in excised atypical pigmented skin lesions to identify early melanomas.
Forty-one excised pigmented skin lesions with a clinically/dermoscopically focal area of concern for melanoma, with the suspicious focus marked prior to excision with a punch biopsy 'score' (a partial incision into the skin surface), were analysed. Melanoma was diagnosed in nine of 41 cases (22%). In eight of nine cases (89%) the melanoma was associated with a naevus, and in seven of nine (88%) cases the melanoma was identified preferentially by the scored focus. In six of nine cases (67%), the melanoma was entirely encompassed by the scored focus. In one case of melanoma in situ, the diagnostic material was identified only on further levelling through the scored focus. In 28 of 32 of non-melanoma cases (88%), the scored focus identified either diagnostic features of a particular lesion or pathological features that correlated with the clinical impression of change/atypia including altered architecture or distribution of pigmentation, features of irritation or regression.
The 'punch scoring technique' allows direct clinicopathological correlation and facilitates early melanoma diagnosis by focusing attention on clinically suspicious areas. Furthermore, it does not require special expertise in ex-vivo clinical techniques for implementation. Nevertheless, in some cases examination of the lesion beyond the scored focus is also necessary to make a diagnosis of melanoma.
早期识别和准确诊断是黑色素瘤生存的基础。识别与先前存在病变相关的早期黑色素瘤通常具有挑战性。然而，必须识别和组织学检查临床可疑病灶，无论其多么小。本研究评估了切除不典型色素性皮损时用打孔活检“评分”可疑病灶来识别早期黑色素瘤的准确性。
分析了 41 例切除的色素性皮损，这些皮损的临床/皮肤镜检查有一个局灶性可疑黑色素瘤的区域，在切除前用打孔活检“评分”标记可疑病灶（对皮肤表面进行部分切开）。在 41 例病例中诊断出黑色素瘤 9 例（22%）。在 9 例黑色素瘤中，有 8 例（89%）与痣有关，在 9 例黑色素瘤中，有 7 例（88%）优先通过评分焦点识别。在 9 例黑色素瘤中，有 6 例（67%）完全被评分焦点所包含。在 1 例原位黑色素瘤中，仅通过进一步通过评分焦点进行平整才能识别诊断材料。在 32 例非黑色素瘤病例中，有 28 例（88%）评分焦点识别出特定病变的诊断特征或与临床改变/异型性印象相关的病理特征，包括结构改变或色素分布、刺激或退行性改变的特征。
“打孔评分技术”允许直接进行临床病理相关性，并通过将注意力集中在临床可疑区域来促进早期黑色素瘤的诊断。此外，它不需要特殊的临床技术专长来实施。然而，在某些情况下，还需要检查评分焦点之外的病变以做出黑色素瘤的诊断。
