Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
JAMA Dermatol. 2017 Dec 1;153(12):1278-1284. doi: 10.1001/jamadermatol.2017.3114.
The management of lentigo maligna (LM) and LM melanoma (LMM) is challenging because of extensive subclinical spread and its occurrence on cosmetically sensitive areas. Reflectance confocal microscopy (RCM) improves diagnostic accuracy for LM and LMM and can be used to delineate their margins.
To evaluate whether handheld RCM with radial video mosaicing (HRCM-RV) offers accurate presurgical assessment of LM and LMM margins.
DESIGN, SETTING, AND PARTICIPANTS: This prospective study included consecutive patients with biopsy-proven LM and LMM located on the head and neck area who sought consultation for surgical management from March 1, 2016, through March 31, 2017, at the Dermatology Service of the Memorial Sloan Kettering Cancer Center. Thirty-two patients underwent imaging using HRCM-RV, and 22 patients with 23 LM or LMM lesions underwent staged surgery and contributed to the analysis.
Clinical lesion size and area, LM and LMM area based on HRCM-RV findings, surgical defect area estimated by HRCM-RV, and observed surgical defect area. In addition, the margins measured in millimeters estimated for tumor clearance in each quadrant based on HRCM-RV findings were calculated and compared with the surgical margins.
Among the 22 patients (12 men and 10 women; mean [SD] age, 69.0 [8.6] years [range, 46-83 years]) with 23 lesions included in the final analysis, the mean (SD) surgical defect area estimated with HRCM-RV was 6.34 (4.02) cm2 and the mean (SD) area of surgical excision with clear margins was 7.74 (5.28) cm2. Overall, controlling for patient age and previous surgery, surgical margins were a mean of 0.76 mm (95% CI, 0.67-0.84 mm; P < .001) larger than the HRCM-RV estimate.
Mapping of LM and LMM with HRCM-RV estimated defects that were similar to but slightly smaller than those found in staged excision. Thus, mapping of LM using HRCM-RV can help spare healthy tissue by reducing the number of biopsies needed in clinically uncertain areas and may be used to plan treatment of LM and LMM and counsel patients appropriately.
由于广泛的亚临床扩散以及发生在美容敏感区域，因此管理恶性雀斑样痣（LM）和 LM 黑色素瘤（LMM）具有挑战性。反射共聚焦显微镜（RCM）提高了 LM 和 LMM 的诊断准确性，并可用于描绘其边界。
评估手持径向视频镶嵌共聚焦显微镜（HRCM-RV）是否能准确评估 LM 和 LMM 边界的术前情况。
设计、设置和参与者：这项前瞻性研究纳入了 2016 年 3 月 1 日至 2017 年 3 月 31 日期间因头颈部位置活检证实的 LM 和 LMM 而寻求手术治疗咨询的连续患者，这些患者均来自 Memorial Sloan Kettering 癌症中心皮肤科服务部。32 名患者接受了 HRCM-RV 成像，22 名患者的 23 个 LM 或 LMM 病变接受了分期手术，并纳入了分析。
临床病变大小和面积、基于 HRCM-RV 检查结果的 LM 和 LMM 面积、HRCM-RV 估计的手术缺损面积以及观察到的手术缺损面积。此外，还计算并比较了基于 HRCM-RV 检查结果在每个象限中估计的用于肿瘤清除的毫米级边界，并与手术边界进行了比较。
在最终分析的 22 名患者（12 名男性和 10 名女性；平均[标准差]年龄 69.0[8.6]岁[范围 46-83 岁]）和 23 个病变中，HRCM-RV 估计的手术缺损面积平均为 6.34（4.02）cm2，切缘无肿瘤残留的手术切除面积平均为 7.74（5.28）cm2。总体而言，在控制患者年龄和既往手术的情况下，手术边界平均比 HRCM-RV 估计值大 0.76 毫米（95%CI，0.67-0.84 毫米；P < 0.001）。
使用 HRCM-RV 对 LM 和 LMM 进行成像，其估计的病变大小与分期切除发现的病变相似，但略小。因此，使用 HRCM-RV 对 LM 进行成像有助于通过减少临床不确定区域所需的活检数量来保留健康组织，并可用于规划 LM 和 LMM 的治疗和适当咨询患者。
