Valdebran Manuel, Bandino Justin, Elbendary Amira, Gad Abdallah, Arudra Krishna C, de Feraudy Sébastien, Elston Dirk M
Department of Dermatology, University of California, Irvine, California.
Department of Dermatology, San Antonio Military Medical Center, San Antonio, Texas.
J Cutan Pathol. 2018 Mar;45(3):204-207. doi: 10.1111/cup.13085. Epub 2017 Dec 28.
Interpretation of Clark's nevi has generated debate over the years; although criteria have been proposed for grading morphological features of melanocytes, there is still confusion and variability in the assessment of these lesions.
This is a retrospective observational study conducted on 100 Clark's nevi and 84 melanomas. A single expert dermatopathologist evaluated all blinded and randomized photomicrographs of both the Clark's nevi and melanomas for the presence of 14 cytologic features. Subsequently, a multivariate model was used to obtain sensitivity and specificity.
Clark's nevi showed a significantly higher frequency of absent-or-inconspicuous nucleoli over melanoma, whereas mitotic figures, pleomorphism, notching, multiple nucleoli, peppered moth nuclear pattern, flattened adjacent nuclei, prominent nucleoli and vesicular nucleus with rounded nucleoli were found significantly higher in frequency in melanomas.
Our data suggest that nuclear alterations are of value in the differentiation of atypical nevi from melanoma.
多年来，对克拉克痣的解读一直存在争议；尽管已经提出了评估黑素细胞形态特征的标准，但在这些病变的评估中仍存在困惑和差异。
这是一项对100例克拉克痣和84例黑色素瘤进行的回顾性观察研究。一位专业的皮肤病理学家对克拉克痣和黑色素瘤的所有盲法和随机显微照片进行评估，以确定14种细胞学特征的存在情况。随后，使用多变量模型来获得敏感性和特异性。
与黑色素瘤相比，克拉克痣中核仁缺失或不明显的频率显著更高，而有丝分裂象、多形性、切迹、多个核仁、胡椒蛾核型、相邻核扁平、核仁突出以及核仁呈圆形的泡状核在黑色素瘤中的出现频率显著更高。
我们的数据表明，核改变在非典型痣与黑色素瘤的鉴别中具有价值。
