First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece.
Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
JAMA Dermatol. 2018 Apr 1;154(4):414-419. doi: 10.1001/jamadermatol.2017.6447.
The accuracy of melanoma-specific dermoscopic criteria has been tested mainly in studies including invasive tumors. Scarce evidence exists on the usefulness of these criteria for the diagnosis of melanoma in situ (MIS).
To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of MIS.
DESIGN, SETTING, AND PARTICIPANTS: A diagnostic accuracy study with retrospective patient enrollment was conducted in 3 centers specializing in skin cancer diagnosis and management. A total of 1285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors that were histopathologically diagnosed or monitored for at least 1 year were included. Dermoscopic images of MIS and other flat, pigmented skin tumors were evaluated by 3 independent investigators for the presence of predefined criteria. Evaluators were blinded to the clinic dermoscopic and histopathologic diagnosis.
Frequencies of dermoscopic criteria per diagnosis were calculated. Crude odds ratios, adjusted odds ratios, and corresponding 95% CIs were calculated by univariate and multivariate logistic regression, respectively.
A total of 1285 patients were included in the study (642 [50%] male); mean age was 45.9 years (range, 9-91 years). Of a total of 1285 lesions obtained from these patients, 325 (25.3%) were MIS; 574 (44.7%) were nevi (312 [24.3%] excised and 262 [20.4%] not excised); 67 (5.2%) were seborrheic keratoses, solar lentigines, or lichen planus-like keratoses; 91 (7.1%) were pigmented superficial basal cell carcinomas; 26 (2.0%) were pigmented intraepithelial carcinomas; 100 (7.8%) were Reed nevi; and 102 (7.9%) were invasive melanomas with a Breslow thickness less than 0.75 mm. The most frequent dermoscopic criteria for MIS were regression (302 [92.9%]), atypical network (278 [85.5%]), and irregular dots and/or globules (163 [50.2%]). The multivariate analysis revealed 5 main positive dermoscopic indicators of MIS: atypical network (3.7-fold; 95% CI, 2.5-5.4), regression (4.7-fold; 95% CI, 2.8-8.1), irregular hyperpigmented areas (5.4-fold; 95% CI, 3.7-8.0), prominent skin markings (3.4-fold; 95% CI, 1.9-6.1), and angulated lines (2.2-fold; 95% CI, 1.2-4.1). When compared only with excised nevi, 2 of these criteria remained potent MIS indicators, namely, irregular hyperpigmented areas (4.3-fold; 95% CI, 2.7-6.8) and prominent skin markings (2.7-fold; 95% CI, 1.3-5.7).
Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS.
黑色素瘤特异性皮肤镜标准的准确性主要在包括侵袭性肿瘤的研究中进行了测试。关于这些标准在原位黑色素瘤 (MIS) 诊断中的有用性的证据很少。
研究皮肤镜标准在 MIS 诊断中的准确性。
设计、地点和参与者：这是一项在 3 家专门从事皮肤癌诊断和管理的中心进行的回顾性患者入组的诊断准确性研究。共纳入 1285 名组织病理学诊断为 MIS 或其他扁平、色素性皮肤肿瘤的患者，这些肿瘤通过组织病理学诊断或至少随访 1 年进行监测。3 名独立的研究者评估 MIS 和其他扁平、色素性皮肤肿瘤的皮肤镜图像是否存在预先定义的标准。评估者对临床皮肤镜和组织病理学诊断均不知情。
计算了每种诊断的皮肤镜标准的频率。分别通过单变量和多变量逻辑回归计算了未调整和调整后的优势比及相应的 95%置信区间。
共纳入 1285 例患者（642 [50%] 为男性）；平均年龄为 45.9 岁（范围，9-91 岁）。从这些患者中获得的 1285 个病变中，325 个（25.3%）为 MIS；574 个（44.7%）为痣（312 个切除，262 个未切除）；67 个（5.2%）为脂溢性角化病、老年性黑子或扁平苔藓样角化病；91 个（7.1%）为色素性浅表基底细胞癌；26 个（2.0%）为色素性上皮内癌；100 个（7.8%）为 Reed 痣；102 个（7.9%）为侵袭性黑色素瘤，Breslow 厚度小于 0.75mm。MIS 最常见的皮肤镜标准为退色（302 [92.9%]）、非典型网络（278 [85.5%]）和不规则点和/或球（163 [50.2%]）。多变量分析显示了 5 个 MIS 的主要阳性皮肤镜指标：非典型网络（3.7 倍；95%CI，2.5-5.4）、退色（4.7 倍；95%CI，2.8-8.1）、不规则的色素沉着区（5.4 倍；95%CI，3.7-8.0）、明显的皮肤标记（3.4 倍；95%CI，1.9-6.1）和角状线（2.2 倍；95%CI，1.2-4.1）。仅与切除的痣相比，其中 2 个标准仍然是强有力的 MIS 指标，即不规则的色素沉着区（4.3 倍；95%CI，2.7-6.8）和明显的皮肤标记（2.7 倍；95%CI，1.3-5.7）。
临床医生应考虑上述皮肤镜指标来诊断 MIS。
