Division of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Division of Dermatology, University of Ferrara, Ferrara, Italy.
J Eur Acad Dermatol Venereol. 2019 Apr;33(4):676-685. doi: 10.1111/jdv.15329. Epub 2018 Dec 4.
Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or malignant skin neoplasms, and in-vivo reflectance confocal microscopy could assist. Our aim was to identify specific reflectance confocal microscopy features for cutaneous malignant melanoma metastases, and epidermal and dermal involvement.
A retrospective, multicentre observational study of lesions with proven cutaneous malignant melanoma metastases diagnosis between January 2005 and December 2016. Lesions were retrospectively assessed according to morphological features observed at reflectance confocal microscopy. Potential homogeneous subgroups of epidermal or dermal involvement were investigated with cluster analysis.
Cutaneous malignant melanoma metastases (51 lesions in 29 patients) exhibited different frequencies of features according to metastasis dermoscopy patterns. Lesions classified at dermoscopy with nevus-like globular and non-globular patterns were more likely to be epidermotropic, showing characteristics of epidermal and dermal involvement at reflectance confocal microscopy. Other dermoscopy pattern classifications were more likely to be dermotropic, showing characteristics od dermal involvement at reflectance confocal microscopy. Distinguishing features at reflectance confocal microscopy included irregular (78%) and altered (63%) epidermis, pagetoid infiltration (51%), disarranged junctional architecture (63%), non-edged papillae (76%), dense and sparse, and cerebriform nests in the upper dermis (74%), and vascularity (51%). Cluster analysis identified three groups, which were retrospectively correlated with histopathological diagnoses of dermotropic and epidermotropic diagnoses (P < 0.001). The third cluster represents lesions with deep dermis morphological changes, which were too deep for evaluation with reflectance confocal microscopy.
Specific reflectance confocal microscopy features of cutaneous malignant melanoma metastases for correct diagnosis, and subtype diagnosis, seem achievable in most cases where morphological alterations are located above the deep dermis.
皮肤恶性黑色素瘤转移的鉴别诊断具有挑战性，因为临床和皮肤镜特征可能模拟原发性黑色素瘤或其他良性或恶性皮肤肿瘤，而体内反射共聚焦显微镜可以辅助诊断。我们的目的是确定皮肤恶性黑色素瘤转移的特定反射共聚焦显微镜特征，以及表皮和真皮受累情况。
这是一项回顾性、多中心观察性研究，纳入了 2005 年 1 月至 2016 年 12 月期间经证实的皮肤恶性黑色素瘤转移病变。根据反射共聚焦显微镜观察到的形态学特征对病变进行回顾性评估。使用聚类分析研究潜在的表皮或真皮受累同质亚组。
皮肤恶性黑色素瘤转移（29 例患者 51 个病变）根据转移皮肤镜模式显示出不同的特征频率。在皮肤镜下分类为痣样球形和非球形模式的病变更可能为表皮型，在反射共聚焦显微镜下表现出表皮和真皮受累的特征。其他皮肤镜分类模式更可能为真皮型，在反射共聚焦显微镜下表现出真皮受累的特征。反射共聚焦显微镜下的鉴别特征包括不规则（78%）和改变（63%）的表皮、派杰样浸润（51%）、不规则的交界结构（63%）、非边缘状乳头（76%）、致密和稀疏、以及脑回状巢在真皮上层（74%），以及血管（51%）。聚类分析确定了三个组，这三个组与组织病理学诊断的真皮型和表皮型诊断具有回顾性相关性（P<0.001）。第三个聚类代表了真皮深层形态改变的病变，由于反射共聚焦显微镜的评估深度不够，无法进行评估。
对于大多数位于真皮深层以上的形态改变病变，实现皮肤恶性黑色素瘤转移的正确诊断和亚型诊断似乎是可以实现的，这需要特定的反射共聚焦显微镜特征。
