在皮肤镜下表现为黑素瘤样的病变经组织病理证实为基底细胞癌：反射共聚焦显微镜的评估。
Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy.
机构信息
Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
出版信息
Dermatology. 2019;235(1):35-44. doi: 10.1159/000493727. Epub 2018 Nov 7.
BACKGROUND
Atypical basal cell carcinoma (BCC), characterized by equivocal dermoscopic features typical of malignant melanoma (MM), can be difficult to diagnose. Reflectance confocal microscopy (RCM) enables in vivo imaging at nearly histological resolution.
OBJECTIVES
To evaluate with RCM atypical melanocytic lesions identified in dermoscopy, according to common RCM criteria for the differential diagnosis of BCC, and to identify representative RCM parameters for superficial (sBCCs) and nonsuperficial (nsBCCs) basal cell carcinomas (BCCs).
METHODS
A retrospective analysis of consecutive patients evaluated with RCM, selecting excised lesions classified at dermoscopy with ≥1 score from the re visited 7-point checklist, mimicking melanoma, registered between 2010 and 2016. Cluster analysis identified BCC subclassifications.
RESULTS
Of 178 atypical lesions, 34 lesions were diagnosed as BCCs with RCM. Lesions were confirmed BCCs with histopathology. Dermoscopic features included atypical network (55.9%) and regression structures (35.5%) associated with sBCCs, and an atypical vascular pattern (58.8%) and irregular blotches (58.8%) with nsBCCs. Hierarchical cluster analysis identified 2 clusters: cluster 1 (100% sBCCs) was characterized by the presence of cords connected to the epidermis (90%, p < 0.001), tumor islands located in the epidermis (100%, p < 0.001), smaller vascular diameter (100%, p < 0.001) and solar elastosis (90%, p = 0.017), and cluster 2 (nsBCCs 85%) was defined by the dermic location of tumor islands (87.5%, p < 0.001) with branch-like structures (70.8%, p = 0.007) and surrounding collagen (83.3%, p = 0.012), peripheral palisading (83.3%, p = 0.012) and coiled vascular morphology (79.2%, p < 0.001) with a larger vascular diameter (50%, p < 0.001).
CONCLUSIONS
RCM is able to diagnose BCCs mimicking melanoma at dermoscopy and seems able to identify sBCCs and nsBCCs.
背景
非典型基底细胞癌（BCC）的特征是存在具有恶性黑色素瘤（MM）特征的可疑皮肤镜特征，因此难以诊断。反射共聚焦显微镜（RCM）可实现近乎组织学分辨率的体内成像。
目的
根据 RCM 用于鉴别诊断 BCC 的常见标准，评估皮肤镜下识别的非典型黑素细胞病变，并确定浅表（sBCC）和非浅表（nsBCC）基底细胞癌（BCC）的代表性 RCM 参数。
方法
对 2010 年至 2016 年间通过 RCM 评估并在皮肤镜下分类为≥1 分的模拟黑色素瘤的连续患者进行回顾性分析，选择切除病变。聚类分析确定 BCC 分类。
结果
在 178 个非典型病变中，有 34 个病变通过 RCM 诊断为 BCC。通过组织病理学证实了病变为 BCC。皮肤镜特征包括与 sBCC 相关的非典型网络（55.9%）和退行性结构（35.5%），以及与 nsBCC 相关的非典型血管模式（58.8%）和不规则斑（58.8%）。层次聚类分析确定了 2 个聚类：聚类 1（100% sBCC）的特征是与表皮相连的索状结构（90%，p < 0.001）、位于表皮中的肿瘤岛（100%，p < 0.001）、较小的血管直径（100%，p < 0.001）和太阳弹性纤维（90%，p = 0.017），聚类 2（85% nsBCC）的特征是肿瘤岛位于真皮（87.5%，p < 0.001），具有分支状结构（70.8%，p = 0.007）和周围胶原（83.3%，p = 0.012）、周边栅栏状结构（83.3%，p = 0.012）和螺旋状血管形态（79.2%，p < 0.001），以及更大的血管直径（50%，p < 0.001）。
结论
RCM 能够诊断皮肤镜下模拟黑色素瘤的 BCC，并且似乎能够识别 sBCC 和 nsBCC。
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