Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Physical Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan.
JAMA Dermatol. 2019 May 1;155(5):578-584. doi: 10.1001/jamadermatol.2018.5926.
It is challenging to differentiate melanoma from melanocytic nevus on the volar skin in the absence of typical dermoscopic patterns.
To identify the frequency and clinical and dermoscopic characteristics of melanocytic lesions on the volar skin not displaying a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern on results of dermoscopy.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, a total of 504 melanocytic lesions on the volar skin were evaluated in the Shinshu University Hospital department of dermatology between January 1, 2000, and December 31, 2012. Dermoscopic images were independently assessed by 3 dermoscopists for the presence of established dermoscopic criteria. Statistical analysis was performed from October 1, 2017, to April 30, 2018.
Frequency of dermoscopic criteria and corresponding clinical (patient age and size and location of lesion) and histopathologic features.
Of 504 lesions, 110 (21.8%) (melanocytic nevus, 97; melanoma, 8; and equivocal melanocytic lesion, 5) from 108 patients (68 female and 40 male patients; mean age, 40.1 years [range, 1-86 years]) did not show a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern. Among them, the mean patient age was significantly higher for melanoma than for melanocytic nevus (65.3 vs 38.0 years; P < .001), as was mean maximum lesion diameter (11.8 vs 5.7 mm; P < .001). Melanomas and equivocal melanocytic lesions tended to be distributed on weight-bearing areas of the foot sole, such as the heel, while nevi were spread over non-weight-bearing regions. Dermoscopically, 95 melanocytic nevi (97.9%) were symmetrical in 1 or 2 axes while melanomas were not. A total of 91 melanocytic nevi (93.8%) had 1 or 2 colors per lesion, and 4 melanomas (50.0%) had more than 2 colors. Vascular structures were seen in 3 melanocytic nevi (3.1%) and 3 melanomas (37.5%). Blue-white structures were seen in 18 melanocytic nevi (18.6%) and 3 melanomas (37.5%). Dots and globules were seen in 22 melanocytic nevi (22.7%) and 4 melanomas (50.0%). Vascular structures, blue-white structures, and dots and globules were irregularly distributed in the melanomas. Ulcer, hyperkeratosis, and irregular streaks were observed only in melanomas.
More than one-fifth of melanocytic lesions on the volar skin did not display typical dermoscopic patterns. Asymmetry, numerous colors (≥3), and other melanoma-specific dermoscopic findings were more frequently observed for melanomas. Clinical information, including patient age and lesion size and location, was helpful in differentiating melanoma from melanocytic nevus. Further prospective clinical studies are warranted to clarify the diagnostic accuracy of dermoscopy combined with clinical information.
在缺乏典型皮肤镜模式的情况下，区分掌部皮肤的黑素瘤与黑素细胞痣具有挑战性。
确定在皮肤镜检查结果中未显示平行沟纹、网格状、纤维状或平行脊状模式的掌部皮肤黑素细胞病变的频率以及临床和皮肤镜特征。
设计、设置和参与者：在这项回顾性队列研究中，2000 年 1 月 1 日至 2012 年 12 月 31 日，共评估了信州大学医院皮肤科的 504 例掌部皮肤黑素细胞病变。3 名皮肤镜医生独立评估皮肤镜图像是否存在既定的皮肤镜标准。统计分析于 2017 年 10 月 1 日至 2018 年 4 月 30 日进行。
皮肤镜标准的频率以及相应的临床（患者年龄和病变大小及位置）和组织病理学特征。
在 108 例患者（68 例女性和 40 例男性；平均年龄 40.1 岁[范围，1-86 岁]）的 504 个病变中（黑素细胞痣 97 个；黑素瘤 8 个；疑似黑素细胞病变 5 个），有 110 个（21.8%）未显示平行沟纹、网格状、纤维状或平行脊状模式。其中，黑素瘤的平均患者年龄明显高于黑素细胞痣（65.3 岁比 38.0 岁；P<0.001），最大病变直径也明显更大（11.8 毫米比 5.7 毫米；P<0.001）。黑素瘤和疑似黑素细胞病变倾向于分布在脚底等承重区域，而痣则分布在非承重区域。皮肤镜下，95 个黑素细胞痣（97.9%）在 1 或 2 个轴线上呈对称分布，而黑素瘤则不然。共有 91 个黑素细胞痣（93.8%）每病变有 1 或 2 种颜色，而 4 个黑素瘤（50.0%）有超过 2 种颜色。3 个黑素细胞痣（3.1%）和 3 个黑素瘤（37.5%）有血管结构。18 个黑素细胞痣（18.6%）和 3 个黑素瘤（37.5%）有蓝白结构。22 个黑素细胞痣（22.7%）和 4 个黑素瘤（50.0%）有斑点和小结节。血管结构、蓝白结构和斑点和小结节在黑素瘤中不规则分布。溃疡、角化过度和不规则条纹仅见于黑素瘤。
超过五分之一的掌部皮肤黑素细胞病变未显示典型的皮肤镜模式。不对称、多种颜色（≥3 种）和其他黑素瘤特异性皮肤镜发现更常出现在黑素瘤中。临床信息，包括患者年龄和病变大小及位置，有助于区分黑素瘤和黑素细胞痣。需要进一步的前瞻性临床研究来阐明皮肤镜结合临床信息的诊断准确性。
