Ozbagcivan Ozlem, Akarsu Sevgi, Ikiz Necla, Semiz Fatma, Fetil Emel
Ozlem Ozbagcivan, MD, Dokuz Eylul University, Faculty of Medicine, Department of Dermatology, 35340 Inciralti, Izmir, Turkey;
Acta Dermatovenerol Croat. 2019 Sep;27(3):146-152.
The differential diagnosis of lentigo maligna (LM) from pigmented actinic keratosis (PAK) and solar lentigines (SL) remains a challenge for clinicians, especially in the early stages of LM when there are no distinctive dermoscopic features. Objective of this study was to evaluate the frequencies of selective dermoscopic criteria in LM, PAK, and SL and to find the specific combination of distinguishing dermoscopic criteria for LM. Dermoscopists blinded to histopathological diagnosis evaluated 42 LM, 107 PAK, and 16 SL for the presence of predefined dermoscopic criteria. The differences in the presence of dermoscopic criteria between LM and others were evaluated with the chi-squared test or Fisher's exact test as appropriate. Multivariate logistic regression analysis with the forward conditional stepwise method were performed and odds ratios and corresponding 95% confidence intervals for LM, PAK, and SL were calculated. LM, PAK, and SL showed many common dermoscopic findings. In multivariate logistic regression analysis, darkening at dermoscopic examination (sevenfold), gray circles (sevenfold), target-like pattern (sixfold), gray rhomboids (sixfold), and slate-gray dots/globules (threefold) represented the strongest predictors of LM, while hyperkeratosis (thirteenfold), white circles (twelvefold), and red rhomboids (sixfold) represented the strongest predictors of PAK. The dermoscopic diagnosis of a given lesion should be based on the presence of the combination of specific dermoscopic criteria rather than a single benign or malignant criterion. Our results suggest that the presence of darkening at dermoscopic examination, gray circles, target-like pattern, gray rhomboids, and slate-gray dots/globules should be considered supportive findings for the diagnosis of early LM.
对临床医生而言，鉴别恶性雀斑样痣（LM）与色素性光化性角化病（PAK）及日光性雀斑（SL）仍是一项挑战，尤其是在LM早期，此时尚无明显的皮肤镜特征。本研究的目的是评估LM、PAK和SL中选择性皮肤镜标准的出现频率，并找出区分LM的皮肤镜标准的特定组合。对组织病理学诊断不知情的皮肤镜检查人员评估了42例LM、107例PAK和16例SL是否存在预先定义的皮肤镜标准。根据情况，采用卡方检验或Fisher精确检验评估LM与其他疾病在皮肤镜标准出现情况上的差异。采用向前条件逐步法进行多因素逻辑回归分析，并计算LM、PAK和SL的比值比及相应的95%置信区间。LM、PAK和SL显示出许多共同的皮肤镜表现。在多因素逻辑回归分析中，皮肤镜检查时颜色加深（七倍）、灰色圆圈（七倍）、靶样模式（六倍）、灰色菱形（六倍）和蓝灰色点/小球（三倍）是LM最强的预测指标，而角化过度（十三倍）、白色圆圈（十二倍）和红色菱形（六倍）是PAK最强的预测指标。对特定病变的皮肤镜诊断应基于特定皮肤镜标准的组合，而非单一的良性或恶性标准。我们的结果表明，皮肤镜检查时颜色加深、灰色圆圈、靶样模式、灰色菱形和蓝灰色点/小球的出现应被视为早期LM诊断的支持性表现。
