Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy,
Dermatology. 2020;236(3):241-247. doi: 10.1159/000503284. Epub 2019 Nov 8.
The head and neck are considered one single anatomical unit. No data on clinical, dermoscopic and confocal aspects of neck melanoma are currently available.
To identify clinical, dermoscopic and confocal diagnostic features of neck melanomas.
Consecutive malignant (cases) and benign (controls) melanocytic skin lesions located on the neck, excised as suspected of being melanoma from March 2011 to February 2018, were retrospectively retrieved. Dermoscopic criteria of the 7-point checklist, integrated by other melanoma features (such as grey colour and irregular hyperpigmented areas) were assessed. Reflectance confocal microscopy (RCM) images were examined when available.
282 lesions located to the head and neck area were biopsied to rule out melanoma. Thirty-one out of 282 (11%) lesions were located on the neck: 21 melanomas and 10 naevi. Melanoma patients were older than patients with naevi (mean age: 60.4 vs. 37.9 years, p < 0.001). Neck melanomas were more frequently located on sun-damaged skin compared to naevi (76.2 vs. 30%, p = 0.02). Dermoscopically, neck melanomas were characterized by irregular dots/globules, grey colour and regression (76.2, 81 and 46.7% of cases) and showed criteria of lentigo maligna melanoma (LMM) in 52.4% of cases. Regression, grey colour, irregular hyperpigmented areas and criteria of LMM typified melanomas on sun-damaged skin, whereas tumours located on non-sun-damaged areas were often characterized by irregular pigmentation (blotches). RCM, implemented to dermoscopy, correctly diagnosed 10/12 melanomas and 3/5 naevi.
Neck melanoma has peculiar clinical and dermoscopic aspects that could help clinicians to distinguish it from naevi and to diagnose melanoma earlier.
头颈部被视为单一解剖单位。目前尚无颈部黑素瘤的临床、皮肤镜和共聚焦方面的数据。
确定颈部黑素瘤的临床、皮肤镜和共聚焦诊断特征。
回顾性检索 2011 年 3 月至 2018 年 2 月期间因疑似黑色素瘤而切除的连续发生于颈部的恶性（病例）和良性（对照）黑素细胞皮肤病变。评估了 7 点检查表的皮肤镜标准，这些标准综合了其他黑色素瘤特征（如灰色和不规则色素沉着区域）。当有条件时，检查反射共聚焦显微镜（RCM）图像。
为排除黑色素瘤，对头颈部区域的 282 个病变进行了活检。282 个病变中有 31 个位于颈部：21 个黑素瘤和 10 个痣。黑素瘤患者比痣患者年龄大（平均年龄：60.4 岁比 37.9 岁，p < 0.001）。与痣相比，颈部黑素瘤更常位于日光损伤的皮肤（76.2%比 30%，p = 0.02）。皮肤镜下，颈部黑素瘤的特征为不规则点/球、灰色和退行（76.2%、81%和 46.7%），52.4%的病例符合恶性雀斑样痣黑素瘤（LMM）标准。退行、灰色、不规则色素沉着区和 LMM 标准是日光损伤皮肤黑素瘤的特征，而位于非日光损伤区的肿瘤常表现为不规则色素沉着（斑片状）。RCM 与皮肤镜结合，正确诊断了 12 个黑素瘤中的 10 个和 5 个痣中的 3 个。
颈部黑素瘤具有独特的临床和皮肤镜特征，有助于临床医生将其与痣区分开来，并更早地诊断黑素瘤。
