Pescarini Elena, De Antoni Eleonora, Azzena Gian Paolo, Vindigni Vincenzo, Brambullo Tito
Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
J Plast Reconstr Aesthet Surg. 2020 Apr;73(4):716-722. doi: 10.1016/j.bjps.2019.09.032. Epub 2019 Oct 1.
Dermoscopy improves sensitivity and specificity and helps in the early detection of melanoma and nonmelanoma skin cancers (NMSC). Because of the multidisciplinary approach to melanoma, plastic surgeons may be required to perform dermoscopy evaluation. For this reason, in some university hospitals, plastic surgeons in training might perform these evaluations. To assess the validity of digital dermoscopy conducted by plastic surgery registrars, the authors collected the diagnoses of excised lesions from a dermoscopy outpatient clinic, comparing results with literature.
A total of 1094 consecutive dermoscopy evaluations performed at Padova University Hospital between 2015 and 2018 were included in the study. All examinations were carried out by 3 plastic surgery registrars who received comparable training on dermoscopy. Excised lesions were classified according to pathological reports.
Four hundred sixty-six lesions were excised, and of them, 224 (48%) were considered pathological or atypical lesions: 34 melanomas (15%), 83 dysplastic or uncertain significance nevi (37%), and 107 NMSC and their precursors (48%). Considering only the 347 pigmented lesions, 34% were malignant or dysplastic lesions. The number needed to treat (NNT) was 10. The nevi-to-melanoma ratio (NMR) was 8, and the malignant melanoma-to-melanoma in situ ratio (MM:MMIS ratio) was 0.36.
This retrospective study tested the performance of specifically trained plastic surgery registrars in the detection of malignant skin lesions. Compared to literature, the analysis reflects a good sensibility for melanoma, especially in early curable stages. Moreover, our study underlines quite a high number of total excisions, which could be explained by the "surgical imprinting" of plastic surgery registrars.
皮肤镜检查可提高敏感性和特异性，有助于黑色素瘤和非黑色素瘤皮肤癌（NMSC）的早期检测。由于黑色素瘤的多学科治疗方法，整形外科医生可能需要进行皮肤镜评估。因此，在一些大学医院，接受培训的整形外科医生可能会进行这些评估。为了评估整形外科住院医师进行的数字皮肤镜检查的有效性，作者收集了皮肤镜门诊切除病变的诊断结果，并与文献进行了比较。
本研究纳入了2015年至2018年在帕多瓦大学医院连续进行的1094次皮肤镜评估。所有检查均由3名接受过皮肤镜检查相关培训的整形外科住院医师进行。切除的病变根据病理报告进行分类。
共切除466个病变，其中224个（48%）被认为是病理性或非典型病变：34个黑色素瘤（15%），83个发育异常或意义不确定的痣（37%），以及107个NMSC及其前驱病变（48%）。仅考虑347个色素沉着病变，34%为恶性或发育异常病变。治疗所需人数（NNT）为10。痣与黑色素瘤的比例（NMR）为8，恶性黑色素瘤与原位黑色素瘤的比例（MM:MMIS比例）为0.36。
这项回顾性研究测试了经过专门培训的整形外科住院医师在检测恶性皮肤病变方面的表现。与文献相比，该分析反映出对黑色素瘤具有良好的敏感性，尤其是在早期可治愈阶段。此外，我们的研究强调了相当高的总切除率，这可以用整形外科住院医师的“手术烙印”来解释。
