Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, Barcelona, Spain.
Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
J Am Acad Dermatol. 2021 Nov;85(5):1151-1160. doi: 10.1016/j.jaad.2020.02.067. Epub 2020 Mar 5.
Pigmented labial macules (PLMs) are clinical, dermoscopic, and histopathologic challenges.
To describe and evaluate the utility of reflectance confocal microscopy (RCM) in PLMs and to establish a correlation between dermoscopy, RCM, histopathology, and immunohistochemistry.
Prospective study of PLMs from 4 tertiary referral dermatology centers. The study included 51 biopsy specimen-proven PLMs. Dermoscopic, RCM images, and histopathologic preparations were evaluated for malignant criteria. Diagnostic accuracy of RCM for melanoma diagnosis, RCM Lip Score previously reported, and κ values between techniques were calculated.
Included were 5 melanomas and 46 benign PLMs. Dermoscopically, melanomas exhibited more frequently ≥3 colors and ≥3 structures. With RCM, pagetoid spreading, epithelial disarray, continuous proliferation of atypical cells around papillae, nonhomogeneously distributed papillae, marked cellular atypia, and a higher number of dendritic cells per papillae were more frequent in melanomas. The RCM Lip Score was significantly higher in malignant lesions. Good κ values were observed in most of the evaluated features. A perfect sensitivity and specificity was obtained combining dermoscopy and RCM.
A low number of melanomas were obtained.
RCM improves lip melanoma diagnosis, and the RCM Lip Score represents a useful tool for the evaluation of a PLM.
色素性唇斑（PLMs）在临床、皮肤镜和组织病理学方面均具有挑战性。
描述和评估反射共聚焦显微镜（RCM）在 PLMs 中的应用，并建立皮肤镜、RCM、组织病理学和免疫组织化学之间的相关性。
对来自 4 个三级转诊皮肤科中心的 PLMs 进行前瞻性研究。该研究纳入了 51 例经活检证实的 PLMs。对皮肤镜、RCM 图像和组织病理学标本进行了恶性标准评估。计算了 RCM 对黑色素瘤诊断的准确性、先前报道的 RCM Lip Score 以及不同技术之间的κ 值。
纳入了 5 例黑色素瘤和 46 例良性 PLMs。皮肤镜下，黑色素瘤更常出现≥3 种颜色和≥3 种结构。在 RCM 下， pagetoid 扩散、上皮紊乱、乳头周围不典型细胞连续增殖、乳头分布不均匀、明显的细胞异型性以及每个乳头的树突状细胞数量更多，这些在黑色素瘤中更为常见。恶性病变的 RCM Lip Score 显著更高。在大多数评估的特征中观察到良好的κ 值。结合皮肤镜和 RCM 可获得完美的敏感性和特异性。
获得的黑色素瘤数量较少。
RCM 提高了唇部黑色素瘤的诊断准确性，RCM Lip Score 是评估 PLM 的有用工具。
