Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, China.
Skin Res Technol. 2020 Sep;26(5):690-695. doi: 10.1111/srt.12854. Epub 2020 Apr 6.
To investigate the application and challenge of reflectance confocal microscopy (RCM) in the diagnosis of pigmented nevus.
A total of 997 patients with clinical diagnosis of pigmented nevus were included in the study, and RCM imaging was performed on the lesion of each patient. A biopsy was performed in 78 of these patients for histological diagnosis. We retrospectively analyzed the results of RCM diagnosis and histological diagnosis and then found the RCM characteristics of the histologically confirmed lesion.
According to the RCM images, 823 of the 997 (82.55%) patients were diagnosed with pigmented nevus, while 113 (11.33%) were not diagnosed by dermatologists using RCM. Of the 78 biopsy lesions, 36 of the 46 (78.26%) cases diagnosed with pigmented nevus were consistent with histological diagnosis, while three were rediagnosed with dermatofibromas, four were seborrheic keratosis, one was malignant melanoma in situ, and two were lentigo.
RCM exhibits a high diagnostic accuracy for patients with clinical diagnosis of pigmented nevus. However, due to the limitation of RCM scanning depth and the commonality of the microscopic characteristics of related diseases, RCM still faces certain challenges in the diagnosis of pigmented nevus.
探讨反射式共聚焦显微镜（RCM）在色素痣诊断中的应用及挑战。
共纳入 997 例临床诊断为色素痣的患者，对每位患者的皮损进行 RCM 成像，其中 78 例患者行皮损活检以行组织学诊断。回顾性分析 RCM 诊断与组织学诊断结果，并进一步找出经组织学证实的皮损的 RCM 特征。
根据 RCM 图像，997 例患者中 823 例（82.55%）被诊断为色素痣，而 113 例（11.33%）未被 RCM 诊断为皮肤科医生诊断的色素痣。78 例活检皮损中，46 例（78.26%）诊断为色素痣的病例与组织学诊断一致，其中 3 例重新诊断为纤维瘤，4 例为脂溢性角化病，1 例为原位恶性黑色素瘤，2 例为色素斑。
RCM 对临床诊断为色素痣的患者具有较高的诊断准确性。然而，由于 RCM 扫描深度的限制以及相关疾病的微观特征的普遍性，RCM 在色素痣的诊断中仍面临一定的挑战。
