Department of Pediatrics, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 49, Brooklyn, NY, 11203, USA.
Department of Dermatology, University of Florida, 4037 NW 86th Terrace, 4th Floor, Gainesville, FL, 32606, USA.
Am J Clin Dermatol. 2020 Aug;21(4):513-524. doi: 10.1007/s40257-020-00517-z.
As a result of increasing melanoma incidence and challenges with clinical and histopathologic evaluation of pigmented lesions, noninvasive techniques to assist in the assessment of skin lesions are highly sought after. This review discusses the methods, benefits, and limitations of adhesive patch biopsy, electrical impedance spectroscopy (EIS), multispectral imaging, high-frequency ultrasonography (HFUS), optical coherence tomography (OCT), and reflectance confocal microscopy (RCM) in the detection of skin cancer. Adhesive patch biopsy provides improved sensitivity and specificity for the detection of melanoma without a trade-off of higher sensitivity for lower specificity seen in other diagnostic tools to aid in skin cancer detection, including EIS and multispectral imaging. EIS and multispectral imaging provide objective information based on computer-assisted diagnosis to assist in the decision to biopsy and/or excise an atypical melanocytic lesion. HFUS may be useful for the determination of skin tumor depth and identification of surgical borders, although further studies are necessary to determine its accuracy in the detection of skin cancer. OCT and RCM provide enhanced resolution of skin tissue and have been applied for improved accuracy in skin cancer diagnosis, as well as monitoring the response of nonsurgical treatments of skin cancers and the determination of tumor margins and recurrences. These novel approaches to skin cancer assessment offer opportunities to dermatologists, but are dependent on the individual dermatologist's comfort, knowledge, and desire to invest in training and implementation of noninvasive techniques. These noninvasive modalities may have a role in the complementary assessment of skin cancers, although histopathologic diagnosis remains the gold standard for the evaluation of skin cancer.
由于黑色素瘤发病率的增加以及对色素性病变的临床和组织病理学评估的挑战，人们迫切需要非侵入性技术来协助评估皮肤病变。本文讨论了粘性贴片活检、电阻抗光谱（EIS）、多光谱成像、高频超声（HFUS）、光相干断层扫描（OCT）和反射共聚焦显微镜（RCM）在皮肤癌检测中的方法、优点和局限性。粘性贴片活检在检测黑色素瘤方面提高了敏感性和特异性，而不会牺牲其他诊断工具（如 EIS 和多光谱成像）在提高敏感性的同时降低特异性的优势，有助于皮肤癌的检测。EIS 和多光谱成像提供基于计算机辅助诊断的客观信息，有助于决定对非典型黑素细胞病变进行活检和/或切除。HFUS 可用于确定皮肤肿瘤的深度和识别手术边界，但需要进一步研究来确定其在皮肤癌检测中的准确性。OCT 和 RCM 提供了皮肤组织的增强分辨率，并已应用于提高皮肤癌诊断的准确性，以及监测非手术治疗皮肤癌的反应以及确定肿瘤边界和复发。这些皮肤癌评估的新方法为皮肤科医生提供了机会，但取决于皮肤科医生的舒适度、知识和投资于培训和实施非侵入性技术的意愿。这些非侵入性方法可能在皮肤癌的辅助评估中发挥作用，尽管组织病理学诊断仍然是评估皮肤癌的金标准。
