Miami Cancer Institute, Dermatology, Miami, Florida.
University of CT Dermatology Department, Farmington, Connecticut; University of Florida Dermatology Department, Gainesville, Florida.
J Am Acad Dermatol. 2020 Oct;83(4):1035-1043. doi: 10.1016/j.jaad.2020.05.071. Epub 2020 May 19.
Melanoma in situ and dysplastic nevi with severe atypia present overlapping histopathologic features. Reflectance confocal microscopy findings can be integrated with the dermatopathology report to improve differentiation between melanoma and dysplastic nevi with severe atypia.
To compare prevalence of reflectance confocal microscopy findings between melanoma in situ and dysplastic nevi with severe atypia.
This retrospective observational study compared reflectance confocal microscopy findings in dermatopathologically diagnosed dysplastic nevi with severe atypia and melanoma in situ, collected between 2007 and 2017 at a private pigmented-lesion clinic. Concordant pathologic diagnosis was defined as unanimous agreement between 3 dermatopathologists who independently reviewed all cases; all other cases were classified as discordant.
The study included 112 lesions, 62 concordant melanomas in situ, 28 concordant dysplastic nevi with severe atypia, and 22 discordant lesions. In comparing reflectance confocal microscopy findings in concordant cases, melanoma in situ showed more frequently than dysplastic nevi with severe atypia the presence of epidermal atypical melanocytes as round cells (19/62 vs 0/28; P < .001) and dendritic cells (50/62 vs 6/28; P < .001), as well as a diffuse distribution of epidermal atypical melanocytes (50/54 vs 3/6; P = .002). In contrast, dysplastic nevi with severe atypia showed the presence of dense melanocytic nests more frequently than melanoma in situ did (15/28 vs 14/62; P = .003).
The study was based on a limited number of lesions originating from a single clinic.
Reflectance confocal microscopy findings may help differentiate a subset of dysplastic nevi with severe atypia from melanoma in situ.
原位黑素瘤和伴重度异型的发育不良痣具有重叠的组织病理学特征。反射共聚焦显微镜的检查结果可以与皮肤病理报告相结合，以提高对黑素瘤和伴重度异型的发育不良痣的区分。
比较原位黑素瘤和伴重度异型的发育不良痣的反射共聚焦显微镜检查结果的差异。
本回顾性观察性研究比较了 2007 年至 2017 年期间在一家私人色素性病变诊所通过皮肤病理诊断为伴重度异型的发育不良痣和原位黑素瘤的反射共聚焦显微镜检查结果。一致的病理诊断定义为 3 位独立审查所有病例的皮肤科病理学家之间的一致意见；所有其他病例均被归类为不一致。
研究纳入了 112 个病变，其中 62 个为一致的原位黑素瘤，28 个为一致的伴重度异型的发育不良痣，22 个为不一致的病变。在比较一致病例的反射共聚焦显微镜检查结果时，与伴重度异型的发育不良痣相比，原位黑素瘤更常表现为圆形细胞的表皮不典型黑素细胞（19/62 比 0/28；P<.001）和树突状细胞（50/62 比 6/28；P<.001），以及弥漫性分布的表皮不典型黑素细胞（50/54 比 3/6；P=.002）。相反，伴重度异型的发育不良痣更常表现为密集的黑素细胞巢（15/28 比 14/62；P=.003）。
该研究基于来自单个诊所的有限数量的病变。
反射共聚焦显微镜检查结果可能有助于区分伴重度异型的发育不良痣的一个亚组与原位黑素瘤。
