Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Dermatol. 2020 Aug 1;156(8):882-890. doi: 10.1001/jamadermatol.2020.1450.
Basal cell carcinoma (BCC) is the most common skin cancer. Dermoscopic imaging has improved diagnostic accuracy; however, diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration, and shiny white structures.
To assess multiple aggregated yellow-white (MAY) globules as a diagnostic feature for BCC.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, single-center, case-control study, nonpigmented skin tumors, determined clinically, were identified from a database of lesions consecutively biopsied during a 7-year period (January 1, 2009, to December 31, 2015). A subset of tumors was prospectively diagnosed, and reflectance confocal microscopy, optical coherence tomography, and histopathologic correlation were performed. Data analysis was conducted from July 1 to September 31, 2019.
Investigators evaluated for the presence or absence of known dermoscopic criteria. MAY globules were defined as aggregated, white-yellow structures visualized in polarized and nonpolarized light.
The primary outcome was the diagnostic accuracy of MAY globules for the diagnosis of BCC. Secondary objectives included the association with BCC location and subtype. Interrater agreement was estimated.
A total of 656 nonpigmented lesions from 643 patients (mean [SD] age, 63.1 [14.9] years; 381 [58.1%] male) were included. In all, 194 lesions (29.6%) were located on the head and neck. A total of 291 (44.4%) were BCCs. MAY globules were seen in 61 of 291 BCC cases (21.0%) and in 3 of 365 other diagnoses (0.8%) (P < .001). The odds ratio for diagnosis of BCC was 32.0 (96% CI, 9.9-103.2). The presence of MAY globules was associated with a diagnosis of histologic high-risk BCC (odds ratio, 6.5; 95% CI, 3.1-14.3). The structure was never seen in cases of superficial BCCs.
The findings suggest that MAY globules may have utility as a new BCC dermoscopic criterion with a high specificity. MAY globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.
基底细胞癌（BCC）是最常见的皮肤癌。皮肤镜成像提高了诊断的准确性；然而，非色素性 BCC 的诊断仍然仅限于树枝状血管、溃疡和有光泽的白色结构。
评估多个聚集的黄白色（MAY）球作为 BCC 的诊断特征。
设计、地点和参与者：在这项回顾性、单中心、病例对照研究中，从 2009 年 1 月 1 日至 2015 年 12 月 31 日期间连续活检的病变数据库中确定了临床上确定的非色素性皮肤肿瘤。肿瘤的一部分进行了前瞻性诊断，并进行了反射共焦显微镜、光相干断层扫描和组织病理学相关性分析。数据分析于 2019 年 7 月 1 日至 9 月 31 日进行。
研究人员评估了是否存在已知的皮肤镜标准。MAY 球被定义为在偏振光和非偏振光下观察到的聚集的白色-黄色结构。
主要结果是 MAY 球对 BCC 诊断的诊断准确性。次要目标包括与 BCC 位置和亚型的关联。估计了组内一致性。
共纳入 643 例患者的 656 个非色素性病变（平均[SD]年龄 63.1[14.9]岁；381[58.1%]为男性）。共有 194 个病变（29.6%）位于头颈部。共有 291 个（44.4%）为 BCC。291 例 BCC 中有 61 例（21.0%）和 365 例其他诊断中有 3 例（0.8%）可见 MAY 球（P < .001）。BCC 诊断的优势比为 32.0（96%CI，9.9-103.2）。MAY 球的存在与组织学高危 BCC 的诊断相关（优势比，6.5；95%CI，3.1-14.3）。这种结构从未在浅表 BCC 病例中出现过。
研究结果表明，MAY 球可能作为一种新的具有高特异性的 BCC 皮肤镜标准具有应用价值。MAY 球与浅表 BCC 呈负相关，与更深、组织学上更高等级的肿瘤亚型呈正相关。
