Section of Dermatology, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy.
Department of Medical Biotechnologies, University of Siena, Siena, Italy.
Clin Exp Dermatol. 2021 Oct;46(7):1216-1222. doi: 10.1111/ced.14566. Epub 2021 Jul 9.
Dermoscopy is the most widely used noninvasive imaging technique for the clinical diagnosis of melanoma (MM). Super-high (× 400) magnification dermoscopy (D400) has recently been developed; compared with traditional dermoscopy, it can reveal additional features, down to the identification of single melanocytes in the skin.
To evaluate which structures are visible at D400 and to compare them in atypical naevi and MMs.
A prospective observational multicentre study was conducted. We enrolled patients who were identified as having atypical melanocytic skin lesions by clinical and/or × 20 magnification dermoscopy (D20) examination, and who were assigned to either excision or follow-up. Lesions were imaged by videodermoscopy at D20 and D400. The presence of pigmented cells and their features were assessed at D400.
In total, there were 79 patients with 57 naevi and 31 MMs. Of the total 88 lesions, 63 (71.6%) were given a histological diagnosis, while the others were followed up for ≥ 12 months, during which they showed no change and were all diagnosed as naevi. Pigmented cells were identified in > 90% of the lesions at D400. Compared with naevi, MMs had a higher frequency of scattered, large, irregular (in shape and size), dendritic/roundish, violet/blue pigmented cells under D400 (P < 0.001). Moreover, dots (P < 0.01), out-of-focus blue structureless areas (P < 0.01) and vessels (P < 0.001) were also more frequent in MMs than in naevi at D400.
This study showed that D400 can reveal many elements not otherwise visible in traditional D20 dermoscopy, such as pigmented cells and their morphology, which could be useful for the diagnosis of MM.
皮肤镜检查是用于临床诊断黑色素瘤 (MM) 的最广泛使用的非侵入性成像技术。最近已经开发出超高（× 400）放大倍数皮肤镜检查（D400）；与传统皮肤镜检查相比，它可以揭示其他特征，甚至可以识别皮肤中的单个黑素细胞。
评估 D400 下可见的结构，并对非典型痣和 MM 进行比较。
进行了一项前瞻性观察性多中心研究。我们招募了通过临床和/或× 20 倍皮肤镜检查（D20）检查被确定为具有非典型黑素细胞皮肤病变的患者，并将其分配到切除或随访。使用视频皮肤镜在 D20 和 D400 下对病变进行成像。在 D400 下评估色素细胞的存在及其特征。
共有 79 名患者，其中 57 名患有痣，31 名患有 MM。在总共 88 个病变中，63 个（71.6%）进行了组织学诊断，而其余病变则随访了≥12 个月，在此期间它们没有发生变化，均被诊断为痣。在 D400 下，超过 90%的病变中都可以识别出色素细胞。与痣相比，MM 下更频繁地出现散在、大、不规则（形状和大小）、树枝状/圆形、紫色/蓝色色素细胞（P<0.001）。此外，D400 下斑点（P<0.01）、失焦蓝色无结构区域（P<0.01）和血管（P<0.001）也比痣更常见。
这项研究表明，D400 可以揭示传统 D20 皮肤镜检查下无法看到的许多元素，例如色素细胞及其形态，这对 MM 的诊断可能有用。
