First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.
Department of Dermatology, School of Medicine, University of Chile, Santiago, Chile.
Dermatology. 2022;238(2):301-306. doi: 10.1159/000516468. Epub 2021 Jun 7.
Blue color in dermoscopy can be seen in a wide range of benign and malignant lesions, melanocytic or not. Some blue-colored dermoscopic criteria have been associated with specific tumors, such as blue-white veil with melanoma and homogeneous blue with blue nevi. However, when blue color occupies a large part of the lesion's surface, the dermoscopic assessment might be particularly challenging.
To identify dermoscopic predictors associated with benignity and malignancy in tumors characterized by a predominant dermoscopic presence of blue color.
We retrospectively screened our institutional database for tumors exhibiting blue color in at least 50% of their surface with available histopathologic diagnosis. Lesions with blue color covering less than 50% of their extent and lesions not histopathologically assessed were excluded. The dermoscopic images were evaluated for the presence of predefined criteria, including the characteristics of the blue color, coexisting colors, and the vascular structures.
Of 91 included tumors, 53 were benign (35 blue nevi, 10 angiomas, and 8 seborrheic keratoses) and 38 malignant (12 melanomas and 26 basal cell carcinomas). Our analysis revealed 3 potent dermoscopic predictors of benignity: extension of blue color in more than 75% of the surface, diffuse distribution of blue color, and absence of vessels, posing a 2.3-fold, 5.6-fold, and 6.7-fold increased probability of benignity, respectively. In contrast, asymmetric distribution of blue color, blue clods, coexistence of gray color and linear vessels were significantly predictive of malignancy, posing a 8.9-fold, 2.8-fold, 13.5-fold, and 10.4-fold increased probability, respectively.
In predominantly blue tumors, the probability of malignancy is high when blue color is seen in clods or is asymmetrically distributed and when gray color or linear vessels coexist. In contrast, a diffuse distribution of blue color, its expansion in more than 75% of the surface, and the absence of vessels are highly suggestive of a benign tumor.
在广泛的良性和恶性病变中，包括黑素细胞和非黑素细胞病变，都可以观察到皮肤镜下的蓝色。一些蓝色皮肤镜特征与特定的肿瘤相关，例如黑色素瘤的蓝白幕和蓝色痣的均匀蓝色。然而，当蓝色占据病变表面的大部分时，皮肤镜评估可能特别具有挑战性。
确定以蓝色为主的病变中与良恶性相关的皮肤镜预测指标。
我们回顾性地筛选了我们机构数据库中至少有 50%表面呈现蓝色且有可用组织病理学诊断的肿瘤。蓝色覆盖面积小于病变的 50%且未进行组织病理学评估的病变被排除在外。对皮肤镜图像进行了评估，以确定是否存在预定的标准，包括蓝色特征、共存颜色和血管结构。
在 91 个纳入的肿瘤中，有 53 个是良性的（35 个蓝色痣、10 个血管瘤和 8 个脂溢性角化病），38 个是恶性的（12 个黑色素瘤和 26 个基底细胞癌）。我们的分析显示，3 个强有力的皮肤镜预测良性的指标：蓝色在表面的 75%以上延伸、蓝色弥漫性分布和无血管，分别使良性的可能性增加 2.3 倍、5.6 倍和 6.7 倍。相反，蓝色的不对称分布、蓝色团块、灰色和线性血管共存显著预测恶性，分别使恶性的可能性增加 8.9 倍、2.8 倍、13.5 倍和 10.4 倍。
在以蓝色为主的肿瘤中，当蓝色以团块形式出现或分布不对称，并且存在灰色或线性血管时，恶性的可能性很高。相反，蓝色弥漫性分布、在超过 75%的表面扩展以及无血管存在高度提示为良性肿瘤。
