Englert Karolina, Kłosowicz Agata, Lazar Alicja, Wojas-Pelc Anna
Department of Dermatology, Collegium Medicum, Jagiellonian University in Cracow, Poland.
Medical Center Karolina Englert, Alwernia, Poland.
Pol Merkur Lekarski. 2021 Dec 16;49(294):430-433.
The vast majority of melanoma lesions show typical dermoscopic features such as the presence of atypical pigmented network, the variety of colors within nevi, the asymmetry of structures and the presence of structureless areas. The clinical appearance of melanocytic lesions evolving over time also constitutes a clue to discover their malignant potential. Albeit there are some cases that do not exhibit typical dermoscopic and clinical findings suggesting their malignant potential.
We report 4 cases of melanoma with their equivocal dermoscopic images and ambiguous clinical pictures. We acknowledge dermoscopic features such as: the presence of variform, peripheral globules suggesting the possible growth of the nevus, the presence of terminal hair within the melanoma lesion and we confirm that only on the basis of this criterion we cannot qualify such melanocytic lesions to the benign category. We also report the case of the two-component lesion consisted of reticular-homogenous pattern and concentrated globules in the superior pole of the nevus with no significant signs of evolution during one year period of surveillance and the case of the two-component lesion consisted of reticular - homogenous pattern with focal areas of higher density network and the presence of polymorphous, dotted, coiled, comma-like vessels which met the criterion of the ugly duckling sign. Dermoscopy is the most useful noninvasive diagnostic tool designed to discriminate skin nevi. Despite its benefits, the interpretation of a dermoscopic image is not always unequivocal. Some melanoma lesions exhibit only single features included in the assessment algorithms used in everyday dermatological practice such as: the ABCDE rule, the pattern analysis, the 7-points Glasgow checklist, the Menzies method, the 3-point checklist. The presence and the shape of vessels within nevi also constitute an important diagnostic indicator of melanoma. Dotted vessels are related to early stages of melanoma and polymorphous, elongated, linear, vessels are connected with more advanced stages. Therefore, dermoscopic examination should be performed by trained physicians. In case when predicted biological potential of melanocytic lesions is uncertain the excision of suspected lesions followed by histopathological examination should be carried out.
绝大多数黑色素瘤病变显示出典型的皮肤镜特征，如存在非典型色素网络、痣内颜色多样、结构不对称以及无结构区域的存在。随着时间推移演变的黑素细胞病变的临床表现也构成了发现其恶性潜能的线索。尽管有些病例没有表现出提示其恶性潜能的典型皮肤镜和临床发现。
我们报告了4例黑色素瘤，其皮肤镜图像不明确，临床情况模糊。我们认识到皮肤镜特征，如：存在形态各异的周边小球，提示痣可能生长，黑色素瘤病变内存在终毛，并且我们确认仅基于此标准，我们不能将此类黑素细胞病变归为良性类别。我们还报告了由网状均匀模式和痣上极密集小球组成的双成分病变病例，在一年的监测期内无明显演变迹象，以及由网状均匀模式和高密度网络局部区域以及多形性、点状、盘绕状、逗号状血管组成的双成分病变病例，这些血管符合丑小鸭征的标准。皮肤镜检查是用于鉴别皮肤痣的最有用的非侵入性诊断工具。尽管有其优点，但对皮肤镜图像的解读并不总是明确的。一些黑色素瘤病变仅表现出日常皮肤科实践中使用的评估算法中包含的单一特征，如：ABCDE规则、模式分析、7分格拉斯哥检查表、门齐斯方法、3分检查表。痣内血管的存在和形状也是黑色素瘤的重要诊断指标。点状血管与黑色素瘤的早期阶段相关，多形性、细长、线性血管与更晚期阶段相关。因此，皮肤镜检查应由训练有素的医生进行。如果黑素细胞病变的预测生物学潜能不确定，应切除可疑病变并进行组织病理学检查。
