Gouda Gracy, Pyne John, Dicker Tony
Faculty of Health Sciences, University of New South Wales, Sydney, Australia.
Faculty of Medicine, University of Queensland, Australia.
Dermatol Pract Concept. 2022 Oct 1;12(4):e2022194. doi: 10.5826/dpc.1204a194. eCollection 2022 Nov.
Differentiating early melanoma from other flat pigmented lesions on the head and neck is challenging both clinically and dermoscopically, partly due to the wide differential diagnosis and the lack of specific diagnostic algorithms.
To review publications covering the dermoscopic features of pigmented macules on the head and neck.
Embase and PubMed (Medline) database from January 2015 to January 2021 were searched using a four-step search. Keywords used were dermoscopy/dermatoscopy or epiluminescence microscopy, lentigo maligna, lentigo maligna melanoma, lichen-planus-like-keratosis, solar lentigo, seborrheic keratosis, pigmented actinic keratosis (PAK), pigmented Bowen disease (pBD), pigmented intraepidermal carcinoma (pIEC) and head and neck.
The commonest reported dermoscopic features of facial melanoma were irregular dots, atypical dots/globules, asymmetric pigmented follicular openings, rhomboid gray/black structures, increased vascular network, brown globules/dots and a pattern of circles. Pseudopods, radial streaming, blue white veil, irregular blotches, scar-like depigmentation and atypical pigment network were recorded in low frequencies. For PAK, pBD and pIEC perifollicular erythema, white/yellow surface scale, linear wavy vessels around hair follicles, hair follicular openings surrounded by a white halo, evident follicles or follicular or keratotic plugs, rosette sign and sharply demarcated borders were the salient features.
Further studies are needed to determine the dermoscopic criteria for pigmented melanocytic and non-melanocytic lesions on the head and neck. Furthermore, there is a gap in the knowledge of site-specific dermoscopic features on specific sites, namely ears, nose, cheeks, scalp and neck which will also benefit from further studies.
在临床和皮肤镜检查中，将早期黑色素瘤与头颈部其他扁平色素性病变区分开来具有挑战性，部分原因是鉴别诊断范围广泛且缺乏特定的诊断算法。
回顾有关头颈部色素斑皮肤镜特征的文献。
使用四步检索法检索2015年1月至2021年1月的Embase和PubMed（Medline）数据库。使用的关键词为皮肤镜检查/皮肤显微镜检查或表皮透光显微镜检查、恶性雀斑、恶性雀斑样黑色素瘤、扁平苔藓样角化病、日光性雀斑、脂溢性角化病、色素性光化性角化病（PAK）、色素性鲍恩病（pBD）、色素性表皮内癌（pIEC）以及头颈部。
面部黑色素瘤最常报告的皮肤镜特征为不规则点状、非典型点状/小球、不对称色素沉着的毛囊开口、菱形灰/黑色结构、血管网增多、棕色小球/点状以及环状模式。伪足、放射状流、蓝白色面纱、不规则斑片、瘢痕样色素脱失和非典型色素网络的记录频率较低。对于PAK、pBD和pIEC，毛囊周围红斑、白色/黄色表面鳞屑、毛囊周围线性波浪状血管、被白色晕圈包围的毛囊开口、明显的毛囊或毛囊或角化栓、玫瑰花结征和边界清晰是其显著特征。
需要进一步研究以确定头颈部色素性黑素细胞和非黑素细胞病变的皮肤镜标准。此外，在特定部位（即耳朵、鼻子、脸颊、头皮和颈部）的部位特异性皮肤镜特征方面存在知识空白，这也将受益于进一步的研究。
