Steiner A, Pehamberger H, Wolff K
Department of Dermatology I, University of Vienna Medical School, Austria.
J Am Acad Dermatol. 1987 Oct;17(4):584-91. doi: 10.1016/s0190-9622(87)70240-0.
Pattern analysis by epiluminescence microscopy of pigmented skin lesions was tested in a study of 318 small pigmented skin lesions that were diagnostically equivocal when examined with the naked eye. An improvement of clinical diagnosis was achieved by epiluminescence microscopy for practically all lesions, both benign and malignant, and was equally impressive for melanocytic and nonmelanocytic lesions. Improvement in diagnostic accuracy was as follows: for small nodular melanomas, from 50% to 70%; for superficial spreading melanoma in situ, from 46% to 80%; for invasive superficial spreading melanoma, from 64% to 90%; and for early lentigo maligna and lentigo maligna melanoma, from 67% to 88%. Conversely, the diagnosis of pigmented Spitz nevi improved from 46% to 93% and of pigmented basal cell carcinomas from 60% to 90%, which appears equally important because most of these lesions had clinically been considered to represent melanomas. The use of epiluminescence microscopy also resulted in considerable improvement in the diagnosis of dysplastic nevi, which was particularly helpful in making therapeutic decisions. Epiluminescence microscopy greatly expands the diagnostic armamentarium available for pigmented skin lesions at a clinical level and thus increases the chances of detecting or ruling out melanoma in its earliest stages.
在一项对318例色素沉着性皮肤病变的研究中，对肉眼检查时诊断不明确的色素沉着性皮肤病变进行了落射荧光显微镜模式分析。落射荧光显微镜对几乎所有病变（包括良性和恶性）的临床诊断都有改善，对黑素细胞性和非黑素细胞性病变同样有效。诊断准确性的提高如下：小的结节性黑素瘤，从50%提高到70%；原位浅表扩散性黑素瘤，从46%提高到80%；侵袭性浅表扩散性黑素瘤，从64%提高到90%；早期恶性雀斑样痣和恶性雀斑样痣黑素瘤，从67%提高到88%。相反，色素性斯皮茨痣的诊断从46%提高到93%，色素性基底细胞癌的诊断从60%提高到90%，这似乎同样重要，因为这些病变大多数在临床上曾被认为是黑素瘤。落射荧光显微镜的使用也使发育异常痣的诊断有了显著改善，这对做出治疗决策特别有帮助。落射荧光显微镜在临床水平上极大地扩展了可用于色素沉着性皮肤病变的诊断手段，从而增加了在最早阶段检测或排除黑素瘤的机会。
