Nazir Zaeem H, Rishpon Ayelet, Kose Kivanc, Marghoob Nadeem G, Liopyris Konstantinos, Navarrete-Dechent Cristian, Dusza Stephen W, Daoud Alexander, Marghoob Ashfaq A
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 800 Veterans Memorial Highway 2nd Floor, Hauppauge, New York, NY, 11788, USA.
Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Arch Dermatol Res. 2023 Sep;315(7):2145-2147. doi: 10.1007/s00403-023-02524-6. Epub 2023 Feb 24.
Epinephrine is commonly used in combination with local anesthetic (lidocaine/epinephrine) due to its beneficial vasoconstrictive properties. Typically, pallor is appreciated after injection as a sign of effect; however, we observed that some cutaneous malignancies paradoxically revealed increased redness and vascularity after injection of lidocaine/epinephrine. In this study, we investigate this phenomenon among a series of biopsied lesions to identify characteristics of lesions associated with increased redness and/or vascularity.
To determine characteristics of lesions which become redder or more vascular after injection with lidocaine/epinephrine prior to biopsy.
This cross-sectional study consisted of a convenience sample of lesions scheduled for biopsy. Lesions were photographed prior to and 7 min after injection of lidocaine/epinephrine as a part of standard care. Two readers blinded to study objectives and histopathological diagnosis assessed lesions for changes in redness and vascular features.
Fifty-four lesions from 47 patients-61.7% male, mean age 64.8 years, age-range 24-91 were included. Thirty-six lesions were biopsy confirmed malignant, with 5 in situ and 31 invasive malignancies; the remaining 18 lesions were benign. In comparison with non-malignant lesions, malignant lesions were associated with an increase in clinically appreciable vascular features after injection of lidocaine/epinephrine, X (1) = 21.600, p < 0.001. Further stratification into benign, in situ, and invasive lesions strengthened the association, X (1) = 23.272, p < 0.001.
Combination lidocaine/epinephrine has been shown to paradoxically increase the visibility of vessels seen in cutaneous malignancies. This is consistent with prior literature suggesting aberrant adrenergic signaling in neoangiogenic vessels.
由于肾上腺素具有有益的血管收缩特性，它通常与局部麻醉剂（利多卡因/肾上腺素）联合使用。通常，注射后皮肤苍白被视为起效的标志；然而，我们观察到一些皮肤恶性肿瘤在注射利多卡因/肾上腺素后反而出现发红和血管增多的现象。在本研究中，我们对一系列活检病变进行调查，以确定与发红和/或血管增多相关的病变特征。
确定在活检前注射利多卡因/肾上腺素后会变得更红或血管更丰富的病变特征。
这项横断面研究包括一个计划进行活检的病变便利样本。作为标准护理的一部分，在注射利多卡因/肾上腺素前和注射后7分钟对病变进行拍照。两名对研究目的和组织病理学诊断不知情的读者评估病变的发红和血管特征变化。
纳入了47例患者的54个病变，其中男性占61.7%，平均年龄64.8岁，年龄范围为24 - 91岁。36个病变经活检确诊为恶性，其中5个为原位癌，31个为浸润性恶性肿瘤；其余18个病变为良性。与非恶性病变相比，恶性病变在注射利多卡因/肾上腺素后临床上可观察到的血管特征增加，X(1)=21.600，p<0.001。进一步分为良性、原位和浸润性病变后，这种关联得到加强，X(1)=23.272，p<0.001。
已证明利多卡因/肾上腺素联合使用会反常地增加皮肤恶性肿瘤中可见血管的明显程度。这与先前文献表明新生血管中存在异常肾上腺素能信号一致。
