Negrutiu Mircea, Danescu Sorina, Popa Theodor, Rogojan Liliana, Vesa Stefan Cristian, Baican Adrian
Department of Dermatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Rehabilitation, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Front Med (Lausanne). 2024 Aug 9;11:1436078. doi: 10.3389/fmed.2024.1436078. eCollection 2024.
The aim of this study is to correlate the diagnostic criteria described in dermoscopy, ultrasonography (US), and histology of the most common types of cutaneous melanoma (CM).
We conducted a prospective study including 40 CM cases, which were analyzed by dermoscopy using the Delta 30 dermatoscope and Vidix 4.0 videodermoscope, by ultrasound (US) using a high-resolution 20 MHz linear probe, along with histopathological analysis.
The study involved 40 patients with histopathologically confirmed CM, comprising 10 nodular melanomas (NM), 21 superficial spreading melanomas (SSM), and nine melanomas (MIS). US measurements of tumor thickness exhibited strong correlations with the histopathological Breslow index (BI), particularly in the NM and SSM groups. A notable correlation was observed between the presence of ulceration in histopathology and ultrasonography. Dermoscopic analysis revealed significant associations between specific features and CM types. For instance, the presence of an atypical network, irregular globules, irregular dots, prominent skin margins, angulated lines/polygons, dotted and short linear vessels, and negative network correlated with a median BI ≤ 0.5 mm. Conversely, the presence of blue-white veil, atypical vessels, blue-black color, and milky red color were associated with a median BI ≥ 2.3 mm. Furthermore, regression observed in histopathology correlated with regression identified in dermoscopy, we also found statistical correlations between the presence of vascularization at US with the high Clark level, and the presence of prominent skin markings at dermoscopy. The presence of histopathological regression was more frequently associated with tumors that had precise margins, absent vascularization and with those that did not have ulceration on US. The high mitotic rate was associated with tumors that presented imprecise margins, increased vascularization and US detectable ulceration.
Innovative CM diagnosis using non-invasive methods like dermoscopy and ultrasound may enhance accuracy and treatment guidance by assessing lesion characteristics.
本研究的目的是将皮肤镜、超声检查（US）以及最常见类型的皮肤黑色素瘤（CM）组织学中描述的诊断标准进行关联。
我们进行了一项前瞻性研究，纳入40例CM病例，使用Delta 30皮肤镜和Vidix 4.0视频皮肤镜进行皮肤镜分析，使用高分辨率20MHz线性探头进行超声（US）检查，并进行组织病理学分析。
该研究涉及40例经组织病理学确诊的CM患者，包括10例结节性黑色素瘤（NM）、21例浅表扩散性黑色素瘤（SSM）和9例肢端雀斑样痣黑色素瘤（MIS）。肿瘤厚度的US测量值与组织病理学Breslow指数（BI）呈现出强相关性，尤其是在NM和SSM组中。在组织病理学和超声检查中观察到溃疡的存在之间存在显著相关性。皮肤镜分析揭示了特定特征与CM类型之间的重要关联。例如，非典型网络、不规则小球、不规则小点、明显的皮肤边缘、成角线条/多边形、点状和短线性血管以及阴性网络的存在与中位BI≤0.5mm相关。相反，蓝白幕、非典型血管、蓝黑色以及乳红色的存在与中位BI≥2.3mm相关。此外，组织病理学中观察到的消退与皮肤镜中识别出的消退相关，我们还发现US检查中血管化的存在与高Clark分级之间以及皮肤镜中明显的皮肤标记之间存在统计学相关性。组织病理学消退的存在更常与边界精确、无血管化且US检查无溃疡的肿瘤相关。高有丝分裂率与边界不精确、血管化增加且US可检测到溃疡的肿瘤相关。
使用皮肤镜和超声等非侵入性方法进行创新的CM诊断，通过评估病变特征，可能提高准确性并为治疗提供指导。
