Zou Yunmin, Li Lu, Xia Rushan, Wang Fei
Department of Dermatology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
Department of Dermatology, Wuxi No. 2 People's Hospital, Wuxi, Jiangsu, China; and.
Am J Dermatopathol. 2025 Oct 1;47(10):769-774. doi: 10.1097/DAD.0000000000003099. Epub 2025 Aug 6.
Acral lentiginous melanoma (ALM) is a highly malignant skin tumor that is often difficult to differentiate from acral melanocytic nevi (AMN), potentially delaying diagnosis. Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that produces images consistent with histopathology. However, few studies have reported on the use of RCM for the differential diagnosis of ALM and AMN. This study aimed to assess the diagnostic accuracy of RCM in differentiating ALM from AMN. This retrospective study analyzed the RCM features of ALM and AMN, assessed concordance with histopathology using Cohen kappa coefficient, and evaluated the diagnostic accuracy of RCM. Receiver operating characteristic curve analysis was also performed to assess overall diagnostic performance. ALM and AMN exhibited distinct RCM features. RCM showed high concordance with histopathology (Cohen kappa = 0.799, P < 0.001). The diagnostic accuracy of RCM was 90.3%, with a sensitivity of 91.7%, specificity of 89.5%, and an area under the curve of 0.906 (95% CI: 0.820-0.992, P < 0.001). RCM is a reliable, noninvasive tool for differentiating ALM from AMN, and may help guide clinical decision making.
肢端雀斑样痣黑素瘤（ALM）是一种高度恶性的皮肤肿瘤，通常难以与肢端黑素细胞痣（AMN）相鉴别，这可能会延误诊断。反射式共聚焦显微镜（RCM）是一种非侵入性成像技术，可产生与组织病理学一致的图像。然而，很少有研究报道使用RCM对ALM和AMN进行鉴别诊断。本研究旨在评估RCM鉴别ALM与AMN的诊断准确性。这项回顾性研究分析了ALM和AMN的RCM特征，使用Cohen卡方系数评估与组织病理学的一致性，并评估RCM的诊断准确性。还进行了受试者工作特征曲线分析以评估总体诊断性能。ALM和AMN表现出不同的RCM特征。RCM与组织病理学显示出高度一致性（Cohen卡方=0.799，P<0.001）。RCM的诊断准确性为90.3%，敏感性为91.7%，特异性为89.5%，曲线下面积为0.906（95%CI：0.820-0.992，P<0.001）。RCM是一种可靠的非侵入性工具，可用于鉴别ALM与AMN，并可能有助于指导临床决策。
