Nachbar F, Stolz W, Merkle T, Cognetta A B, Vogt T, Landthaler M, Bilek P, Braun-Falco O, Plewig G
Department of Dermatology, University of Munich, Germany.
J Am Acad Dermatol. 1994 Apr;30(4):551-9. doi: 10.1016/s0190-9622(94)70061-3.
The difficulties in accurately assessing pigmented skin lesions are ever present in practice. The recently described ABCD rule of dermatoscopy (skin surface microscopy at x10 magnification), based on the criteria asymmetry (A), border (B), color (C), and differential structure (D), improved diagnostic accuracy when applied retrospectively to clinical slides.
A study was designed to evaluate the prospective value of the ABCD rule of dermatoscopy in melanocytic lesions.
In 172 melanocytic pigmented skin lesions, the criteria of the ABCD rule of dermatoscopy were analyzed with a semiquantitative scoring system before excision.
According to the retrospectively determined threshold, tumors with a score higher than 5.45 (64/69 melanomas [92.8%]) were classified as malignant, whereas lesions with a lower score were considered as benign (93/103 melanocytic nevi [90.3%]). Negative predictive value for melanoma (True-Negative divided by [True-Negative+False-Negative]) was 95.8%, whereas positive predictive value (True-Positive divided by [True-Positive+False-Positive]) was 85.3%. Diagnostic accuracy for melanoma (True-Positive divided by [True-Positive+False-Positive+False-Negative]) was 80.0%, compared with 64.4% by the naked eye. Melanoma showed a mean final dermatoscopy score of 6.79 (SD, +/- 0.92), significantly differing from melanocytic nevi (mean score, 4.27 +/- 0.99; p < 0.01, U test).
The ABCD rule can be easily learned and rapidly calculated, and has proven to be reliable. It should be routinely applied to all equivocal pigmented skin lesions to reach a more objective and reproducible diagnosis and to obtain this assessment preoperatively.
在实际操作中，准确评估色素沉着性皮肤病变一直存在困难。最近描述的皮肤镜检查（10倍放大的皮肤表面显微镜检查）ABCD规则，基于不对称性（A）、边界（B）、颜色（C）和差异结构（D）标准，在回顾性应用于临床玻片时提高了诊断准确性。
设计一项研究以评估皮肤镜检查ABCD规则在黑素细胞性病变中的前瞻性价值。
在172例黑素细胞性色素沉着性皮肤病变中，在切除前用半定量评分系统分析皮肤镜检查ABCD规则的标准。
根据回顾性确定的阈值，评分高于5.45的肿瘤（69例黑色素瘤中的64例[92.8%]）被分类为恶性，而评分较低的病变被认为是良性的（103例黑素细胞痣中的93例[90.3%]）。黑色素瘤的阴性预测值（真阴性除以[真阴性+假阴性]）为95.8%，而阳性预测值（真阳性除以[真阳性+假阳性]）为85.3%。黑色素瘤的诊断准确性（真阳性除以[真阳性+假阳性+假阴性]）为80.0%，而肉眼观察的诊断准确性为64.4%。黑色素瘤的最终皮肤镜检查平均评分为6.79（标准差，±0.92），与黑素细胞痣有显著差异（平均评分，4.27±0.99；p<0.01，U检验）。
ABCD规则易于学习且计算迅速，已被证明是可靠的。它应常规应用于所有可疑的色素沉着性皮肤病变，以获得更客观、可重复的诊断，并在术前进行这种评估。
