Kenet R O, Kang S, Kenet B J, Fitzpatrick T B, Sober A J, Barnhill R L
Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston 02114.
Arch Dermatol. 1993 Feb;129(2):157-74.
Epiluminescence microscopy (ELM) is a clinical technique that permits in vivo visual inspection of pigmented anatomic structures of the epidermis, dermoepidermal junction, and papillary dermis. A protocol is proposed for systematic visual inspection of pigmented lesions. Seventy pigmented lesions were imaged with a digital ELM camera system. Images were visually inspected for eight "global" ELM features, 23 "local" ELM features, and 18 network features. An atlas of the most clinically significant ELM features is presented with pilot estimates of their sensitivity and specificity for detecting melanoma.
Preliminary data suggest that ELM features that may be most specific for melanoma include multicomponent pattern, nodular pattern, pseudopods, radial streaming, blue-gray areas, whitish veil (milky way), and sharp network margins. Epiluminescence microscopic features that may be most sensitive for melanoma include pigment dots, peripheral erythema, peripheral dark network patches, marked mean network irregularity, network line thickness variability, radial streaming, blue-gray areas, and whitish veil (milky way). Epiluminescence microscopic features that may be most sensitive for severe melanocyte atypia include pigment dots, peripheral erythema, hypopigmented network patches, peripheral dark network patches, marked mean network irregularity, and focal absence of network. In addition, features that may have a very high specificity for benign lesions include saccular pattern (suggests hemangioma), globular pattern (suggests a compound or dermal nevus), and multiple comedolike openings (suggests seborrheic keratosis).
Features most sensitive for severe atypia and melanoma could form the basis for a screening test for considering biopsy. Features most specific for melanoma then could be applied to further triage management of pigmented lesions that meet initial screening criteria. In addition, features with very high specificity for benign lesions may help develop ELM criteria to avoid unnecessary surgery.
表皮荧光显微镜检查（ELM）是一种临床技术，可对表皮、真皮表皮交界处和乳头层真皮的色素性解剖结构进行体内视觉检查。本文提出了一种对色素性病变进行系统视觉检查的方案。使用数字ELM相机系统对70个色素性病变进行成像。对图像进行视觉检查，观察8种“整体”ELM特征、23种“局部”ELM特征和18种网络特征。本文展示了具有临床意义的ELM特征图谱，并初步估计了它们对检测黑色素瘤的敏感性和特异性。
初步数据表明，对黑色素瘤可能最具特异性的ELM特征包括多成分模式、结节模式、伪足、放射状流、蓝灰色区域、白色面纱（银河）和清晰的网络边缘。对黑色素瘤可能最敏感的表皮荧光显微镜特征包括色素点、外周红斑、外周深色网络斑块、显著的平均网络不规则性、网络线厚度变异性、放射状流、蓝灰色区域和白色面纱（银河）。对严重黑素细胞异型性可能最敏感的表皮荧光显微镜特征包括色素点、外周红斑、色素减退网络斑块、外周深色网络斑块、显著的平均网络不规则性和局部网络缺失。此外，对良性病变可能具有非常高特异性的特征包括囊状模式（提示血管瘤）、球状模式（提示复合痣或皮内痣）和多个粉刺样开口（提示脂溢性角化病）。
对严重异型性和黑色素瘤最敏感的特征可作为考虑活检的筛查试验的基础。对黑色素瘤最具特异性的特征可用于对符合初始筛查标准的色素性病变进行进一步的分类管理。此外，对良性病变具有非常高特异性的特征可能有助于制定ELM标准，以避免不必要的手术。
