Provost N, Kopf A W, Rabinovitz H S, Stolz W, DeDavid M, Wasti Q, Bart R S
Ronald O. Perelman Department of Dermatology, New York University School of Medicine, N.Y., USA.
Dermatology. 1998;196(3):299-304. doi: 10.1159/000017925.
One of the most difficult problems in the in vivo diagnosis of cutaneous tumors is the differentiation clinically between early malignant melanoma (MM) and atypical (dysplastic) melanocytic nevi (AMNs) because these lesions share clinical features. High-quality digital imaging systems and store-and-forward technology have the potential for use in a teledermatology system with which experts would be able to immediately transmit their diagnostic opinions concerning these challenging lesions.
The main purpose of this study was to determine if the clinical and dermoscopic diagnoses and the dermoscopic features of AMN and early MM are unaltered after telephonic transmission of their digitized images.
Conventional and dermoscopic photographic transparencies of 22 AMNs and 9 early MMs, viewed on rearview projectors and then scanned, compressed, transmitted (Internet) and viewed on color monitors, were evaluated.
The concordance in the diagnosis of AMN and of early MM by all four observers, both clinically and dermoscopically, when comparing rearview-projected conventional transparency slides to transmitted, compressed, digitized images, was high. For most specific dermoscopic features, the concordance was good, although less so for the presence or absence of some dermoscopic creatures, namely 'dots', 'blue/gray' color and 'red' color.
The results reported support the conclusion that Internet transmission of digitized images of MMs and AMNs retains sufficient information for diagnostic purposes. This study is a step in the creation of an international teledermoscopy network for pigmented cutaneous lesions.
皮肤肿瘤的体内诊断中最困难的问题之一是临床上早期恶性黑色素瘤（MM）与非典型（发育异常）黑素细胞痣（AMN）的鉴别，因为这些病变具有共同的临床特征。高质量数字成像系统和存储转发技术有潜力用于远程皮肤病学系统，借助该系统专家能够立即就这些具有挑战性的病变传输其诊断意见。
本研究的主要目的是确定AMN和早期MM的数字化图像经电话传输后，其临床和皮肤镜诊断以及皮肤镜特征是否保持不变。
对22例AMN和9例早期MM的传统和皮肤镜摄影透明片进行评估，这些透明片先在后视投影仪上观察，然后进行扫描、压缩、传输（通过互联网）并在彩色显示器上观察。
当比较后视投影仪上的传统透明幻灯片与传输、压缩后的数字化图像时，所有四位观察者在临床和皮肤镜下对AMN和早期MM的诊断一致性都很高。对于大多数特定的皮肤镜特征，一致性良好，不过对于某些皮肤镜表现，即“点状”、“蓝/灰色”和“红色”的有无，一致性稍差。
报告的结果支持以下结论，即MM和AMN数字化图像的互联网传输保留了足够用于诊断目的的信息。本研究是创建色素性皮肤病变国际皮肤镜网络的一个步骤。
