PDF(Pubmed)
Abstract：
Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve melanoma diagnosis, particularly in high-risk patients. This study assessed the benefits of combining these advanced imaging techniques in a three-step programme in managing high-risk patients. This study included 410 high-risk melanoma patients who underwent a specialised imaging consultation in addition to their regular skin examinations in outpatient care. At each visit, the patients underwent a 3D-TBP, a DD for suspicious findings, and an RCM for unclear DD findings. The histological findings of excisions initiated based on imaging consultation and outpatient care were compared. Imaging consultation detected sixteen confirmed melanomas (eight invasive and eight in situ) in 39 excised pigmented lesions. Outpatient care examination detected seven confirmed melanomas (one invasive and six in situ) in 163 excised melanocytic lesions. The number needed to excise (NNE) in the imaging consultation was significantly lower than that in the outpatient care (2.4 vs. 23.3). The NNE was 2.6 for DD and 2.3 for RCM. DD, 3D-TBP, or RCM detected melanomas that were not detected by the other imaging methods. The three-step imaging programme improves melanoma detection and reduces the number of unnecessary excisions in high-risk patients.
摘要：
现代诊断程序,例如三维全身摄影(3D-TBP)，数字皮肤镜（DD），和反射共聚焦显微镜（RCM），可以改善黑色素瘤的诊断，特别是高危患者。这项研究评估了将这些先进的成像技术结合在三步程序中管理高危患者的好处。这项研究包括410名高危黑色素瘤患者，他们除了在门诊护理中定期进行皮肤检查外，还接受了专门的影像学咨询。每次访问,患者接受了3D-TBP,可疑发现的DD，以及不清楚DD发现的RCM。比较了基于影像学咨询和门诊护理开始切除的组织学发现。影像学咨询在39个切除的色素性病变中发现了16个确诊的黑色素瘤（8个侵袭性和8个原位）。门诊检查在163个切除的黑素细胞病变中发现了7个确诊的黑素瘤（1个侵袭性和6个原位）。影像学会诊中需要切除的人数（NNE）明显低于门诊（2.4vs.23.3).DD的NNE为2.6，RCM为2.3。DD,3D-TBP,或RCM检测到其他成像方法未检测到的黑色素瘤。三步成像程序改善了黑色素瘤的检测，并减少了高危患者不必要的切除次数。
