背景:面外恶性扁豆(EF-LM)出现在头颈部以外。EF-LM呈现了恶性扁豆的经典组织学特征。EF-LM的皮肤观察方面的研究很少。
目的:我们研究的主要目的是分析和描述临床,一系列组织学证实的EF-LM的皮肤镜和共聚焦显微镜特征。
方法:我们进行了一项回顾性多中心研究。从我们的数据库中,我们选择了48例光损伤皮肤上具有EF-LM组织学特征的薄黑色素瘤,皮肤镜和共聚焦显微镜图像可用,和一个45个病变的对照组,可以进行鉴别诊断,例如太阳扁豆,苔藓样角化病,脂溢性角化病和黑素细胞痣,其中皮肤镜和共聚焦显微镜图像可用。
结果:EF-LM具有较高的类扁豆色素模式,成角度的线条,和锯齿形结构。在共聚焦显微镜下,LM-EF病例显示出更高的pagetoid扩散患病率,圆形细胞,表皮中的树突状细胞,真皮-表皮交界处的非典型细胞,交界处的树突状细胞,网状图案,我们的研究表明,RCM对这种类型的黑色素瘤的鉴别诊断具有90%的敏感性和97%的特异性。
结论:EF-LM不具有浅表扩散黑色素瘤的经典皮肤镜特征,观察到的最多的皮肤观察标准是成角度的线条和无白斑样边界的白斑样色素图案。RCM可以是评估皮肤镜检查中所有可疑皮肤病变的有价值的成像工具,这些病变突出了提示黑色素瘤的细胞异型性。
BACKGROUND: Extra facial lentigo maligna (EF-LM) arises outside the head and neck area. EF-LM presents the classic histological features of lentigo maligna. The dermoscopic aspects of EF-LM have been poorly studied.
OBJECTIVE: The primary aims of our study were to analyse and describe the clinical, dermoscopic and confocal microscopy features of a series of histologically confirmed EF-LM.
METHODS: We conducted a retrospective and multicentric study. From our database, we selected 48 cases of thin melanomas on photodamaged skin with histological features of EF-LM of which clinical, dermoscopic and confocal microscopy images were available, and a control group of 45 lesions, that can be subjected to differential diagnosis such as solar lentigo, lichenoid keratosis, seborrheic keratosis and melanocytic nevi, of which dermoscopic and confocal microscope images were available.
RESULTS: Extra facial lentigo maligna had a higher prevalence of lentigo-like pigment patterns, angulated lines and zigzag structures. At confocal microscopy, LM-EF cases showed a higher prevalence of pagetoid spreading, round cells, dendritic cells in the epidermis, atypical cells at the dermo-epidermal junction, dendritic cells at the junction, meshwork pattern and elastosis. Our study shows that reflectance confocal microscopy (RCM) has a sensitivity of 90% and a specificity of 97% for the differential diagnosis of this type of melanoma.
CONCLUSIONS: Extra facial lentigo maligna does not have the classic dermoscopic features of superficial spreading melanoma, the most observed dermoscopic criteria are angulated lines and lentigo-like pigment patterns without lentigo-like border. RCM can be a valuable imaging tool for the evaluation of all those suspicion skin lesions at dermoscopy highlighting cellular atypia suggestive for melanoma.