皮肤激光共聚焦显微镜诊断和鉴别色素痣和黑素瘤评价

The Differential Diagnosis between Melanocytic Nevi and Melanomas using the Reflectance Confocal Microscopy

目的了解皮肤激光共聚焦显微镜(皮肤三维CT)观察不同类型色素痣和黑素瘤的镜像特征,为诊断和鉴别这两种疾病提供参考依据。方法皮肤激光共聚焦显微镜观察101例拟诊为色素痣患者的镜像特征,组织病理最终确诊,所有资料录入excel表,采用描述性研究方法分析结果。结果皮肤CT诊断不同类型色素痣99例,早期黑素瘤患者2例;组织病理确诊不同类型色素痣98例,早期黑素瘤患者3例。色素痣皮肤三维CT镜像特征主要为蜂窝状排列高折光物质(痣细胞巢)的规则性分布,表皮及真表皮交界处结构基本正常;早期黑素瘤皮肤三维CT镜像特征主要为较大且中央折光度稍低或者不规则树枝状突起的异形细胞的出现,表皮及真表皮处结构紊乱,真皮浅层可见炎症细胞浸润。结论规律分布的痣细胞巢以及不规则形态异性细胞是皮肤激光共聚焦显微镜早期鉴别色素痣和黑素瘤的重要特征。

Objective Using the reflectance confocal microscopy （RCM） to give the differential diagnosis between melanocytic nevi and melanomas and provide the clues for the dermatologists. Methods One hundred and one primary nevi patients obtained the confocal microscopic and histopathologic examinations. All data were recorded in Excel and the results were analyzed by descriptive study method. Results Using the confocal microscopic, the 99 different nevi and 2 melanomas were diagnosed, but 98 different nevi and 3 melanomas were confirmed by histopathologic examinations. The characters of RCM for nevi are the melanocytic nests or the typical pigment globules distributed within the skin as regular and the keratinocytes and epidermis are normal. The characters of RCM for melanoma are that there are some larger than the typical keratinocytes with highly reflective cytoplasm and occasionally with branching dendritic structures （called atypical cells） and located at the dermoepidermal junction and/or spreading the whole epidermis and the inflammatory cell infiltration and small vascular distortion and expansion could be observed in the papillary dermis. Conclusions The appearance of the regular distribution of the melanocytic nests and irregular morphology of the cells is an important feature of the early identification of melanocytic nevi and melanoma using RCM.