皮肤镜在辅助确定基底细胞癌手术切缘中的作用研究

Auxiliary Detection of the Surgical Excision Margin of Basal Cell Carcinoma Using Dermoscopy

目的:比较皮肤镜观察基底细胞癌(basal cell carcinoma,BCC)肿瘤边界是否优于单纯的肉眼观察,并由此确定最佳的肿瘤手术切缘。方法:收集42例BCC患者,术前先以肉眼观察肿瘤边界并标记,而后根据BCC经典皮肤镜特征利用皮肤镜观察并最终确定肿瘤边界。以皮肤镜观察的肿瘤边界向外扩大5mm设计手术切缘并进行外科切除。所有切除的肿瘤标本从皮肤镜标记的肿瘤边界向外每隔2mm取"3、6、9、12"四个时钟方向的皮肤组织分别进行病理学检查,观察肿瘤组织的残留情况。结果:皮肤镜观察肿瘤边界与单纯肉眼观察相比,42例BCC患者中有28例(66.7%)观察结果一致,14例(33.3%)结果不一致。当切缘位于皮肤镜确定的肿瘤边界外侧2mm时,42例BCC患者中有8例(19.0%)提示肿瘤组织残留,而168个切缘标本中只有13个(7.7%)标本提示肿瘤细胞阳性,患者标本的整体肿瘤阳性率与切缘标本的肿瘤阳性率比较,差异有统计学意义(P<0.05);当切缘位于皮肤镜肿瘤边界外侧4mm时,42例BCC患者的168个切缘标本均未见肿瘤组织残留。结论:利用皮肤镜观察BCC肿瘤边界优于单纯肉眼观察。以皮肤镜确定的肿瘤边界为基准向外扩切2mm时不能完全切净肿瘤,扩切4mm时可切净肿瘤。

Objective To compare and ascertain whether dermoscopy can detect the tumor margin of basal cell carcinoma (BCC) more accurately than examination with naked eye alone, and obtain the optimal surgical excision margin of BCC. Methods A total of 42 BCC patients were enrolled for the study. The tumor margin was detected and marked by naked eye first, and confirmed by dermoscopy according to the classical dermoscopic features of BCC. The definitive excision margin 5mm from dermoscopy-detected tumor margin was designed for the followed surgical excision. All specimens of excised tumors were divided into serial sections according to “3, 6,9,12” clock-orientation at every 2mm interval from dermoscopy-detected tumor margin and submitted to histopathologic examination to confirm whether the excision margins were tumor-free or not. Results The comparison between using naked eye and dermoscopy in the detection of the tumor margin of BCC showed concordance in 28 patients (66.7%) whereas the remaining 14 patients (33.3%) showed difference. With excision margin 2mm from the dermoscopydetected tumor margin, excision margins in 8 patients (19.0%) proved to be inadequate but only 13 specimens (7.7 %) in the whole 168 excision margin specimens proved to be tumor-positive, with significant differences (P <0.05). While with 4mm margin, 42 patients including 168 excision margin specimens were all tumor-free. Conclusion Using dermoscopy can better define the tumor margin of BCC than using naked eye alone. 2mm dermoscopically detected excision margins cannot remove tumor completely while 4mm margins can achieve complete excisions for BCC.