不同临床亚型基底细胞癌皮肤镜特征差异分析

Dermoscopic Features in Different Subtypes of Basal Cell Carcinoma

目的比较不同临床亚型基底细胞癌(basal cell carcinoma,BCC)皮肤镜下的模式特征,为应用皮肤镜鉴别不同亚型BCC提供依据,提高临床诊断准确性。方法收集2016年3月-2018年7月在武汉市第一医院就诊的59例经组织病理确诊的BCC患者皮肤镜影像资料,比较不同亚型BCC在血管模式、色素相关模式、非血管和色素相关模式等方面的差异。结果结节溃疡型BCC中最常见的指征为溃疡(84.21%)、大的蓝灰色卵圆形巢(84.21%)、粗大分支状血管(73.68%);色素型BCC常见的皮肤镜表现为溃疡(86.67%)、大的蓝灰色卵圆形巢(100%)、粗大分支状血管(60.00%)、亮白无结构区(66.67%);而浅表型BCC最常见的表现为多发性小溃疡(80.00%)、轮辐状区域(90.00%)、浅表短细血管(80.00%)、红白背景无结构区(80.00%)。三型BCC皮肤镜指征差异主要是大的蓝灰色巢、轮辐状结构、粗大分支状血管、浅表短细血管、红白背景无结构区和亮白无结构区(P<0.05)。结论不同类型BCC具有不同的皮肤镜模式特征。多发性小溃疡、轮辐状区域、浅表短细血管、红白背景无结构区等在浅表型BCC中较常见,而大溃疡、大的蓝灰色卵圆形巢、粗大分支状血管在结节型和色素型BCC中出现频率较高。通过识别这些皮肤镜特征性的结构,有助于提高诊断BCC的准确性。

Objective To analyze the dermoscopic features of different subtypes of basal cell carcinoma (BCC),so as to increase the diagnostic accuracy of BCC.Methods The dermoscopic images of 59 BCC cases were collected from March 2016 to July 2018 in the first hospital of Wuhan.The images were evaluated for a range of vascular,pigment and nonvascular/nonpigment-related patterns.Results The ulcerated nodular BCC were primarily typified by the presence of ulceration (84.21%),blue-grey ovoid nests (84.21%) and arborizing vessels (73.68%).The pigmented BCC typically showed ulceration (86.67%),blue-grey ovoid nests (100%),arborizing vessels (60.00%) and shiny structureless areas (66.67%).The most frequent dermoscopic criteria of superficial BCC (sBCC) were multiple small erosions (80.00%),short fine superficial telangiectasia (80.00%),spoke wheel areas (90.00%) and shiny white-red structureless areas (80.00%).The primary differences of dermoscopic features in all categories were blue-grey ovoid nests,spoke-wheel areas,arborizing vessels,short fine superficial telangiectasia,shiny white-red structureless areas and shiny structureless areas (P<0.05,respectively).Conclusion The dermoscopic features of different BCC subtypes are various.Multiple small erosions,spoke wheel areas,short fine superficial telangiectasia and shiny white-red structureless areas are more frequent in sBCC than ulcerated nodular BCC and pigmented BCC,whereas arborizing vessels,blue-gray ovoid nests,and ulceration are more often in non-sBCC.Dermoscopy could improve the diagnostic accuracy for BCC by allowing the visualization of specific structures.