结节溃疡型基底细胞癌临床、组织病理与皮肤镜特征分析

Analysis of clinical,histopathological and dermoscopic features of nodular-ulcerative basal cell carcinoma

目的:研究结节溃疡型基底细胞癌(nodular-ulcerative basal cell carcinoma, NUBCC)的临床、组织病理与皮肤镜特征。方法:回顾性分析59例NUBCC和23例非结节溃疡型基底细胞癌(non-nodular-ulcerative basal cell carcinoma, NNUBCC)患者的临床资料和皮肤镜图像资料。结果:71.2%的NUBCC皮损位于面部中1/3区域,较同部位发病的NNUBCC皮损(39.1%)更为多见(P<0.05);而26.1%的NNUBCC皮损位于躯干,较同部位发病的NUBCC皮损(6.8%)更多见(P<0.05)。组织病理上,NUBCC以结节型为主,NNUBCC以浅表型为主。在皮肤镜下,NUBCC较NNUBCC更容易出现树枝状毛细血管扩张、蓝灰色卵圆形巢和大蓝灰色无结构区(P值均<0.05)。所有研究对象中,有23.2%可见到褐色结构性区。结论:NUBCC的发病部位及病理分型的分布与NNUBCC相比有差别。皮肤镜有助于鉴别NUBCC与NNUBCC,尤其是大蓝灰色无结构区有助于NUBCC的皮肤镜诊断,值得重视。

Objective:To investigate the clinical,histopathological and dermoscopic features of nodular-ulcerative basal cell car-cinoma(NUBCC).Methods:A retrospective analysis of 59 NUBCC and 23 non-nodular-ulcerative basal cell carcinoma(NNUBCC)was conducted.Results:About 71.2%of NUBCC lesions were found in the middle 1/3 area of the face.It was more common than NNUBCC lesions in the same area(39.1%,P<0.05).Compared with NUBCC lesions in the same area,NNUBCC lesions were more likely to be found in the trunk(26.1%,P<0.05).Histopathologically,most NUBCCs were of the nodular type,while most NNUBCCs were of the superficial type.Dermoscopic examination showed that NUBCCs were more likely to have branching vessels(P<0.05),blue-gray oval nests(P<0.05),and large blue-gray unstructured areas(P<0.05)than NNUBCCs.Of all the cases in this study,23.2%had brown structural areas.Conclusion:The location and pathological classification of NUBCC are different from those of NNBCC Dermoscopy helps to distinguish NUBCC from NNUBCC.The large grey-blue structureless area under dermoscope is worthy of attention because it helps to diagnose NUBCC.