基底细胞癌临床初诊误诊57例分析

Analysis of Misdiagnosis of 57 Cases with Basal Cell Carcinoma in Patients When First Visit

目的分析基底细胞癌(basal cell carcinoma,BCC)初诊误诊情况及使用皮肤镜辅助诊断对误诊的影响。方法回顾性分析了238例经组织病理确诊的BCC患者临床及组织病理资料,探讨初诊误诊情况;将238例患者分为两组:观察组145例,为使用皮肤镜辅助进行初诊病例;对照组93例,为仅结合病史、皮损特点进行初诊的病例。结果所收集的238例病例中,57例被误诊,不同性别组间、不同年龄组间和不同皮损分布组间误诊率差异均无统计学意义(P>0.05);首诊误诊病种中色素痣12例,脂溢性角化8例,鳞癌4例,黑素瘤4例,鲍温病3例,日光角化病3例,角化棘皮瘤2例,毛发上皮瘤2例,寻常疣3例,肉芽肿3例,血管瘤1例,皮脂腺囊肿1例,表皮囊肿1例,皮肤溃疡2例,盘状红斑狼疮1例,增生性瘢痕1例,性质待查6例。观察组对BCC初步诊断的准确率明显高于对照组,差异有统计学意义(P<0.05)。结论基底细胞癌皮损多样,易误诊。积累临床经验,仔细查体,必要时结合皮肤镜检查可减少误诊的发生,确诊需要行组织病理检查。

Objective To analyze the misdiagnosis rate of basal cell carcinoma in patients who was first visit and to assess the value of dermatoscope in diagnosis.Methods The clinical and histopathological data of 238 patients of basal cell carcinoma were analyzed retrospectively.All 238 patients were divided into two groups.The observation group(145 cases)were initially diagnosed with the help of dermatoscope,while the control group(93 cases)were preliminarily diagnosed only by medical history and skin lesions characteristics.Results Among the 238 cases,57 cases were misdiagnosed.There was no significant difference in the misdiagnosis rate between gender,age and lesion distribution(P>0.05).Among the misdiagnosed diseases,12 cases were misdiagnosed as mole,8 cases as seborrheic keratosis,4 cases as squamous cell carcinoma,4 cases as malignant melanoma,3 cases as Bowen's disease,3 cases as actinic keratosis,2 cases as keratoacanthoma,2 cases as trichoepithelioma,3 cases as verruca vulgaris,3 cases as granuloma,1 case as hemangioma,and 1 case as sebaceous cyst,and 1 case as epidermocele.There were 2 cases misdiagnosed as ulcer,1 case as discoid lupus erythematosus,1 cases as hypertrophic scar and 6 cases as mass pending diagnosis.The accuracy of preliminary diagnosis of BCC in the observation group was significantly higher than that in the control group(χ;=30.450,P<0.05).Conclusion Basal cell carcinoma is easy to be misdiagnosed,because of its various lesions.To reduce the incidence of misdiagnosis,it is important to accumulate clinical experience,conduct careful physical examination,combined with dermatoscopy when necessary.Histopathology can be used to make a exact diagnosis.