误诊为色素痣的其他疾病140例分析

Analysis of 140 Patients with Other Diseases Misdiagnosed as Pigmented Nevus

目的分析其他相关疾病误诊为色素痣原因,并探讨防范措施,提高临床诊断水平。方法回顾性分析2019年1月—2022年12月宣城市人民医院病理数据库中140例初诊为色素痣,但经组织病理检查排除色素痣诊断的患者临床及组织病理资料。结果误诊为皮肤色素痣140例,男55例,女85例,年龄(46.64±15.27)岁。皮损发生部位:头面颈部55例,躯干部44例,四肢22例,手足部13例,外阴6例。经组织病理诊断为脂溢性角化病70例,血管角皮瘤9例,基底细胞癌8例,皮肤纤维瘤7例,角质层出血6例,寻常疣4例,表皮囊肿4例,表皮鳞状上皮增生3例,皮赘3例,日光性角化病2例,恶性黑素瘤2例,皮脂腺增生2例,毛发上皮瘤2例,汗孔瘤2例,钙化上皮瘤2例,其他14例。结论多种疾病与色素痣临床特征相似,临床误诊率较高,综合临床特征、皮肤镜检查、皮肤组织病理检查等可明确诊断,提高诊断率。

Objective To analyze causes of misdiagnosis of other related diseases as pigmented nevus,and to explore preventive measures so as to improve the clinical diagnosis.Methods A retrospective analysis was conducted on the clinical and pathological data of 140 cases which were selected from the pathological database of Xuancheng People's Hospital from January 2019 to December 2022 and initially misdiagnosed as pigmented nevus before histopathological examination.Results Among the 140 cases clinically misdiagnosed as pigmented nevus,55 were males and 85 were females,aged 46.64±15.27 years.There were 55 cases of skin lesions on head,face and neck,44 cases on trunk,22 cases on limbs,13 cases on hands and feet,and 6 cases on vulva.Based on histopathological manifestation,70 cases were misdiagnosed with Seborrheic keratosis,9 with angiokeratoma,8 with basal-cell carcinoma,7 with cutaneous fibroma,6 with epidermis hemorrhage,4 with verruca vulgaris,4 with epidermoid cyst,3 with epidermal squamous cell hyperplasia,3 with soft fibroma,2 with actinic keratosis,2 with malignant melanoma,2 with sebaceous gland hyperplasia,2 with hair epithelioma,2 with syringoma,2 with calcified epithelioma and 14 with other skin diseases.Conclusion In clinical practice,many kinds of diseases are similar to pigmented nevus and are more likely to be misdiagnosed.Combination of clinical features,dermatoscopic examination and skin histopathology can make definite diagnosis and improve the diagnostic rate.