单发易误诊伴Meyerson现象的血管角皮瘤皮肤镜分析

Dermatoscopic analysis of vascular keratoderma with single misdiagnosis and Meyerson phenomenon

目的探讨单发易误诊伴Meyerson现象的血管角皮瘤皮损特点及皮肤镜图像特征。方法回顾性选取2019年1月至2023年9月于南京医科大学附属无锡人民医院皮肤科接诊的13例单发被误诊为其他皮肤肿瘤的伴Meyerson现象的血管角皮瘤患者作为研究对象,分析其皮损的皮肤镜特征及临床资料。结果13例患者中,4例累及背部,6例累及下肢,1例累及腹部,1例累及右上肢,1例累及臀部。皮损表现为黑红色至黑色斑块,周围可见红斑,9例患者周围红斑呈环状,4例患者周围红斑呈片状。皮肤镜下:13例患者中心皮损均表现为红斑背景上可见群集性分布圆形、椭圆形、不规则结构的紫红色、黑色腔隙,表面可见白色面纱样结构。6例患者局部可见出血性血痂,6例患者局部可见沟脊结构,1例患者见少量白色鳞屑,4例患者中心皮损周围可见片状红斑,9例患者中心皮损周围可见环状红斑,皮损中心与环状红斑两者间可见黄色均质样结构。组织病理学改变均可见表皮角化过度,棘层不规则肥厚,真皮乳头层可见多发扩张性、薄壁的血管,真皮浅层血管周围炎症细胞浸润,以淋巴细胞为主。结论单发伴Meyerson现象的血管角皮瘤仅凭借肉眼诊断极易被误诊,甚至会被误诊为皮肤恶性肿瘤,组织病理学仍是诊断和鉴别的金标准,皮肤镜是诊断伴Meyerson现象的血管角化瘤的一种简单实用的工具,可以提高医师对本病的诊断准确率。

Objective To investigate the lesion and dermoscopic features of a single angiokeratoma with Meyerson phenomenon,which is easily misdiagnosed.Methods A total of 13 patients with vascular keratoderma with Meyerson phenomenon who were misdiagnosed as other skin tumors and were treated in the Department of Dermatology,Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2019 to September 2023 were retrospectively analyzed.Their dermatoscopic features and clinical data of the lesions were analyzed.Results Among the 13 cases,4 cases involved the back,6 cases involved the lower limbs,1 case involved the abdomen,1 case involved the right upper limb,and 1 case involved the buttock.The skin lesions appeared as black-red to black plaques with surrounding erythema.The surrounding erythema was ring-like in 9 patients and flaky in 4 patients.Under dermoscopy,the central skin lesions of 13 patients showed clusters of purplish red or black cavities with round,oval,or irregular structures on an erythematous background,and white veil-like structures on the surface.Local hemorrhagic eschar was seen in 6 patients,local groove ridge structure was seen in 6 patients,a small amount of white scale was seen in 1 patient,patchy erythema was seen around the central skin lesion in 4 patients,ring erythema was seen around the central skin lesion in 9 patients,and yellow homogeneous structure was seen between the center of the skin lesion and the ring erythema.Histopathological changes showed epidermal hyperkeratosis,irregular hypertrophy of the spinous layer,multiple dilated and thin-walled blood vessels in the papillary dermis,and perivascular inflammatory cell infiltration(mainly lymphocytes)in the superficial dermis.Conclusion A single angiokeratoma with Meyerson phenomenon is easily misdiagnosed by gross examination,and may even be misdiagnosed as a cutaneous malignant tumor.Histopathology is still the gold standard for diagnosis and differential diagnosis.Dermoscopy is a simple and practical tool for the diagnosis of angiokeratoma with Meyerson phenomenon,which can improve the diagnostic accuracy of the disease.