566例头面部色素痣样皮损的临床病理特征及误诊原因分析

Analysis of Clinical and Pathological Characteristics and Misdiagnosis Causesin 566 Cases of Facial Pigmented Nevus-Like Skin Lesions

目的探讨566例头面部色素痣样皮损的临床及病理学特点,比较临床诊断与病理诊断的符合率,提高临床医师对色素痣样皮损的认识及相关皮肤病的鉴别诊断。方法回顾性分析566例头面部色素痣样皮损患者的临床资料,采用临床诊断、皮肤镜检查和病理活检等方法,分析不同年龄和性别中各种色素痣样皮损皮肤病的分布情况及误诊情况。结果566例中,男性267例,女性299例;病理诊断为色素痣245例,脂溢性角化病210例,蓝痣26例,基底细胞癌3例,疣状表皮痣71例,其他如皮脂腺痣、皮脂腺增生、雀斑样痣、皮脂腺囊肿、毛发上皮瘤等共11例。色素痣样皮损发病部位多在两颊部(36.9%),其次为额部、头皮、耳周和眼周(占比分别为19.3%、11.7%、11.3%和10.8%),前颈仅占2.1%。临床诊断与皮肤镜和活检病理诊断一致的病例为486例,总符合率为85.9%,误诊率为14.1%。结论色素痣样皮损临床诊断为色素痣符合率较高,但仍存在一定程度的误诊情况,应适当采用辅助检查以明确诊断。

Objective To explore the clinical and pathological characteristics of 566 cases of facial pigmented nevus-like skin lesions,compare the consistency between clinical diagnosis and pathological diagnosis,and improve the understanding of pigmented nevus-like skin lesions by clinical physicians and the differential diagnosis of related skin diseases.Method A retrospective analysis was conducted on the clinical and pathological data of 566 patients with facial pigmented nevus-like skin lesions.Clinical diagnosis,skin microscopic observation,pathological biopsy,and other methods were used to analyze the distribution and misdiagnosis of various pigmented nevus-like skin lesions in different ages and genders.Results Among the 566 cases,there were 267 males and 299 females,pathological diagnosis showed 245 cases of pigmented nevi,210 cases of seborrheic keratosis,26 cases of blue nevi,3 cases of basal cell carcinoma,71 cases of verrucous epidermal nevi,and a total of 11 cases of other types such as sebaceous nevi,sebaceous gland hyperplasia,freckle\|like nevi,sebaceous gland cysts,and hair epithelial tumors.The most common site of pigmented nevus-like skin lesions is on the cheeks,accounting for 36.9%,followed by the forehead,scalp,ear and eye areas,accounting for 19.3%,11.7%,11.3%,and 10.8%,respectively.The anterior neck only accounts for 2.1%.There were 486 cases whose clinical diagnosis was consistent with the pathological diagnosis of dermatoscopy and biopsy,with a total conformity rate of 85.9%,80 cases did not match,with a misdiagnosis rate of 14.1%.Conclusion The clinical diagnosis of pigmented nevus-like skin lesions has a high accuracy rate,but there is still a certain degree of misdiagnosis,auxiliary examinations should be appropriately used to further confirm the diagnosis.