意大利皮肤黑素瘤患者的自我监测

Self-detection of suspicious pigmented skin lesion combined with rapid referr al to dermatologie centres is the key strategy in the fight against melanoma. Th e investigation of factors associated with pattern of detection of melanoma (sel f-vs. nonself-detection) may be useful to refine educational strategies for th e future. We investigated the frequency of melanoma self-detection in a Mediter ranean populat ionatintermediatemelanoma risk. A multicentric survey identified 816 consecutive cases of cutaneous melanoma in the period January to December 20 01 in 11 Italian clinical centres belonging to the Italian Multidisciplinary Group on M elanoma. All patients filled a standardized questionnaire and were clinically ex amined by expert dermatologists. Self-detected melanomas were 40.6%, while the remaining lesions were detected by a dermatologist (18.5%), the family physici an (15.2%), other specialists (5%), the spouse (12.5%), a friend or someone e lse (8.2%). Variablesassociated with self-detected melanomas were female sex, young age, absence of atypical nevi, knowledge of the ABCD rule, habit of perfor ming skin self-examination. Self-detected melanomas did not differ from nonsel f-detected tumours in term of lesion thickness; however, patients with self-de tected melanomas waited a longer period before having a diagnostic confirmation (patient’s delay) (>3 months:odds ratio, 3.89; 95%confidence interval, 2.74- 5.53). In order to reduce the patients’delays, educational messages should adeq uately stress the need for a prompt referral to a physician once a suspicious pi gmented lesion is self-detected.

外阴部色素沉着性脂溢性角化病临床表现似恶性黑素瘤:对1例患者进行临床、表皮发光显微镜病理学研究

The diagnosis of seborrheic keratosis is, in general, a clinical one, but in s ome cases, the differential diagnosis between pigmented seborrheic keratosis and malignant melanoma is difficult. Dermoscopy may improve the early diagnosis of vulvar melanoma and thus play a role in the preoperative classification of pigme nted lesions at this particular site. We report the first case of a pigmented se borrheic keratosis of the vulva clinically mimicking a malignant melanoma, whose dermoscopic features have been investigated together with their pathologic corr elates. Dermoscopically our case shows the absence of comedo-like openings and the presence of the pseudo-network. Dermoscopy is therefore a useful method for the differential diagnosis of pigmented lesions even in the vulva.

黑色素细胞痣的电子皮肤镜特征

In order to investigate the possible role of dermoscopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Two dermatologists expert in dermoscopy retrospectively evaluated all images based on the presence of dermoscopic findings to analyze which epiluminescence microscopy features were more frequently associated with each type of combined nevus. Dermoscopy may provide useful information in the non-invasive diagnosis of combined nevi, allowing a conservative management, but this may be limited to combined nevi including a blue nevus component. Conversely, combined nevi including a Spitz nevus component may be difficult to classify even by dermoscopy, thus requiring careful monitoring or surgical excision.

对“真性”无黑色素性黑色素瘤的皮肤镜检查:一项临床皮肤镜-病理的病例研究

Completely amelanotic melanomas are rare and therefore often misclassified, with tragic consequences for patients. The use of dermoscopy for these lesions has not been validated yet because of the lack of studies that are based on large series. The analysis of the vascular pattern, which is often the only dermoscopic parameter to be seen, is therefore essential for a correct diagnosis. We present a case of “ true” amelanotic melanoma on the forehead of an 89- year- old man, which clinically mimicked squamous cell carcinoma. The patient was investigated both clinically and by focusing on his dermoscopic features and their pathologic correlates. The dermoscopic diagnostic algorithms routinely used for pigmented lesions are not helpful in diagnosing amelanotic melanoma because they are based on specific parameters not normally seen in amelanotic lesions. In the light of our experience, pattern analysis is the most reliable method for diagnosing these particular lesions correctly because it allows in- depth morphologic analysis of the few parameters found.

皮肤镜在黑人中的应用

Background: Little is known about the use of dermoscopy in nonwhite-skinned populations and whether it can influence diagnostic performance. Objectives: To evaluate for the first time the utility and efficacy of dermoscopy in a black population for the diagnosis of pigmented cutaneous lesions. Methods: In total, 100 consecutive clinically doubtful or equivocal pigmented skin lesions in black patients were submitted to dermoscopic examination. The lesions were observed using dermoscopy by two groups of dermatologists, one in Brazil (in vivo) and the other in Italy (on slide images). Besides diagnosis, each group recorded on the same type of form the dermoscopic features present. Results: Of 100 clinically suspicious cases, 79 were Clark naevi, 15 seborrhoeic keratoses, four blue naevi, one dermatofibroma and one melanoma. The two groups of observers succeeded in identifying and classifying all the lesions to such a margin of diagnostic accuracy that only a few cases (three Clark naevi) were subjected to surgical excision to confirm diagnosis. Conclusions: Darker pigmentation of the skin does not impede the identification of single dermoscopic features. As in lighter-skinned populations, dermoscopy in black people can also lead to early and accurate diagnosis of melanoma, thereby significantly reducing the number of unnecessary excisions.