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皮肤显微镜检识别黑色素瘤的缺陷

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世界核心医学期刊文摘（皮肤病学分册） 2005年第6期1卷 49-49页

作者： Skvara h. Teban L. Fiebiger M. h.kittler 阎小宁 Dr.Department of Dermatology University of Vienna Medical School Waehringerguertel 18- 20 A-1090 Vienna Austria

Objective: To compare dermoscopic features of melanocytic nevi with those of early melanomas that were not excised initially because of the ir uncharacteristic clinical and dermoscopic appearance. Design: Retrospective study of the baseline images of 325 melanocytic skin lesions that were observed by digital dermoscopy and finally excised because of changes over time. Setting: A dermatologic clinic and a dermatologic department at a university hospital. Main Outcome Measures: Comparison of baseline images of melanomas and melanocytic nevi by pattern analysis, the ABCD rule of dermoscopy, and the 7- point checklist. Results: Baseline dermoscopic images of 262 melanocytic nevi and 63 melanomas from 315 patients were included in the analysis. The patterns of dermoscopic features observed in the baseline images of melanocytic lesions finally diagnosed as melanomas during follow-up did not differ substantially from the patterns observed in the baseline images of melanocytic nevi. Pattern analysis, the ABCD rule of dermoscopy, and the 7- point checklist failed to achieve adequate diagnostic accuracy for melanoma. In retrospect, no dermoscopic feature or pattern of features could be identified that reliably differentiated between melanomas and melanocytic nevi at the time of the first presentation. Conclusion: Dermoscopy depends on the appearance of classic dermoscopic features and is therefore limited in the diagnosis of very early and mainly featureless melanomas.

关键词：黑色素瘤显微镜检黑素细胞痣黑素瘤黑色瘤显微特征大学医院收入分析显微观察列表法

利用连续皮肤镜成像识别无临床特点的初期黑素瘤

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世界核心医学期刊文摘（皮肤病学分册） 2006年第12期2卷 57-58页

作者： kittler h. Guitera P. Riedl E. 王琼 Department of Dermatology University of Vienna Medical SchoolWaehringerguertel 18-20 A-1090 Vienna Austria Dr.

Objectives: To examine the role of sequential dermoscopy imaging in detecting incipient melanoma and to elucidate the impact of length of follow-up on the relevance of observed changes. Design: Baseline and follow-up images of melanomas and melanocytic nevi excised only because of changes across time were inspected on a computer screen and assessed according to prospectively defined criteria. Lesions were strati-fied into 3 groups according to the length of follow-up. Setting: Three hospital-based referral centers in Europe and Australia. Patients: Four hundred sixty-one patients selected for digital dermoscopy monitoring. Main Outcome Measures: Description and comparison of dermoscopy features and changes in melanomas and melanocytic nevi at baseline and after follow-up. Results: We inspected baseline and follow-up images of 499 melanocytic skin lesions from 461 patients. The histopathologic diagnosis was melanoma in 91 cases and melanocytic nevus in 408. Most melanomas (58.2%; n=53) were in situ, and the median thickness of invasive melanomas was 0.38 mm. Dermoscopy features of melanomas and nevi did not differ significantly at baseline. After follow-up of 1.5 to 4.5 months, 61.8%of the melanomas showed no specific dermoscopy features for melanoma. This value declined to 45.0%after follow-up of 4.5 to 8.0 months and to 35.1%after more than 8.0 months. We could not differentiate melanomas and changing nevi by means of observed changes or dermoscopy features when follow-up was shorter than 4.5 months. With longer follow-up, melanomas tended to enlarge asymmetrically with architectural and color changes, and nevi tended to enlarge symmetrically without architectural and color changes. Conclusions: Sequential dermoscopy imaging detects incipient melanomas when they are still featureless. Interpretation of changes observed during follow-up depends on the length of follow-up.

关键词：黑素瘤黑色素瘤皮肤镜黑素细胞痣

3种光剂量δ-氨基-γ-酮戊酸光动力疗法治疗光线性角化病的疗效:一项随机、观察者盲法、患者自评的比较研究

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世界核心医学期刊文摘（皮肤病学分册） 2006年第2期2卷 10-11页

作者： Radakovic-Fijan S. Blecha-ThalhammerU. kittler h. A. Tanew 冯义国 Division of Special and EnvironmentalDermatology Department of DermatologyMedical University of ViennaWaehringer Guertel 18- 20 A- 1090Vienna AustriaDr.

Background: Topical 5- aminolevulinic acid- based photodynamic therapy (ALA- PDT) has been established in recent years as an effective treatment for disseminated actinic keratosis (AK). As yet, however, data are lacking to define the optimal light dose for activation of ALA- induced protoporphyrin IX in AK. Objective: In the present study our purpose was to compare the efficacy and tolerability of 3 different doses of red light for ALA- PDT of AK. Methods: Twenty- seven patients with at least 3 clearly definable, mild or moderate AKs on the scalp or face entered the study. After occlusion for 4 hours with 20% ALA, one AK each was irradiated at random with a single dose of 70, 100, or 140 J/cm2. PDT- induced pain was assessed by the patients by means of a visual analog scale that graded pain intensity between 0 and 10. Follow- up examinations were performed 1 and 3 months after PDT. Results: One month after PDT, the rate of complete remission (CR)was 89% for 70 J/cm2, 92% for 100 J/cm2, and 81% for 140 J/cm2. The CR rates at 3 months were 81% for 70 J/cm2, 77% for 100 J/cm2, and 69% for 140 J/cm2. No significant difference in therapeutic efficacy was found among the 3 light doses at either 1month (P = .36) or 3 months (P=.96) after PDT. The degree of PDT- induced pain during irradiation was substantial and not statistically different (P=.06) for all 3 light doses. Limitations: The conclusions from this study are limited by the small sample size and only apply to topical ALA- PDT. Conclusion: Our results indicate that a red light dose of 70 J/cm2 may be sufficient for effective topical ALA- PDT of disseminated, mild to moderate AK on the face and scalp.

关键词：光线性角化病光动力疗法患者自评光剂量盲法原卟啉封包疼痛强度播散性完全缓解率