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皮肤肿瘤的血管结构:皮肤镜研究

世界核心医学期刊文摘（皮肤病学分册） 2005年第4期1卷 59-60页

作者： Argenziano G. zalaudek I. Corona R. 田中伟 Department of Dermatology Second University of Naples Nuovo Policlinico-Edificio 13 Via Pansini 5 80131 Napoli Italy Dr.

Objectives: To describe the different vascular structures seen by dermoscopy and to evaluate their association with various melanocytic and nonmelanocytic skin tumors in a large series of cases. Design: Digital dermoscopic images of the lesions were evaluated for the presence of various morphologic types of vessels. Setting: Specialized university clinic. Patients: From a larger database, 531 excised lesions (from 517 patients) dermoscopically showing any type of vascular structures were included. Main Outcome Measures: The frequency and positive predictive value of the different vascular structures seen in various tumors were calculated, and the differences were evaluated by the χ2 or Fisher exact test. Results: Arborizing vessels were seen in 82.1%of basal cell carcinomas, with a 94.1%positivepredictive value (P < .001). Dotted vessels were generally predictive for a melanocytic lesion (90.0%, P < .001), and were especially seen in Spitz nevi (77.8%of lesions). In melanoma, linear-irregular, dotted, and polymorphous/atypical vessels were the most frequent vascular structures, whereas milky-red globules/areas were the most predictive ones (77.8%, P=.003). The presence of erythema was most predictive for Clark nevus, whereas comma, glomerular, crown, and hairpin vessels were significantly associated with dermal/congenital nevi, Bowen disease, sebaceous hyperplasia, and seborrheic keratosis, respectively (P < .001 for all). Conclusions: Different morphologic types of vessels are associated with different melanocytic or nonmelanocytic skin tumors. Therefore, the recognition of distinctive vascular structures may be helpful for diagnostic purposes, es-pecially when the classic pigmented dermoscopic structures are lacking.

关键词：皮肤肿瘤血管结构基底细胞癌脂溢性角化黑素瘤博温病血管形态学点状血管精确概率法阳性预测值

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头皮黑色素瘤的皮肤镜检特征

世界核心医学期刊文摘（皮肤病学分册） 2005年第1期1卷 35-36页

作者： zalaudek I Leinweber B. Soyer H.P. 刘超

There is a need to improve the early detection of melanoma of the scalp because it is characterized by a poorer prognosis compared with melanoma on other body *** is a useful tool for the early detection of melanoma but no previous reports on dermoscopic features of scalp melanoma have been *** describe the first case of melanoma of the scalp seen by dermoscopy exhibiting a multicomponent global pattern with atypical pigment network, irregular streaks, and regression *** contrast to the dermoscopic features usually seen in melanoma occurring on the face, the same morphologic type of pigment network usually seen in melanoma of the trunk was observed in our case of scalp melanoma.

关键词：黑色素瘤皮肤镜检早期检测成分构成文献报道分布形态

1例15岁女性慢性萎缩性肢端皮炎患者误诊为静脉功能不全6年

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世界核心医学期刊文摘（皮肤病学分册） 2005年第10期1卷 5-6页

作者： zalaudek I Leinweber B Kerl H Müllegger R.R 罗素菊 Department of Dermatology Medical University of Graz Auenbruggerplatz 8 A-8036 Graz Austria.Dr

Acrodermatitis chronica atrophicans, the characteristic cutaneous manifestation of late Lyme borreliosis, typically occurs in elderly women. To our knowledge, only 4 cases of acrodermatitis chronica atrophicans in children have been described. Prompt diagnosis and treatment are important to prevent progression of disease and extracutaneous complications. We describe a 15-year-old girl with acrodermatitis chronica atrophicans of the left leg that had been misdiagnosed as chronic venous insufficiency for 6 years. Because of the long-standing disease course, skin changes expanded and progressed to marked atrophy. The correct diagnosis was finally based on clinical, histopathologic, and serologic findings. The girl was treated with oral doxycycline for 6 weeks, but her skin changes did not fully normalize. This case illustrates the possibility of acrodermatitis chronica atrophicans appearing in childhood and the difficulties in differentiating vascular disorders from acrodermatitis chronica atrophicans on the basis of the clinical appearance alone.

关键词：莱姆疏螺旋体病程长血管病血清学多西环素

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美罗华治疗原发性皮肤B细胞淋巴瘤

世界核心医学期刊文摘（皮肤病学分册） 2005年第9期1卷 59-60页

作者： Fink-Puches R. Wolf I.H. zalaudek I. L.Cerroni 焦婷 Department of Dermatology University of Graz Auen bruggerplatz 8 A-8036 Graz Austria Dr.

Background: Rituximab is a genetically engineered antibody directed against the CD20 antigen. Intravenous administration of rituximab has been used for the treatment of patients with low-, intermediate-, and high-grade B-cell non-Hodgkin’s lymphomas and is a registered treatment modality for this indication. Treatment of primary cutaneous B-cell lymphoma (CBCL)with intralesionally o rsystemically administered rituximab has been described only in a few cases. Objective: Our purpose was to assess the efficacy of rituximab in the treatment of CBCL. Methods: We performed a retrospective study on 9 patients with CBCL who were treated with intralesional or systemic administration of rituximab. Results: Two patients treated with systemic rituximab achieved complete remission. Complete remission could be observed in 6 of 7 patients after 1 to 8 cycles of intralesional treatment with rituximab. In one patient one of two lesions showed a partial remission after 4 cycles of treatment, whereas the second showed complete remission. A local recurrence was observed in one patient after 27 months of follow-up and in two patients recurrences developed at other body sites after 12 and 14 months of follow-up. No severe side effect occurred except for slight pain during intralesional injection. Conclusion: Rituximab therapy is a well-tolerated and effective treatment for primary CBCL. In comparison to intravenous administration, intralesional application of the drug allows the use of lower dosages. Intralesional therapy with rituximab deserves further investigation and comparison to systemic administration of the drug in controlled multicenter studies.

关键词：美罗华 B细胞淋巴瘤 CBCL 局部注射皮损内注射用药量工程研制单株

色素性光化性角化病的临床和皮肤镜诊断上的不足

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世界核心医学期刊文摘（皮肤病学分册） 2006年第3期2卷 13-13页

作者： zalaudek I. FerraraG. Leinweber B. 崔荣 Department of Dermatology Second University of Naples Via S. Pansini 5 I- 80131 Naples Italy Dr

Pigmented actinic keratosis andmelanomamay exhibit overlapping clinical features, thus representing a diagnostic challenge for dermatologists. Although the differentiation between these two entities is traditionally done by histopathology,dermoscopy has been utilized as a useful additional aid for improving the clinical diagnostic accuracy of such pigmented skin lesions. We report the clinical and dermoscopic features of two pigmented actinic keratoses to discuss the difficulties in their preoperative differential diagnosis.

关键词：色素性皮肤病光化性角化病临床诊断诊断能力皮肤镜组织病理学检查鉴别诊断皮肤科医师黑色素瘤

皮肤镜用于有挑战性的黑色素瘤:如何对临床上看似良性的黑色素瘤预警

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世界核心医学期刊文摘（皮肤病学分册） 2005年第10期1卷 37-37页

作者： zalaudek I Ferrara G Di Stefani A Argenziano G 冯义国 Department of Dermatology Second University of Naples Via S. Pansini 5 I-80131 Naples Italy.Dr

Melanoma may mimic clinically a number of benign skin tumours by exhibiting overlapping features that do not allowaccurate differentiation. Dermoscopy is a noninvasive diagnostic tool allowing the evaluation of specific subsurface morphological structures that are useful in most cases to distinguish melanoma from other melanocytic and nonmelanocytic skin tumours. In order to minimize the risk of missing melanoma, the diagnosis should be based on a good correspondence between the clinical and the dermoscopic findings. The case presented here refers to a melanoma clinically simulating dermatofibroma that was biopsied because dermoscopic examination revealed unusual features that did not confirm the clinical diagnosis.

关键词：黑色素瘤非损伤性诊断文章报道

获得性黑色素细胞痣皮肤镜检类型的年龄相关分布

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世界核心医学期刊文摘（皮肤病学分册） 2006年第6期2卷 27-27页

作者： zalaudek I. Grinschgl S. Argenziano G. R. Hofmann Wellenhof 刘艳 Department of Dermatology Medical University of Graz Auenbruggerplatz 8 A-8036Graz Austria

Background: Based on the dermoscopic classification of acquired melanocytic naevi, six different dermoscopic types can be distinguished by morphology (globular, globular-reticular, globular-homogeneous, reticular, reticular-homogeneous, homogeneous) and by pigment distribution (uniform, central hyperpigmentation, central hypopi- gmentation, peripheral hyperpigmentation, peripheral hypopigmentation, multifocal hyper/ hypopigmentation). It has been suggested that most individuals harbour one predominant dermoscopic type among their naevi. Objectives: To evaluate whether the age of the patient influences the predominant naevus pattern observed in individuals with multiple acquired melanocytic naevi. Methods: Individuals were recruited from the pigmented skin lesion clinic in Graz between July 2000 and February 2001. Individuals with at least 10 melanocytic naevi were selected consecutively until a total of 10 individuals in each of five age groups was obtained. Age groups were: 0-15 years, 16-30 years, 31-45 years, 46-60 years and > 60 years. Digitized images of acquired melanocytic naevi, defined as benign melanocytic proliferations having a diameter of at least 5 mm with a macular component and which were not apparent within the first year of life, were evaluated by dermoscopic criteria. The associations of dermoscopic features as a function of patient age were analysed. We calculated absolute numbers and frequencies, given as percentages, as well as predominance of the dermoscopic types of naevi in the different age groups. Results: Analysis of 1268 naevi revealed that the globular pattern predominated in the youngest age group. By contrast, the reticular and/or homogeneous patterns were increasingly exhibited in naevi from older individuals (older than 15 years). Uniform pigmentation was most common in melanocytic naevi in the youngest age group, while central hyperpigmentation was predominantly seen in the group of individuals aged 16-30 years. Conclusions: The pr

关键词：黑色素细胞痣年龄相关皮肤镜获得性镜检不同年龄组患者年龄色素沉着色素减退色素性皮肤病

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Bowen病的皮肤镜检查

世界核心医学期刊文摘（皮肤病学分册） 2005年第1期1卷 3-3页

作者： zalaudek I. Argenziano G. Leinweber B. 罗素菊冯义国 Department of Dermatology Second University of Naples Via S. Pansini 5 I-80131 Naples Italy Dr.

Background: Dermoscopy improves the diagnostic accuracy in pigmented skin lesions, but it is also useful in the evaluation of nonpigmented skin tumours as it allows the recognition of vascular structures that are not visible to the naked eye. Bowens disease (BD) or squamous cell carcinoma in situ is usually nonpigmented, but may also rarely be pigmented. Objective: To describe the dermoscopic features in a series of pigmented and nonpigmented BD. Methods: Dermoscopic images of 21 histopathologically proven BD were evaluated for the presence of various dermoscopic features. Each lesion was photographed using the Dermaphot (Heine Optotechnik, Herrsching, Germany), at 10-fold magnification, and the colour slides were scanned to digital format using a Kodak Photo CD system. Results: The majority of cases of BDrevealed a peculiar dermoscopic pattern characterized by glomerular vessels (90%) and a scaly surface (90%). In addition, in pigmented BD small brown globules regularly packed in a patchy distribution (90%), and structureless grey to brown pigmentation (80%) were observed. Conclusions: Dermoscopy can be helpful for diagnosing BD because of the presence of repetitive morphological findings such as glomerular vessels and a scaly surface. In pigmented BD, small brown globules and/or homogeneous pigmentation can be seen as well.

关键词： Bowen 皮肤镜检原位鳞状细胞癌皮肤肿瘤色素性组织病理学系统扫描血管结构无结构成片分布

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皮肤镜三点式检查单:一项开放的因特网研究

世界核心医学期刊文摘（皮肤病学分册） 2006年第6期2卷 36-36页

作者： zalaudek I. Argenziano G. Soyer H.P. 罗素菊(译) 不详 Department of Dermatology Second U- niversity of Naples Via S. Pansini 5 I -80131 Naples Italy

Background: In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. Objectives: To reevaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. Methods: The study was conducted via the internet to provide worldwide access for participants. After a short webbased tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. Results: Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0%and this value remained basically uninfluenced by the observers’professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9%and was significantly influenced by the profession, with dermatologists performing best. Conclusions: Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.

关键词：三点式皮肤镜检查因特网诊断敏感性可重复性职业影响网状结构筛查工具世界范围内