关于部分非黑色素性皮肤肿瘤皮肤镜下特点的研究

发布时间：2018-03-18 10:22

本文选题：皮肤镜　切入点：脂溢性角化病　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景：皮肤镜除了可以探测色素结构,也可用于识别血管结构和其他精细的皮肤结构特征。近年来,皮肤镜技术越来越多的在一些非色素性皮肤病中有应用,如非黑色素性肿瘤,炎症性及感染性疾病,甚至用于随访非色素性疾病的治疗效果。脂溢性角化病、基底细胞癌、日光性角化病、鲍温病是临床上常见的四种非黑素性皮肤肿瘤。这四种疾病在临床上有时候仅依据临床表现往往较难鉴别,且这四种疾病的危害性与处理方法各不相同。目的：总结临床和病理确诊的脂溢性角化病、基底细胞癌、日光性角化病、鲍温病的皮肤镜特征,为皮肤镜鉴别色素性皮损提供依据。方法：皮肤镜Heine Delta 20用于观察病理确诊的70例脂溢性角化病,71例基底细胞癌,51例日光性角化病,14例鲍温病患者的皮损,放大倍数一般为10倍,皮肤镜连接于单反相机(Nikon D70,日本尼康公司)上以获取皮肤镜照片。结果：本项研究70例脂溢性角化病患者中皮肤镜下主要表现为粉刺样开口和粟粒样囊肿分别为78.6%和65.7%；此外包括脑回状结构(44.2%),鳞屑(77.1%),发夹状血管结构(25.7%)等。71例基底细胞癌患者中大的蓝灰色卵圆形细胞巢56例(78.9%),多发的蓝灰色小球43例(60.7%),溃疡41例(57.7%),血管模式53例(74.6%)中树枝状血管37例(52.1%),毛细血管扩张37例(52.1%)。在表现有非色素性皮损的17例日光性角化病患者中17例(100%)表现为“草莓表面样”模式,即红斑背景下的假网格状结构(74.5%),绕以白色晕圈的凸出的毛囊开口(43.1%),伴以白色至黄色角质栓(64.7%)的“靶形”样毛囊开口,类似草莓的表面；红斑在非色素性皮损中亦较常见82.4%)。在表现有色素性皮损的19例日光性角化病患者中,表现为毛囊口周围点状或球状结构有10例,“环形颗粒状”结构有6例,表现有褐色或黑色假网格结构7例。14例鲍温病患者中大部分表现有特异性的鳞屑(78.60%)和球状血管(57.1%),白色无结构区域(35.5%),棕褐色点状结构呈簇状分布(50%)。结论：皮肤镜将有助于提高脂溢性角化病、基底细胞癌、日光性角化病、鲍温病的诊断率,为临床上非黑素性肿瘤的鉴别诊断提供有力的帮助。本次研究的不足之处是未展开对诊断标准的诊断敏感性和特异性的评价,有待于进一步的后续研究。而且在应用皮肤镜时,不能脱离病人的临床特点、实验室检查、影像学表现等,亦不能取代病理活检。
[Abstract]:Background: in addition to detecting pigmented structures, dermoscopes can also be used to identify vascular and other fine skin structural features. In recent years, dermatoscopy has been increasingly used in some non-pigmented skin diseases. For example, non-melanoma, inflammatory and infectious diseases, and even for follow-up treatment of non-pigmented diseases. Seborrheic keratosis, basal cell carcinoma, sunlight keratosis, Bowen's disease is a common clinical non-melanoma of the skin. These four diseases are sometimes difficult to distinguish according to their clinical manifestations. Objective: to summarize the clinical and pathological features of seborrheic keratosis, basal cell carcinoma, solar keratosis and Bowen's disease. Methods: the dermatoscope Heine Delta 20 was used to observe the skin lesions of 71 cases of basal cell carcinoma and 51 cases of solar keratosis in 70 cases of seborrheic keratosis diagnosed pathologically, and 14 cases of Bowen's disease. The magnification is usually 10 times, Dermoscopy was attached to Nikon D70 (Nikon D70, Japan) to obtain dermoscopy. Results: in this study, 70 patients with seborrheic keratosis presented mainly with pimple-like openings and miliary cysts, respectively. 78.6% and 65.7; in addition, there were 44.2 gyrus, 77.1 scales and 25.775% of basal cell carcinoma. Among the 71 patients with basal cell carcinoma, 56 cases had large blue-gray oval cell nests, 43 cases had multiple blue-gray pellets, 41 cases had ulcers 57.77.7m, and 53 had vascular pattern. There were 37 cases with dendritic vessels and 37 cases with capillary dilatation. Among the 17 cases with nonpigmented keratosis, 17 cases showed "strawberry surface like" pattern. That is, the pseudo-reticular structure in the background of erythema (74.5a) is similar to the surface of strawberry, with a "target-shaped" hair-follicle opening with a white to yellow keratinocyte (64.7a) around the bulging hair follicle opening with a white halo circle. Erythema was also more common in non-pigmented lesions than in non-pigmented lesions. In 19 cases of solar keratosis with pigmented lesions, there were 10 cases with punctate or spherical structures around the hair follicle orifice, and 6 cases with "ring granular" structure. There were 7 cases of brown or black pseudo-grid structure. 14 cases of Bowen's disease. Most of them showed specific scales 78.60) and spherical vessels 57.1%. The white unstructured area was 35. 5% and the brown spot structure was distributed in cluster shape. Conclusion: the dermatoscope will. Help to improve seborrheic keratosis, The diagnostic rate of basal cell carcinoma, solar keratosis and Bowen's disease provides powerful help for the differential diagnosis of non-melanoma in clinic. The deficiency of this study is that the diagnostic sensitivity and specificity of the diagnostic criteria have not been evaluated. Further research is needed. And the application of dermatoscope cannot be separated from the clinical features, laboratory examination, imaging findings, etc., nor can it replace pathological biopsy.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.5

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