Vertical ex vivo dermoscopy of pigmented skin lesions

[M. V. Popadić]

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Uvod: značaj vertikalne ex vivo dermoskopije u pružanju dijagnostičkih informacija još uvek nije analizirana. Ciljevi: definisati, opisati i utvrditi značaj struktura vidljivih vertikalnom ex vivo dermoskopijom u dijagnostici i diferencijaciji pigmentnih benignih i svih malignih lezija kože bez obzira na pigmentaciju, i utvrditi tačnost tehnike u proceni tumorskih margina. Metod: prospektivno istraživanje sprovedeno je u dva univerzitetska centra. Digitalne fotografije kompletno ekscidiranih lezija kože, fiksiranih u formalinu, pre dalje obrade, dermoskopski su evaluirane analizom obrasca. Rezultati: analizom 80 pigmentih benignih lezija, zapažen je značaj vertikalne ex vivo dermoskopije u dijagnostici i/ili diferencijaciji plavog nevusa, seboroične keratoze i hemangioma od drugih lezija kože. Među malignim lezijama, bazocelularni karcinomi (BCC) su imali najraznovrsniju dermoskopsku prezentaciju na vertikalnom preseku, dok je većina skvamocelularnih carcinoma (SCC) imala sličnu prezentaciju. Vertikalna ex vivo dermoskopija svih tankih melanoma bila je skoro identična, za razliku od nodularnih melanoma. Dermatološka procena tačnosti dubine invazije bila je 0,75 za BCC, 0,81 za SCC i 0,80 za melanom, dok je procena patologa iznosila 0,65, 0,75, odnosno 0,83. Međuposmatračko slaganje iznosilo je 0,71 za BCC, 0,80 za SCC i 0,83 za melanom. Dermatološka procena tačnosti širine bila je 0,82 za BCC, 0,87 za SCC i 1,00 za melanom. Zaključci: vertikalna ex vivo dermoskopija može doprineti međusobnoj diferencijaciji BCC-a, SCC-a i melanoma, kao i diferencijaciji pigmentnih benignih od malignih lezija kože. Bez obzira na specijalnost lekara, vertikalna ex vivo dermoskopija omogućava precizniju procenu dodatnih karakteristika tumora.

dermoskopija, ex vivo dermoskopija, vertikalni pogled, histopatologija, pigmentne lezije kože, maligne lezije kože

Background: the importance of vertical ex vivo dermoscopy in providing diagnostic information has not been analyzed yet. Objectives: to define, describe, and determine the significance of structures visible by vertical ex vivo dermoscopy in the diagnosis and differentiation of pigmented benign and all malignant skin lesions, regardless of pigmentation and to determine the accuracy of the technique in the assessment of tumor margins. Method: the prospective study was conducted in two University centers. Digital images of completely excised skin lesions, fixed in formalin before further processing, were dermoscopically evaluated by pattern analysis. Results: by analyzing 80 pigmented benign lesions, the importance of vertical ex vivo dermoscopy in the diagnosis and/or differentiation of blue nevus, seborrheic keratosis and hemangioma from other skin lesions was noted. Among malignant lesions, basal cell carcinomas (BCCs) had the most diverse dermoscopic presentation on vertical section, while most squamous cell carcinomas (SCCs) had a similar presentation. Vertical ex vivo dermoscopy of all thin melanomas was almost identical, unlike nodular melanomas. Accuracy of dermatologist ҆s estimate of invasion depth was 0.75 for BCC, 0.81 for SCC and 0.80 for melanoma, while for the pathologist ҆s estimate it was 0.65, 0.75, and 0.83, respectively. Interobserver agreement was 0.71 for BCC, 0.80 for SCC and 0.83 for melanomas. Dermatologist ҆s estimate of tumor width accuracy was 0.82 for BCC, 0.87 for SCC and 1.00 for melanoma. Conclusions: vertical ex vivo dermoscopy can contribute to the mutual differentiation of BCC, SCC and melanoma, as well as to the differentiation of pigmented benign from malignant skin lesions. Regardless of the physician's specialty, vertical ex vivo dermoscopy enables more accurate assessment of additional tumor characteristics.

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