中华皮肤科杂志 ›› 2025, Vol. 58 ›› Issue (1): 60-64.doi: 10.35541/cjd.20240404

• 研究报道 • 上一篇    下一篇

皮肤镜联合反射式共聚焦显微镜在老年光线性角化病区域性癌化中的应用价值

李建丹    徐红艳    胡婵    柳小婧    陈诗怡    曹智    张国龙    王秀丽    王佩茹   

  1. 上海市皮肤病医院  同济大学医学院光医学研究所，上海  200443
  • 收稿日期:2024-08-02 修回日期:2024-11-10 发布日期:2025-01-03
  • 通讯作者: 王佩茹 E-mail:wangpeiru@tongji.edu.cn
  • 基金资助:
    国家重点研发计划 （2022YFC2504700、2022YFC2504705）；上海市科技计划项目（22ZR1455400）；上海申康医院发展中心第二轮《促进市级医院临床技能与临床创新三年行动计划》研究型医师创新转化能力培训项目（SHDC2022CRT017）

Application value of dermoscopy combined with reflectance confocal microscopy in field cancerization in actinic keratosis in the elderly

Li Jiandan, Xu Hongyan, Hu Chan, Liu Xiaojing, Chen Shiyi, Cao Zhi, Zhang Guolong, Wang Xiuli, Wang Peiru   

  1. Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China
  • Received:2024-08-02 Revised:2024-11-10 Published:2025-01-03
  • Contact: Wang Peiru E-mail:wangpeiru@tongji.edu.cn
  • Supported by:
    National Key Research and Development Program of China （2022YFC2504700, 2022YFC2504705）; Shanghai Science and Technology Plan Project （22ZR1455400）; Shanghai Shenkang Hospital Development Center's Second Round of "Three Year Action Plan for Promoting Clinical Skills and Clinical Innovation in Municipal Hospitals" Research-oriented Physician Innovation and Transformation Ability Training Project （SHDC2022CRT017）

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摘要： 【摘要】 目的 探讨皮肤镜与反射式共聚焦显微镜（RCM）在发现老年光线性角化病（AK）区域性癌化中的应用价值。方法 回顾性分析2022年1月至2023年12月在上海市皮肤病医院确诊且资料完整的老年（＞60岁）AK患者的临床、皮肤镜及RCM特征。结果 共纳入老年AK患者132例，皮肤镜检查显示，AK皮损可见棕-灰色假网状色素、毛囊角栓、不规则分枝状血管、玫瑰花瓣征。51例行组织病理检查，47例（92.16%）确诊为AK。106例（80.3%）患者的AK皮损合并区域性癌化，其中66例（62.26%）血管结构为不规则分枝状血管，88例（83.02%）色素结构中以棕-灰色假网状色素为主，83例（78.30%）表现为散在褐色色素网/指纹样模式。治疗后随访的63例患者，AK皮损在皮肤镜下见血管及色素结构等均呈不同程度变化，其中毛囊角栓及表面黄白色鳞屑或角质物团块的减少最为显著。41例AK患者行RCM检查，发现所有患者的AK皮损处角质形成细胞排列紊乱，呈不典型蜂窝结构，细胞见异型性；其中20例患者的区域性癌化处皮损RCM均可见角质形成细胞排列紊乱，表现为不规则的蜂窝图案，部分角质形成细胞见轻度异型性。34例AK患者于ALA-PDT治疗前及治疗后第1、3、6个月行RCM动态检测，发现AK皮损角质形成细胞排列逐渐趋于规整，异形细胞减少。结论 老年AK区域性癌化的发生率高，皮肤镜及RCM有助于多发且难以进行多点病理活检的AK及区域性癌化的早期发现。

关键词: 角化病, 光化性, 皮肤镜检查, 显微镜检查, 共焦, 区域性癌化

Abstract: 【Abstract】 Objective To investigate the application value of dermoscopy and reflectance confocal microscopy （RCM） in identifying field cancerization in actinic keratosis （AK） in the elderly. Methods A retrospective analysis was conducted on clinical, dermoscopic, and RCM features of elderly （> 60 years old） patients, who were confirmedly diagnosed with AK and had complete medical records at Shanghai Skin Disease Hospital from January 2022 to December 2023. Results A total of 132 elderly patients with AK were included. Dermoscopy showed brownish-gray pseudonetwork pigment patterns, follicular horn plugs, irregular branched vessels, and rosette signs in AK lesions. Histopathological examination in 51 patients revealed that 47 （92.16%） were confirmedly diagnosed with AK. Field cancerization was observed in 106 patients （80.3%）, among whom 66 （62.26%） had irregular branched vessels, 88 （83.02%） predominantly exhibited brownish-gray pseudonetwork pigment patterns, and 83 （78.30%） showed scattered brown pigment networks/fingerprint-like patterns. Post-treatment follow-up of 63 patients showed varying degrees of changes in vascular and pigment structures by dermoscopy, with significant reductions in follicular horn plugs and superficial yellow-white scales or keratin masses. RCM examinations in 41 AK patients all showed disordered arrangements of keratinocytes presenting as atypical honeycomb patterns, with atypical cells in the AK lesions; in the field cancerization areas of 20 patients, RCM revealed keratinocytes disorderedly arranged in an irregular honeycomb pattern, with some keratinocytes exhibiting mild atypia. Thirty-four AK patients underwent dynamic RCM monitoring before and after 1, 3 and 6 months of ALA-PDT treatment, which showed gradual regularization of arrangements of keratinocytes and reduction of atypical cells, as well as reappearance of atypical keratinocytes upon recurrence. Conclusions The incidence of field cancerization was relatively high in elderly AK patients. Dermoscopy and RCM are helpful for the early identification of AK and field cancerization, especially in patients with multiple lesions and with difficulties in multi-site biopsy.

Key words: Keratosis, actinic, Dermoscopy, Microscopy, confocal, Field cancerization

引用本文

李建丹 徐红艳 胡婵 柳小婧 陈诗怡 曹智 张国龙 王秀丽 王佩茹. 皮肤镜联合反射式共聚焦显微镜在老年光线性角化病区域性癌化中的应用价值[J]. 中华皮肤科杂志, 2025,58(1):60-64. doi:10.35541/cjd.20240404

Li Jiandan, Xu Hongyan, Hu Chan, Liu Xiaojing, Chen Shiyi, Cao Zhi, Zhang Guolong, Wang Xiuli, Wang Peiru. Application value of dermoscopy combined with reflectance confocal microscopy in field cancerization in actinic keratosis in the elderly[J]. Chinese Journal of Dermatology, 2025, 58(1): 60-64.doi:10.35541/cjd.20240404