儿童与成人肢端黑素细胞痣皮肤镜特征分析

Dermoscopic Characterization of Acral Melanocytic Nevus in Children and Adults

摘要: 目的：探讨儿童与成人肢端黑素细胞痣的皮肤镜特征。方法：收集2020年7月至2023年7月儿童和成人肢端黑素细胞痣的皮肤镜资料，回顾性分析儿童与成人肢端黑素细胞痣皮肤镜特征的差异，与痣类型、病变部位的相关性，并观察研究了常见恶性黑素瘤皮肤镜特征在儿童与成人肢端黑素细胞痣中分布情况。结果：收集584例患者，共608处皮损，女性425处(69.9%)，男性183处(30.1%)，儿童组(<18岁)共收集239处皮损(39.3%)，成人组(≥18岁)共收集369处(60.7%)。先天性肢端黑素细胞痣皮肤镜模式：儿童组常见网格样/网球模式(27.2%)和皮沟平行模式(26.2%)，成人组常见非典型模式(45.5%)和均质模式(18.2%)；获得性肢端黑素细胞痣皮肤镜模式：儿童与成人常见模式均为皮沟平行模式(儿童组：36.4%，成人组：21.6%)和纤维素样模式(儿童组：31.8%，成人组：37.2%)。儿童组与成人组皮肤镜模式与痣类型、分布部位相关性不同：先天性黑素细胞痣中，儿童组纤维素样模式(P = 0.017)在足跖受压部位常见；而在成人组各皮肤镜模式未发现与部位有相关性，在不同部位中所占比例无统计学意义。在获得性黑素细胞痣中，儿童组各皮肤镜模式与部位无相关性；而在成人组与部位有相关性：网格样/网球模式(P < 0.001)常见于掌部、纤维素样模式(P < 0.001)常见于足跖受压区、球状模式(P < 0.001)常见于掌部及指趾侧缘。常见恶性黑色素瘤皮肤镜结构观察研究提示，在先天性黑素细胞痣中，皮嵴模式在儿童组出现较多，在儿童和成人两组之间存在统计学差异(P = 0.033)，而在获得性黑素细胞痣中，仅在成人患者中观察到黑素瘤特殊皮肤镜结构。结论：儿童和成人肢端黑素细胞痣皮肤镜模式存在一定差异，与痣的类型及分布部位的相关性也不同，黑素细胞瘤皮肤镜结构中的皮嵴模式在儿童先天性黑素细胞痣中较成人多见，皮嵴模式对于儿童先天性黑素细胞痣与恶性黑素瘤鉴别诊断的特异性较低。掌握儿童与成人肢端黑素细胞痣皮肤镜特征的差异，对改善黑素细胞痣的临床管理具有重要意义，尤其可减少儿童患者不必要的切除。

Abstract: Objective: To investigate the dermoscopic features of acral melanocytic nevus in children and adults. Methods: Dermatoscopic data of acral melanocytic nevus in children and adults were collected from July 2020 to July 2023, and the differences in dermatoscopic features of acral melanocytic nevus in children and adults were retrospectively analyzed for their correlation with the type of nevus and the location of the lesion, and the distribution of dermatoscopic features of common malignant melanomas in acral melanocytic nevus of children and adults was studied observationally. Results: A total of 608 lesions were collected from 584 patients, 425 (69.9%) from females and 183 (30.1%) from males, 239 lesions (39.3%) were collected in the pediatric group (<18 years old) and 369 (60.7%) in the adult group (≥18 years old). Among the dermoscopic patterns of congenital melanocytic nevi: grid-like/grid ball pattern (27.2%) and parallel furrow pattern (26.2%) were common in the children’s group, and atypical pattern (45.5%) and homogeneous pattern (18.2%) were common in the adult group; whereas, among the acquired melanocytic nevus dermoscopic patterns, the common patterns for both children and adults were parallel furrow pattern (children’s group: 36.4%, adult group: 21.6%) and fibrillar pattern (children’s group: 31.8%, adult group: 37.2%). The correlation between dermoscopic patterns and nevus types and distribution sites was different in the pediatric and adult groups: in congenital melanocytic nevi, fibrillar pattern (P = 0.017) was common in the foot-plantar pressure site in the pediatric group; whereas in the adult group, no correlation was found between each dermoscopic pattern and site, and the proportions in different sites were not statistically significant. In acquired melanocytic nevi, each dermoscopic pattern did not correlate with the site in the pediatric group; whereas in the adult group is correlated with the site: grid-like/ grid ball pattern (P < 0.001) was common in the palmar region, fibrillar pattern (P < 0.001) in the foot-plantar pressure area, and globular pattern (P < 0.001) in the palmar region and the lateral margins of the phalanges. Observational studies of dermoscopic structures of common malignant melanomas suggested that in congenital melanocytic nevi, the parallel ridge pattern appeared more frequently in the pediatric group, and there was a statistically significant difference between the two groups of children and adults (P = 0.033), whereas in acquired melanocytic nevi, the melanoma-specific dermoscopic structures were observed only in adult patients. Conclusion: The dermoscopic patterns of acral melanocytic nevus in children and adults are somewhat different, and the correlation with the type and distribution site of the nevus is also different. The parallel ridge pattern in the special dermoscopic structure of melanocytic nevus is more common in congenital melanocytic nevus in children than in adults, and the parallel ridge pattern has lower specificity for the differential diagnosis of congenital melanocytic nevus and malignant melanoma in children. Knowledge of the differences in dermoscopic features of acral melanocytic nevus in children and adults is important for improving the clinical management of melanocytic nevi, especially for reducing unnecessary excisions in pediatric patients.