Diagnostic Application Of Dermoscopy Combine With Reflectance Confocal Microscopy In Benign Proliferative Dermatitis

Part Ⅰ In vivo examination of nevus and seborrheic keratosis by dermoscopy and RCM.Objective: To study the dermoscopy and RCM features of nevus and seborrheic keratosis(SK).Methods: 52 patients suspected of nevus and 58 patients suspected of SK were enrolled in our study from July 2019 to January 2021.After collecting the clinical data,in vivo dermoscopy and RCM examination were performed on the lesions,and take the surrounding normal skin as a control.In the dermoscopy and RCM observation field,recorded the characteristic findings of the examination of the damaged area when they were typical manifestations that meeting the diagnostic criteria of nevus and SK.Performed histopathological examination of atypical skin lesions under dermoscopy and RCM observation.Summarized the dermoscopy and RCM features occurred frequently as the clues of nevus and SK,and used SPSS 25 statistical analysis software to calculate the data.Results: 1.Nevus: According to the distribution of nevus cells,13 cases(26%)of junctional nevi,22 cases(44%)of mixed nevi,and 15 cases(30%)of intradermal nevus were enrolled.Dermoscopy features: The most common dermoscopic pattern of nevus was reticular pattern(34%),followed by the globular pattern(26%)and homogeneous pattern(18%).RCM features: The most common manifestation was typical honeycomb/pebble-like structure of the epidermis(38%),then were difference features between different types of nevus.The junctional nevus were increased of epidermal melanin(100%),bright pigment rings(76.9%)and nevus cell nests(92.3%)in DEJ.The intradermal nevus were regular honeycomb structure in epidermis(73.3%),even(60%)or uneven(40%)distribution of nevus cell nests in dermis,and scattered bundles or cords of high refractive cells in deep dermis(6.7%).The mixed nevus skin lesions have the characteristics of junctional nevus and intradermal nevus,including increased melanin in epidermal(63.6%),high refractive pigment ring(31.8%)and nevus cell nest(59.1%)in DEJ.Nevus cell nests can also appear in the dermis(63.6%).2.SK: Dermoscopy features: gyriform structure(75.9%)and comedo-like openings(57.4%)are the most common features,followed by milia-like cysts(40.7%),fissures and ridges(35.2%)and wormeaten edge(33.3%).RCM features: gyriform structure(79.6%)and corneal pseudocysts(70.4%)had the highest frequency.Conclusion: The study has clarified the common characteristic manifestations of nevus and SK under dermoscopy and RCM,which can provide reference and clues for early non-invasive diagnosis and disease intervention of nevus and SK in exposed areas.Part Ⅱ In vivo examination of keratoacanthoma and primary cutaneous amyloidosis by dermoscopy and RCM.Objective: To study the dermoscopy and RCM features of keratoacanthoma(KA)and primary cutaneous amyloidosis(PCA).Methods: 2 patients suspected of KA and 3 patients suspected of PCA were enrolled in our study.After collecting the clinical data,in vivo dermoscopy and RCM examination were performed on the lesions,and take the surrounding normal skin as a control.Then filled in the application for the biopsy,and pathological examination was performed.The dermoscopy and RCM features of PCA were studied according to the results of dermatology.Under dermoscopy,the features of color,blood vessels,structure,and background of lesions were observed.Upon RCM,the pattern,structure,distribution of cell and papillary blood vessels of dermal were observed focus on.Summarized the dermoscopy and RCM features of KA and PCA.Results: 1.KA: dermoscopy features: concentric circles of central crater,keratin mass,keratin scale,and polymorphic vascular pattern.RCM features: refractile crust and large round nucleated cells in stratum corneum,atypical honeycomb pattern in stratum granulosum,dendritic cells in stratum spinosum,and linear or round vessels traversing dermal papillae in the dermis.2.PCA: dermoscopy features: acular amyloidosis were brownish macules with brown or white centers surrounded by hyperpigmented blotches.Lichen amyloidosis were whitish scar-like center encircled by irregular brownish hyperpigmented spots or patches.RCM features: hyperkeratosis of epidermis,increased melanin deposition in the basal layer,highly refractive structures with various shapes in the enlarged papillary dermis,and the ring structure of the dermal papilla had increased pleomorphism.Conclusion: This is the first time that we used dermoscopy combined with RCM to observe KA and PCA,and the results of the study were recognized.The study has clarified the dermoscopic and RCM features of KA and PCA,and their corresponding relationship with dermatopathology.