| Objective(s):The purpose of this paper is to analyze the diagnostic ability of dermatoscopy in common non-melanoma skin cancer(NMSC),evaluate the application value of dermatoscopy in the diagnosis of NMSC in practical clinical work,summarize and sort out the morphological structure of high frequency appearance of NMSC in dermoscope images,explore the dermoscope image features which are highly related to the diagnosis of NMSC,and deepen clinicians’ understanding of the feature patterns under dermoscope.At the same time,compare the difference of diagnostic accuracy between dermatoscope and dermatologist in clinical practice,evaluate the clinical credibility of dermatoscopy in the diagnosis of NMSC,and explore the possible related risk factors of misdiagnosis,so as to improve the early diagnostic accuracy of dermatoscopy and improve the survival prognosis of patients.Methods: Patients suspected of basal cell carcinoma(BCC)or squamous cell carcinoma(SCC)who were admitted to the dermatology department of our hospital from January 1,2022 to March 1,2023 were included in the study.Dermoscopy and skin biopsy were performed voluntarily with informed consent.1.The skin lesions of the patients were examined with dermatoscope,and the dermoscopy diagnosis was obtained according to the image characteristics,and then the same skin lesion was biopsied.Taking the histopathological results as the diagnostic gold standard,the value of dermoscopy in the diagnosis of BCC and SCC was analyzed and evaluated.2.The data of age,sex,history of sunscreen,skin lesions,location,course of disease,preliminary diagnosis,professional title of first doctor,dermoscopy diagnosis and image features were collected,and the database was established by Excel.The general situation,clinical data and dermoscope features of the subjects were summarized,and the dermoscope features of pathologically confirmed BCC or SCC cases were extracted.By comparing the dermoscopic features of patients with non-BCC or non-SCC skin tumors,and using SPSS25.0 software for statistical analysis,to explore the dermoscopic features that may highly suggest BCC or SCC.3.According to whether the diagnosis of dermatoscope and dermatologist is consistent with the final histopathology,and comparing the difference of diagnostic accuracy between dermatoscope and dermatologist in practical clinical work,the related risk factors of dermatoscope misdiagnosis are discussed through statistical analysis.to provide ideas for improving the diagnostic accuracy.Results:1.A total of 86 clinical suspected NMSC cases were included in this study,of which 50 cases were suspected to be BCC,36 and 50 cases were suspected to be SCC.Taking the diagnosis results of histopathology as the gold standard,from the dimension of distinguishing cases as BCC or non-BCC,the sensitivity,specificity,positive predictive value,negative predictive value,Yoden index,diagnostic coincidence rate and Kappa value for BCC were 92.31%,72.73%,72.73%,0.65,88.00% and 0.78 respectively.From the dimension of distinguishing cases as SCC or non-SCC,the sensitivity,specificity,positive predictive value,negative predictive value,Yoden index,diagnostic coincidence rate and Kappa value for SCC were92.00%,54.55%,82.14%,75.00%,0.46,80.56% and 0.51 respectively.2.The dermoscopy image characteristics of pathologically confirmed BCC and non-BCC,SCC and non-SCC cases were compared.Univariate analysis and binary Logistic regression showed that the risk of diagnosis of BCC in patients with "dendritic vessels" was about 15.053 times higher than that in patients without "dendritic vessels"(OR=15.053,95%CI:1.237-183.229,P<0.05).The risk of diagnosis of SCC in patients with "yellow and white scales" dermatoscope was about 16.241 times higher than that in patients without "yellow and white scales"(OR=16.241,95%CI:1.252-210.724,P<0.05).The risk of diagnosis of SCC in patients with irregular or round ulcers was about 26.880 times higher than that in patients without irregular or round ulcers(OR=26.880,95%CI:2.225-324.776,P<0.05).3.From the dimension of whether the preliminary diagnosis is consistent with the final histopathological results,comparing the diagnostic accuracy of dermatoscopy and dermatologist in this study,it is found that the diagnostic accuracy of dermatoscopy is 73.26%.There was no significant difference between dermatologist and dermatologist(74.42%,Chi-square=0.030,P>0.05).According to the different titles of the first doctor,dermatologists are divided into senior and middle and low professional titles,and the results show that the diagnostic accuracy of senior doctors is 80.70%,which is significantly higher than that of doctors with middle and low professional titles(58.62%,Chi-square=4.783,P<0.05).There was no significant difference between the diagnostic accuracy of senior professional doctors and dermatoscopy(Chi-squar=1.049,P>0.05).4.The case data were included in univariate analysis and Logistic regression to explore the possible risk factors of inconsistency between dermoscopy diagnosis and histopathological results.The results showed that compared with women,dermatoscopy increased the risk of misdiagnosis in male patients by about 4.877times(OR=5.877,95%CI:1.249-27.666,P<0.05).The risk of misdiagnosis of dermatoscope increased by 0.141 times when the course of disease increased by 1year(OR=1.141,95%CI:1.005-1.294,P<0.05),and the risk of misdiagnosis increased by 4.684 times when the length and diameter of skin lesion increased by 1cm(OR=5.684,95%CI:2.071-15.598,P<0.05).5.Among the 39 cases of BCC confirmed by pathology in this study,the ratio of male to female was 0.63:1,the average age was 69.4 ±13.1 years(95%CI:65.2-73.6),27 cases had no sunscreen habit,accounting for 69.23%,36 cases were head and face,accounting for 92.31%(including 16 cases in nose,8 cases in cheek),19 cases were complicated with ulceration,accounting for 48.72%.There were 30 cases of pruritus in skin lesions,accounting for 76.92% of BCC cases.The average length and diameter of skin lesions was 1.2 ±0.6cm(95%CI:1.0-1.4).Among the 25 cases of SCC confirmed by pathology,the ratio of male to female was 0.47:1,the median age was 79.0(70.5,88.5)years old,18 cases(72.0%)had no sunscreen habit,18 cases(72.00%)were involved in head and face(8 cases were in cheeks),6 cases(24.00%)were in limbs(5 cases were in hands),22 cases(88.00%)were complicated with ulceration.There were 20 cases of pruritus in the skin lesions,accounting for 80.0%of the SCC cases.The average length and diameter of the lesions was 2.1 ±0.7cm(95%CI:1.8-2.4).There were significant differences in age distribution,lesion rupture and the overall average length and diameter of lesions between BCC and SCC(P<0.05),but there was no significant difference in gender composition,sunscreen habit,location of skin lesions and itching between the two groups(P>0.05).Conclusion(s): 1.Dermatoscope has high sensitivity,positive predictive value and diagnostic coincidence rate for NMSC,and has the advantages of no injury,no pain,economy,convenience and rapidness.It can help to select treatment plan,mark surgical margin,evaluate postoperative effect and dynamically monitor the changes of skin lesions.It has significant clinical value and is worth actively popularizing and applying in the whole country,especially in the vast grass-roots areas.2.Logistic regression analysis combined with a variety of dermatoscope image features has a certain guiding significance for the diagnosis of NMSC,and can assist the diagnosis according to the dermatoscope image features highly related to NMSC:in this study,"dendritic vessels" may be an independent risk factor for the diagnosis of BCC,and "yellow and white scales" and "irregular or round ulcer" may be independent risk factors for the diagnosis of SCC,which should be paid more attention to in clinic.3.The diagnostic accuracy of dermatoscopy in suspected cases of NMSC is not significantly different from that of dermatologists with senior professional titles,but the diagnostic accuracy of the latter is significantly higher than that of doctors with middle and low professional titles,so it is worth recommending dermatoscopy as a routine examination item for skin tumors in daily clinical work in remote grass-roots medical institutions with low and middle professional titles and lack of dermatologists,which is helpful to the early screening of NMSC in the whole country.4.The possible risk factors for dermatoscope misdiagnosis are male,longer course of disease and larger length of skin lesions.Clinicians should be more patient and careful when facing the above-mentioned types of patients,asking medical history and examining skin lesions should be clear and thorough.Do not blindly pursue the time of diagnosis and treatment,if necessary,take debridement,scab removal and other treatment,after the skin lesions are relatively clear and complete exposure.Select the location of the most typical skin lesions or even multiple locations,and then conduct a standardized dermatoscopy examination.5.The confirmed cases of NMSC included in this study are mainly elderly patients without sunscreen awareness and habits,and there are more females.The lesions are mainly located in exposed parts such as nose,cheek and hands,and most of them have itching symptoms in varying degrees.The age,the proportion of skin lesions and the length and diameter of skin lesions in SCC cases are higher than those in BCC cases,which are different from other studies at home and abroad,but also have something in common. |
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