The Clinical Reaserch Of Dermoscopy In The Diagnosis Of Skin Neoplasms

Objective: This study has two parts.The first part is to research the accuracy and consistency between dermoscopic diagnosis and pathological diagnosis to melanocytic nevus,seborrheic keratosis and solar keratosis to determine the diagnostic value of dermoscopy.The second part is to count the patterns in dermoscopy of skin diseases,including melanocytic nevus,seborrheic keratosis,solar keratoses,dermatofibroma,basal cell carcinoma,blue nevus,melanoma,subcorneal hemorrhage,hemangioma,Bowen’s disease,epidermal cyst,cutaneous horn,keratoacanthoma,fibroxanthoma and acquired digital fibrokeratoma.As references for dermoscopic diagnosis.Methods: 232 cases from November 2013 to March 2015 which chinical diagnosed as skin neoplasms.Accroding to the dermoscopic diagnostic criteria for melanocytic nevus,seborrheic keratosis and solar keratoses to diagnose by two clinical doctors compare with the pathological findings and calculated the concordance rate,sensitivity,specificity,misdiagnosisrate,the rate of misdiagnosis,positive predictive value,negative predictive value,likelihood ratio area,under the negative likelihood ratio,Youden index,Kappa values and AUROC.Besides we count the patterns of melanocytic nevus,seborrheic keratosis,solar keratoses,dermatofibroma,basal cell carcinoma,blue nevus,melanoma,subcorneal hemorrhage,hemangioma,Bowen’s disease,epidermal cyst,cutaneous horn,keratoacanthoma,fibroxanthoma and acquired digital fibrokeratoma in dermoscopy.Result: 1.Diagnostic Test 1.1 melanocytic nevusDiagnose results of the two doctors showed concordance rate、sensitivity 、 specificity 、 misdiagnosis rate 、 the rate of misdiagnosis、positive predictive value、negative predictive value、likelihood ratio area、under the negative likelihood ratio、Youden index、Kappa values and AUROC were 89.3%、94%、84.2%、15.8%、6%、86.7%、92.8%、5.95、0.07、78.2%、0.785、0.891 and 91.2%、95.2%、86.8 %、13.2%、4.8%、88.8%、94.3%、7.23、0.06 、 82% 、 0.823 、 0.910.The Kappa value of two doctors diagnostic results was 0.911.1.2 seborrheic keratosisDiagnose results of the two doctors showed concordance rate、sensitivity 、 specificity 、 misdiagnosis rate 、 the rate of misdiagnosis、positive predictive value、negative predictive value、likelihood ratio area、under the negative likelihood ratio、Youden index、Kappa values and AUROC were 88%、91.7%、83.6%、16.4%、8.3%、86.8%、89.5%、5.59、0.10、75.3%、0.757、0.876 and 91.7%、95.8%、86.9%、13.1%、4.2%、89.6%、94.6%、7.31、0.05 、82.7% 、0.832 、0.914.The Kappa value of two doctors diagnostic results was 0.892.1.3 solar keratosisDiagnose results of the two doctors showed concordance rate、sensitivity 、 specificity 、 misdiagnosis rate 、 the rate of misdiagnosis、positive predictive value、negative predictive value、likelihood ratio area、under the negative likelihood ratio、Youden index、Kappa values and AUROC were 84.1%、82.1%、87.5%、12.5%、17.9%、92%、73.7%、6.57、0.2、70.2%、0.670、0.848 and 86.4%、85.7%、87.5%、12.5% 、14.3%、92.3%、77.8%、6.86、0.16 、73.2% 、0.713 、0.866.The Kappa value of two doctors diagnostic results was 0.860.2.Patterns in dermoscopyThe dermoscopic features of melanocytic nevus were reticular pattern、globular pattern、homogeneous pattern、non-pigmented homogeneous pattern globular-homo-geneous pattern、reticular-homogeneous pattern、linear vessels、follicular orifice、reticular-globular pattern、parallel-furrow pattern、dotted vessels、blue-white structure、fibrillar pattern and comedo-like openings;seborrheic keratosis were comedo-like openings、scale、milia-like cyst、furrow ridge structure、cerebriform structure and hairpin vessels;solar keratosis were strawberry pattern and arborizing vessels;dermatofibroma were single and multiple white structure;basal cell carcinoma were spoke wheel areas、ulceration、wormholed area、arborizing vessels、blue-white structure、leaf-like structure;blue nevus were blue grey and black blue homogeneous pattern;melanoma were satellite lesions、ulceration、blue-white structure、irregular vessels、irregular pigmented patterns;subcorneal hemorrhage were homogeneous pattern and pigmented links;hemangioma was red lacunae;Bowen’s disease were scale and glomerular vessels;epidermal cyst were non-pigmented homogeneous pattern and small pigmented area;cutaneous horn was horny structure;keratoacanthoma were scale、horny structure、crust and tenuous hairpin vessels;fibroxanthoma were yellow homogeneous pattern and linear vessels;acquired digital fibrokeratoma were digital noduleand basal collar-like structure.Conclusion: The diagnostic test show high degree of accuracy to diagnose melanocytic nevus、seborrheic keratosis and solar keratosis by dermoscopy.And the results between the two doctors show a better consistency,means dermoscopic diagnosis has better objectivity.Meanwhile we desrcibe the patterns of this 14 kinds of skin neoplasms and subcorneal hemorrhage in dermoscopy,prove the value of dermoscopy and as references for diagnosis.