Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve melanoma diagnosis, particularly in high-risk patients. This study assessed the benefits of combining these advanced imaging techniques in a three-step programme in managing high-risk patients. This study included 410 high-risk melanoma patients who underwent a specialised imaging consultation in addition to their regular skin examinations in outpatient care. At each visit, the patients underwent a 3D-TBP, a DD for suspicious findings, and an RCM for unclear DD findings. The histological findings of excisions initiated based on imaging consultation and outpatient care were compared. Imaging consultation detected sixteen confirmed melanomas (eight invasive and eight in situ) in 39 excised pigmented lesions. Outpatient care examination detected seven confirmed melanomas (one invasive and six in situ) in 163 excised melanocytic lesions. The number needed to excise (NNE) in the imaging consultation was significantly lower than that in the outpatient care (2.4 vs. 23.3). The NNE was 2.6 for DD and 2.3 for RCM. DD, 3D-TBP, or RCM detected melanomas that were not detected by the other imaging methods. The three-step imaging programme improves melanoma detection and reduces the number of unnecessary excisions in high-risk patients.
现代诊断技术，如三维全身摄影（3D-TBP）、数字皮肤镜（DD）和反射式共聚焦显微镜（RCM），能够提升黑色素瘤的诊断准确性，尤其对高风险患者具有重要价值。本研究评估了将上述先进成像技术整合为三步法方案在管理高风险患者中的临床效益。研究纳入了410例高风险黑色素瘤患者，这些患者在常规门诊皮肤检查之外，还接受了专业影像学咨询。每次就诊时，患者均接受3D-TBP检查，对可疑皮损进行DD评估，并对DD结果不明确的皮损进一步行RCM检查。通过比较影像学咨询与门诊检查所提示切除组织的病理学结果发现：影像学咨询在39个切除的色素性皮损中检出16例确诊黑色素瘤（8例浸润性，8例原位癌）；而门诊检查在163个切除的黑素细胞性皮损中仅检出7例确诊黑色素瘤（1例浸润性，6例原位癌）。影像学咨询的需切除数（NNE）显著低于门诊检查（2.4 vs. 23.3）。其中DD的NNE为2.6，RCM为2.3。DD、3D-TBP和RCM分别检出了其他影像学方法未发现的黑色素瘤。研究表明，三步成像方案可提高高风险患者的黑色素瘤检出率，并减少不必要的切除操作。
肿瘤(癌症)患者之家