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皮损的皮肤镜评估

Authors
Ashfaq A Marghoob, MD
Natalia Jaimes, MD
Section Editor
Hensin Tsao, MD, PhD
Deputy Editor
Rosamaria Corona, MD, DSc
Translators
刘洁, 副主任医师，副教授

引言

皮肤镜检查是一种无创性活体检查技术，主要用于色素性皮损的检查，但其也能帮助临床医生评估无色素性皮损。皮肤镜检查、皮表透光显微镜检查、入射光显微镜检查及皮表显微镜检查都是同义词。皮肤镜检查通过一种称为皮肤镜的手持式仪器来进行。该操作能够显示皮肤表面以下的结构，包括表皮层、表皮真皮交界处及真皮浅层，而这些结构靠肉眼无法观察到[1-3]。

皮肤镜诊断涉及到识别特异性结构的有无，从而排除或证实某诊断。从认知的角度上讲，这可以通过从细节到总体(bottom-up)或从总体到细节(top-down)的策略来完成。从细节到总体法是指观察者通过观察寻找突出的细节(个体特征)来获得诊断；而总体到细节策略是指观察者识别整体情况、假设可能的临床诊断，然后有目的地通过皮肤镜寻找特定表现以证实推测的临床诊断[4]。

本专题将总结几种主要运用从总体到细节策略的流程及评分系统，以帮助临床医生鉴别黑素细胞性皮损和非黑素细胞性皮损(第一步)，并区分良性黑素细胞性皮损与可疑或恶性黑素细胞性皮损(第二步)。皮肤镜检查的一般原则，皮肤镜下结构术语，皮损的皮肤镜评估，以及面部、黏膜和肢端掌跖部皮损的皮肤镜评估将单独讨论。指(趾)甲色素沉着的皮肤镜检查以及皮肤癌分诊的皮肤镜检查流程也将单独讨论。

●(参见“皮肤镜检查概述”)

●(参见“皮肤镜检查在面部皮损中的应用”)

                     

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-17.
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