266例黑甲性皮损的皮肤镜特点分析  

Dermoscopic features of 266 cases of melanonychia

作　　者：闫东[1] 郭艳阳[1] 张宇伟 海璐明 高天文[1] 朱冠男[1] Yan Dong;Guo Yanyang;Zhang Yuwei;Hai Luming;Gao Tianwen;Zhu Guannan(Department of Dermatology,Xijing Hospital,The Fourth Military Medical University,Xi′an 710032,China)

机构地区：[1]第四军医大学西京皮肤医院,西安710032

出　　处：《中华皮肤科杂志》2021年第11期993-997,共5页Chinese Journal of Dermatology

基　　金：国家自然科学基金 (82172607)。

摘　　要：目的比较临床常见黑甲性疾病的皮肤镜表现及特点。方法回顾性分析2016年1月至2020年7月在第四军医大学西京皮肤医院行皮肤镜检查的4种常见黑甲皮损皮肤镜图像特征。结果共纳入266例黑甲性皮损,其中甲黑素瘤64例(24.1%),甲母痣52例(19.5%),甲下出血89例(33.5%),甲真菌病61例(22.9%)。甲黑素瘤及甲母痣多发于指甲,甲黑素瘤发生于拇指甲的比例高(62.8%),甲母痣则更多发生于2~5指甲(73.9%);甲下出血及甲真菌病多发于趾甲,其中甲下出血51例(57.3%),甲真菌病46例(75.4%)。甲黑素瘤好发于40岁以上患者(49例,76.8%),其余3组疾病则多见于40岁以下患者。甲黑素瘤皮肤镜表现主要为纵向规则条带(35例,54.7%)或不规则条带(25例,39.0%),87.5%的病例色素带宽度大于3 mm,36例(56.3%)Hutchinson征阳性,15例(23.4%)破溃,颜色以黑褐色为主;甲母痣表现为单一规则色素带结构(52例,100%),36例(69.2%)色素带宽度小于3 mm,26例(50%)Hutchinson征阳性,无破溃病例;甲下出血表现为弥漫性斑疹(74例,83.1%),85例(95.5%)见暗红色或黑色出血小球结构;黑甲性甲真菌病表现为黑褐色纵向不规则条带(54例,88.5%)。结论皮肤镜下,甲黑素瘤可表现为纵向规则条带,条带宽幅大于3 mm,甲母痣多表现为纵向规则条带,甲下出血表现为弥漫性污斑,甲真菌病可表现为纵行不规则条带。皮肤镜可用于鉴别黑甲性皮损,为甲黑素瘤辅助诊断提供依据。Objective To investigate dermoscopic manifestations and features of melanonychia.Methods A retrospective analysis was carried out on dermoscopic images of 4 common types of melanonychia collected in Department of Dermatology,Xijing Hospital,the Fourth Military Medical University from January 2016 to July 2020.Results A total of 266 cases of melanonychia were collected,including 64(24.1%)of subungual melanoma,52(19.5%)of nail matrix nevi,89(33.5%)of subungual hemorrhage,and 61(22.9%)of onychomycosis.Subungual melanoma and nail matrix nevi mostly occurred in the fingernails.To be specific,subungual melanoma most frequently occurred in the thumbnails(62.8%),while nail matrix nevi mostly involved the 2nd-5th fingernails(73.9%).Subungual hemorrhage and onychomycosis mostly occurred in the toenails,and there were 51(57.3%)cases of subungual hemorrhage of the toenails and 46(75.4%)cases of onychomycosis of the toenails.Subungual melanoma mostly occurred in patients aged over 40 years(49 cases,76.8%),while the other 3 types of melanonychia mostly affected patients aged under 40 years.Dermoscopic manifestations of subungual melanoma mainly included regular longitudinal bands(35 cases,54.7%)or irregular bands(25 cases,39.0%)whose width was greater than 3 mm in 87.5%cases,Hutchinson sign(36 cases,56.3%),and ruptures(15 cases,23.4%)which mainly were black-brown in color;dermoscopic manifestations of nail matrix nevi mainly were a single regular pigmented band(52 cases,100%)whose width was less than 3 mm in 36(69.2%)cases,and Hutchinson sign(26 cases,50%),while no ruptures were observed in nail matrix nevus lesions;subungual hemorrhage dermoscopically manifested as diffuse macules(74 cases,83.1%),and globular dark red or black hemorrhagic structures were observed in 85(95.5%)cases;fungal melanonychia was dermoscopically characterized by irregular dark brown longitudinal bands(54 cases,88.5%).Conclusions Subungual melanoma was dermoscopically characterized by regular longitudinal bands with a width of greater than 3 mm,nail ma

关 键 词：指(趾)甲疾病 痣和黑素瘤 甲癣 皮肤镜检查 甲下血肿 纵向黑甲 

分 类 号：R758.72[医药卫生—皮肤病学与性病学]