儿童蓝痣的临床及病理特征分析  

Clinical and pathological characteristics of childhood blue nevus

作　　者：杨雪琪 杨昕宇 陈钱 朱磊 钱华[1] YANG Xueqi;YANG Xinyu;CHEN Qian;ZHU Lei;QIAN Hua(Children′s Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院,江苏苏州215000

出　　处：《皮肤性病诊疗学杂志》2025年第2期85-91,共7页Journal of Diagnosis and Therapy on Dermato-venereology

摘　　要：目的总结儿童蓝痣患者的临床表现、皮肤镜及病理特征。方法收集2020年9月至2024年3月于苏州大学附属儿童医院皮肤科就诊的104例蓝痣患者的临床资料、皮肤镜图像及病理报告,分析其临床及病理特征。结果104例患儿中,男39例(37.50%),女65例(62.50%);平均发病年龄(6.12±4.31)岁,平均病程(5.66±3.09)年;单发95例(91.35%),多发9例(8.65%);发病部位从多到少依次为四肢(50例,48.08%)、胸背部(20例,19.23%)、臀部(17例,16.35%)、头面部(16例,15.38%)、粘膜(1例,0.96%)。皮疹主要临床表现为蓝色或蓝黑色、坚实的丘疹或结节。皮肤镜下为均质样、蓝色或黑褐色混杂、纤维化和边缘放射状结构。组织病理可见真皮或皮下大量梭形、树突状黑素细胞和嗜黑素细胞呈垂直楔形分布。根据组织病理分型,52例行组织病理检查的患者中有普通型蓝痣42例(80.77%)、细胞型蓝痣7例(13.46%)、联合型蓝痣3例(5.77%)。结论儿童中蓝痣好发于女性,多单发,发病部位以四肢最常见,临床上易与色素痣、血管角皮瘤、血管瘤、Spitzs痣、外源性色素沉着等混淆,分型及良恶性鉴别依靠组织病理。Objective To summarize the clinical,dermatoscopic and pathological features of blue nevus in children.Methods Clinical data,dermatoscopic images,and pathological reports were collected from 104 children with blue nevus at the dermatology department,soochow university affiliated children's hospital between September 2020 and March 2024.The clinical and pathological features were analyzed.Results Among 104 cases,males and females were 39 cases(37.50%)and 65 cases(62.50%),respectively.The mean age of onset was 6.12±4.31 years,and the mean course of disease was 5.66±3.09 years.Patients with single and multiple lesions accounted for 91.35%(95 cases)and 8.65%(9 cases),respectively.The affected areas,in descending order,were the limbs(50 cases,48.08%),chest and back(20 cases,19.23%),hip(17 cases,16.35%),head(16 cases,15.38%)and mucosa(1 cases,0.96%).The main clinical manifestations of the rash were blue or blue-black solid papules or nodules.Dermoscopy showed homogeneous blue or dark brown structure with fibrosis and radial margins.Histopathological examination showed that a large number of spindle and dendritic melanocytes and melanophages were distributed in a vertical wedge shape in the dermis or subcutaneous tissue.According to the histopathological classification,among 52 patients underwent routine histopathological examination,42 cases(80.77%)were ordinary blue nevus,7 cases(13.46%)were cellular blue nevus and 3 cases(5.77%)were combined blue nevus.Conclusions Blue nevus is more common in girls,and the most common site is the extremities.Clinically,blue nevus is easily confused with pigmented nevus,hemangioma,angiokeratoma,spitzs nevus,exogenous pigmentation,etc.The classification and differentiation of benign and malignant lesion should rely on histopathology.

关 键 词：蓝痣 儿童 皮肤镜 组织病理 

分 类 号：R758.51[医药卫生—皮肤病学与性病学]