犬良性皮脂腺增生的皮肤镜特征:描述、评估和观察者间的一致 ...

王帆

Dermoscopic features of benign sebaceous proliferations in dogs: Description, assessment and inter-observer agreement

犬良性皮脂腺增生的皮肤镜特征:描述、评估和观察者间的一致

翻译：王帆

Abstract

Background: Dermoscopy is a useful, noninvasive technique also used to assess sebaceous lesions in humans. Sebaceous hyperplasia, sebaceous adenoma and sebaceous epithelioma are common cutaneous lesions in dogs; however, their dermoscopic features have not been investigated.

Hypothesis/Objectives: The objectives of this study are to describe the dermoscopic features of canine sebaceous lesions and to assess the interobserver agreement on dermoscopic parameters.

Animals: Thirty-four lesions excised from 17 client-owned dogs, histologically confirmed as sebaceous proliferations, were included in this study.

Materials and Methods: Sebaceous lesions were evaluated in vivo at ×10 magnification with a handheld dermoscope. Each dermoscopic image was assessed independently by two ECVD board-certified veterinary referral clinicians and an ECVD resident.

Results: Thirty sebaceous hyperplasias, two sebaceous adenomas and two sebaceous epitheliomas were included. Dermoscopically, most lesions (91%) had single or multiple, well-defined, white-yellowish structures composed of grouped ovoid areas (clods). Irregular linear and, less commonly, arborising vessels were detected at the periphery of the yellow lobular-like structures in 93% of sebaceous hyperplasias and in 50% of neoplastic lesions. Erosions were seen in 6% of sebaceous hyperplasias and 50% of neoplastic lesions. Good interobserver agreement was found for white/yellowish clods (k=0.75), yellow scales (k=0.83), brown/grey dots (k=0.80), erosions (k=0.82) and red/brownish scales/crusts (k=0.75). There was moderate agreement for fissures (k=0.48) and vascular pattern (k=0.51–0.53).

Conclusions and Clinical Relevance: Dermoscopy represents a useful technique to assess sebaceous gland proliferations in dogs, as it is in humans.

摘要

背景: 皮肤镜检查是一种有用的、非侵入性的技术，也用于评估人类皮脂腺病变。皮脂增生、皮脂腺瘤和皮脂腺上皮瘤是犬常见的皮肤病变；然而，他们的皮肤镜特征尚未得到研究。

假设/目的: 本研究的目的是描述犬皮脂腺病变的皮肤镜特征，并评估观察者间对皮肤镜参数的一致性。

动物: 本研究包括从17只家养犬身上切除的34处病变，经组织学证实为皮脂腺增生。

材料和方法: 用手持式皮肤镜在10倍放大率下对皮脂腺病变进行体内评估。每个皮肤镜图像由两名ECVD委员会认证的兽医转诊临床医生和一名ECVD住院医师独立评估。

结果: 包括30例皮脂腺增生、2例皮脂腺瘤和2例皮脂腺上皮瘤。皮肤镜下，大多数病变(91%)具有单一或多个明确的白色-黄色结构，由成组的卵圆形区域 (小块)组成。在93%的皮脂腺增生和50%的肿瘤病变中，在黄色小叶状结构的外围检测到不规则的线性和不常见的树状血管。在6%的皮脂腺增生和50%的肿瘤病变中可见糜烂。观察者间对白色/黄色小块 (k=0.75)、黄色皮屑 (k=0.83)、棕色/灰色小点 (k=0.80)、糜烂 (k=0.82) 和红色/棕色皮屑/结痂 (k=0.75)。裂隙 (k=0.48)和血管形态 (k=0.51–0.53) 之间存在中度一致性。

结论和临床相关性: 皮肤镜检查是评估犬和人类皮脂腺增生的一种有用技术。

 

KEYWORDS dermoscopic features, dermoscopy, dogs, sebaceous adenoma, sebaceous epithelioma, sebaceous hyperplasia

关键词 皮肤镜特征、皮肤镜、犬、皮脂腺、皮脂腺上皮瘤、皮脂腺增生

 

INTRODUCTION

介绍

Dermoscopy, also known as dermatoscopy or epiluminescence microscopy, is a noninvasive diagnostic technique allowing for prompt, magnified in vivo observation of the skin and the visualisation of pigmented, nonpigmented and vascular structures that are poorly visible to the naked eye. Dermoscopy can be performed with a nonpolarised (NPD) or polarised (PD) light source. Sequential use of PD and NPD often provides complementary information and reveals important diagnostic clues regarding skin lesions.

皮肤镜检查又称皮血管镜检查或表皮发光显微镜检查，是一种非侵入性诊断技术，可对皮肤进行及时、放大的活体观察，并显示肉眼不太可见的色素、非色素和血管结构。皮肤镜检查可使用非极化(NPD)或极化(PD)光源进行。PD和NPD的序贯使用通常可提供补充信息，并揭示关于皮肤病变的重要诊断线索。

 

In humans, dermoscopy is considered a relevant diagnostic aid mainly for the early detection of skin cancer, increasing the diagnostic accuracy for pigmented and nonpigmented skin neoplasms, thus reducing the number of unnecessary biopsies.

在人类中，皮肤镜检查被认为是一种相关的诊断辅助手段，主要用于早期发现皮肤癌，提高了对色素和非色素皮肤肿瘤的诊断准确性，从而减少了不必要的活检次数。

 

Sebaceous hyperplasia is the most common sebaceous gland proliferation in humans, characterised by white-yellowish umbilicated papules of 2–9mm in diameter, mainly on the face of older adults; these feature, by dermoscopy, clusters of white-yellowish lobular-like structures (clods) surrounded by fine, linear, sometimes irregular, vessels at the periphery (crown pattern).

皮脂腺增生是人类最常见的皮脂腺细胞增殖，其特征为直径2-9mm的白色-黄色脐形丘疹，主要见于老年人面部;在皮肤镜下，这些特征表现为成簇的白黄色小叶样结构(块状)，周围有细的、线状的、有时不规则的血管(冠状模式)。

 

Nodular sebaceous hyperplasia is a common skin lesion comprising 23% of all non-neoplastic canine skin masses, observed mainly in older dogs and accounting for the majority of canine sebaceous gland lesions. These lesions are generally single or multiple,＜1cm in diameter, yellowish, wart- or cauliflower-like and occurring anywhere on the body.

结节性皮脂腺增生是一种常见的皮肤病变，占犬类所有非肿瘤性皮肤肿块的23%，主要见于老年犬，占犬类皮脂腺病变的大部分。这些病变通常为单个或多个，直径小于1cm，呈黄色，呈疣状或菜花状，可发生在身体的任何部位。

 

Sebaceous skin tumours are more frequently benign in dogs and have recently been reported to represent 5.3%–6% of all canine skin tumours, with adenomas (3.3%) and epitheliomas (1.7%) being more common than carcinomas (0.7%).

皮脂腺皮肤肿瘤在犬类中更为常见，最近有报道称其占犬类皮肤肿瘤的5.3%-6%，腺瘤(3.3%)和上皮瘤(1.7%)比腺癌(0.7%)更为常见。

 

Of note, sebaceous hyperplasia is often found peripheral to and phasing into sebaceous adenoma, epithelioma or, more rarely, adenocarcinoma, and it is likely to be a precursor to their development.

值得注意的是，皮脂腺增生经常出现在皮脂腺瘤、上皮瘤或更罕见的腺癌的周围，它很可能是皮脂腺瘤发展的前兆。

 

The clinical appearance of sebaceous hyperplasia in dogs is considered characteristic, yet histopathological examination is deemed necessary to confirm the diagnosis and to differentiate it from neoplastic lesions.

犬皮脂腺增生的临床表现被认为是特征性的，但组织病理学检查被认为是必要的，以确认诊断并将其与肿瘤病变区分开来。

 

To date, dermoscopy has been used in veterinary dermatological practice to describe normal feline and equine skin, and hair follicle parameters in healthy dogs. Furthermore, dermoscopic features in dogs with pattern alopecia, alopecia areata and diverse infectious (feline and canine dermatophytosis), parasitic (canine demodicosis and sarcoptic mange) and congenital diseases (acral congenital superficial dermal lymphatic malformation in two cats) have been reported. To the best of the authors' knowledge, no information on dermoscopy of canine sebaceous gland hyperplasia and other sebaceous skin tumours is currently available.

迄今为止，皮肤镜已用于兽医皮肤科实践，以描述正常猫和马的皮肤，以及健康犬的毛囊参数。此外，犬的斑秃和各种感染性(猫和犬皮肤癣菌病)、寄生虫性(犬蠕形螨病和疥螨病)和先天性疾病(两只猫的肢端先天性真皮浅层淋巴管畸形)的皮肤镜特征也有报道。据作者所知，目前还没有关于犬皮脂腺增生和其他皮脂腺肿瘤的皮肤镜检查资料。

 

The aims of this study were to describe the dermoscopic features of canine sebaceous hyperplasia, sebaceous adenoma and sebaceous epithelioma that were subsequently excised and examined histologically, and to assess the interobserver agreement of dermoscopic parameters, with histopathological diagnosis as the gold standard.

本研究的目的是描述犬皮脂腺增生、皮脂腺瘤和皮脂腺上皮瘤的皮肤镜特征，随后切除并进行组织学检查，并评估观察者之间皮肤镜参数的一致性，以组织病理学诊断为金标准。

 

MATERIALS AND METHODS

材料和方法

Study population

研究对象

Cases were referred to the dermatology service for the evaluation of cutaneous nodules. Thirty-four lesions excised from 17 client-owned dogs, histologically diagnosed as sebaceous proliferations, were included in this study. There were 30 sebaceous hyperplasias, two sebaceous adenomas and two sebaceous epitheliomas. Lesions came from five intact males, two castrated males, two intact females and eight spayed females, ranging in age from 2 to 13years old (mean age 6.4years). Informed owner consent was obtained before any clinical, surgical or diagnostic procedure, following the good clinical practices in accordance with ethics guidance (published in GURI [Gazzetta Ufficiale della Repubblica Italiana] 1996;289:47–53).

病例被转诊到皮肤科进行皮肤结节的评估。从17只家养犬身上切除34个皮脂腺增生的病变。皮脂腺增生30例，皮脂腺腺瘤2例，皮脂腺上皮瘤2例。病变来自未去势公犬5例，已去势公犬2例，未绝育母犬2例，已绝育母犬8例，年龄2-13岁，平均6.4岁。在进行任何临床、手术或诊断操作之前，根据符合伦理指导(《意大利共和国报》1996; 289:47-53)的良好临床实践，获得了所有人的知情同意。

 

Dermoscopic definitions

皮肤镜检查术语

Morphological analysis was performed in line with the descriptive terminology proposed by Rosendahl et al. According to this paper, anatomical structures, lesions and vessels are described in simple geometric terms that are applicable regardless of the definitive diagnosis (Figure 1).

形态学分析按照Rosendahl等人提出的描述性术语进行。根据这篇论文，解剖结构、病变和血管用简单的几何术语描述，无论最终诊断如何，这些术语都适用(图1)。

 

In detail, Rosendahl reports five basic elements typically used to describe pigmented structures that are objectively defined using the following terms (Figure 1):

详细地说，Rosendahl报告了通常用于描述色素结构的五个基本元素，这些元素使用以下术语客观地定义(图1):

a. line: a 2D continuous object with length greatly exceeding width;

b. pseudopod: a line with a bulbous end;

c. dot: an object too small to have a discernable shape;

d. circle: a curved line equidistant from a central point; and

e. clod: any well-circumscribed, solid object larger than a dot; clods may take any shape.

a线:长度大大超过宽度的二维连续物体;

b伪足:一端为球状的线;

c点:物体太小，无法辨认形状;

d圆:与中心点等距的曲线;

e块:任何比点大的、边界清楚的固体物体;块可以变成任何形状。

 

Lines are further classified into five types related to their architectural pattern: reticular, branched, parallel, radial and curved.

线根据其建筑形态进一步分为五种类型:网状、分支、平行、放射和弯曲。

 

The terms dots, clods and lines also are applied to vessels and to vascular arrangements relating to their specific patterns. Vessels appearing as lines (linear vessels) may take different forms (Figure 1).

“点”、“块”和“线”这些术语也适用于血管和与其特定模式有关的血管排列。呈直线状的血管(线性血管)可能有不同的形式(图1)。

 

In order to better characterise the lesions, additional descriptive terms were added by the authors: fissures (long, narrow folds on the surface of the nodule), scales (white to yellow, small dry clods lying on the skin surface), scales/crusts (red/brownish, medium-sized and thick clods attached to the skin surface) and erosions (loss of epidermal layers with basement membrane sparing) (Figure 2).

为了更好地描述病变，作者添加了额外的描述性术语:裂缝(结节表面长而窄的褶皱)，皮屑(白色到黄色，皮肤表面有小的干块)，皮屑/结痂(红色/棕色，中等和厚的块附着在皮肤表面)和糜烂(表皮层丢缺失，基底膜保留)(图2)。

 

Dermoscopic examination

皮肤镜检查

Cutaneous lesions were evaluated in vivo at ×10 magnification on the same day as the surgical excision with a contact nonpolarised light dermoscope (Heine Delta 20 Plus; Intermed SRL). A gel interface (Ultrasound gel transparent; GIMA SpA) was applied to the lesion before dermoscopic examination in order to reduce the pressure on blood vessels. The dermoscope was connected to a digital camera (D3100; Nikon Europe BV), and all digitised images were captured in JPEG format.

在手术切除当天，使用接触式非偏振光皮肤镜(Heine Delta 20 Plus;Intermed SRL)。有凝胶界面(超声凝胶透明;在皮肤镜检查前涂抹GIMA SpA，以降低血管压力。皮肤镜与数码相机(D3100;尼康欧洲BV)，所有数字化图像均以JPEG格式捕获。

 

 

FIGURE 1 Structures and vessel patterns seen with a dermatoscope. Structures (left): lines (A), pseudopods (B), dots (C), circles (D), clods (E). Lines can be reticular (F), branched (G), parallel (H), radial (I), or curved (J). Vessel patterns (right): vessel structure: dots (1), clods (2), lines (3), looped (4), curved (5), serpentine (6), helical (7), coiled (8). Vessel arrangement: random (a), clustered (b), serpiginous (c), linear (d), centred (e), radial (f), reticular (g), branched (h). Modified and adapted from Rosendahl et al. Dermoscopy in routine practice – ‘chaos and clues’. Aust Fam Physician 2012;41:482–7. Drawings made by the first author

图1皮肤镜观察到的结构和血管模式结构(左):线(A)，伪足(B)，点(C)，圆(D)，块(E)。线可以是网状(F)，分支(G)，平行(H)，放射(I)，或弯曲(J)。血管模式(右):血管结构:点(1)，块(2)，线(3)，环状(4)，弯曲(5)，蛇形(6)，螺旋(7)，卷曲(8)。血管排列:随机(A)，丛(B)，蛇形(C)，线性(D)，中心(E)，放射(F)，网状(G)，分支(H)。日常实践中的皮肤镜检查——“混乱和线索”Fam医师2012;41:482-7。由第一作者绘制

 

 

 

 

FIGURE 2 Basic elements, descriptive terms and vessel patterns observed in neoplastic and non-neoplastic sebaceous lesions in dogs. Drawings made by the first author

图2在犬的肿瘤和非肿瘤皮脂腺病变中观察到的基本要素、描述术语和血管模式。第一作者绘制的图画

 

 

 

Image evaluation

图像评估

A board-certified veterinary referral clinician under the supervision of a dermatological expert in dermoscopy reviewed all dermoscopic images and, applying the specific descriptive terminology and the additional descriptive terms, listed the dermoscopic features (10) variably observed in each of the sebaceous lesions (Figure 2).

在皮肤科专家的监督下，经委员会认证的兽医转诊临床医生检查了所有的皮肤镜图像，并应用特定的描述性术语和额外的描述性术语，列出了皮脂腺病变中观察到的皮肤镜特征(10)(图2)。

 

Two board-certified veterinary referral clinicians and an ECVD resident independently examined all of the images and reported their evaluations in an Excel file that included a list of the 10 features. The three evaluators were asked to indicate the presence (1) or absence (0) of each of the 10 features for every image, and the completed forms were sent for statistical analysis.

两名委员会认证的兽医转诊临床医生和一名ECVD住院医生独立检查了所有图像，并在一个Excel文件中报告了他们的评估，其中包括10个特征的列表。三名评估者被要求指出每幅图像的10个特征中的每一个特征的存在(1)或不存在(0)，并将完成的表格发送给统计分析。

 

The evaluations of the board-certified veterinary referral clinician with the most experience in dermoscopy, verified by a dermatological expert in dermoscopy, were used for correlation analysis to measure the strength of association of each parameter and type of sebaceous proliferation.

在皮肤镜检查方面经验最丰富的兽医转诊临床医生的评估，经皮肤镜检查方面的皮肤科专家验证，用于相关性分析，以衡量每个参数与皮脂腺增生类型的关联强度。

 

Histological examination

组织学检查

After dermoscopic examination and image acquisition, lesions were surgically excised and immediately fixed in 10% buffered formalin for 48–72 h. Samples were trimmed and routinely processed, embedded in paraffin, cut at 4 μm, stained with haematoxylin and eosin, and assessed independently by one ECVP board-certified pathologist and one ECVP third-year resident. Histopathological diagnoses were made following the morphological guidelines of Goldschmidt et al., and were considered as the gold standard diagnostic technique. Epidermal and dermal changes including hyperpigmentation of the epidermis and pigmentary incontinence in the dermis also were assessed. These parameters were scored as 0—absent, 1—minimal, 2—mild, 3—moderate and 4—severe. These lesions also were classified as focal, multifocal or diffuse.

在皮肤镜检查和图像采集后，病变被手术切除，并立即在10%的福尔马林缓冲液中固定48-72小时。样本被修剪和常规处理，包入石蜡，切成4 μm，用苏木精和伊红染色，并由ECVP委员会认证的病理学家和ECVP第三年住院医师独立评估。组织病理学诊断遵循Goldschmidt等的形态学指南，并作为诊断技术的金标准。我们还评估了表皮和真皮的变化，包括表皮的色素沉着和真皮的色素失禁。评分为0 ~无、1 ~极轻度、2 ~轻度、3 ~中度、4 ~重度。将病变分为局灶型、多灶型和弥散型。

 

Statistical analysis

统计学分析

Analysis of the agreement was made with the Cohen's Kappa calculation.

利用科恩的Kappa计算对该协议进行了分析。

 

The agreement between the three evaluators was considered modest for kappa values k between 0.21 and 0.40, moderate for k between 0.41 and 0.60, and good for k between 0.61 and 0.80. For k-values >0.8, there was a near-perfect degree of agreement between the evaluators.

在kappa值k介于0.21和0.40之间时，三个评估者之间的一致性被认为是中等的，在k介于0.41和0.60之间时，被认为是中等的，在k介于0.61和0.80之间时，被认为是好的。对于k值>0.8，评估者之间的一致程度接近完美。

 

The association between the type of sebaceous proliferation (histological diagnosis) and each dermoscopic feature considered was investigated with the Pearson's chi-squared test. The significance threshold was 0.05. All analyses were performed with the software STATA 14.2. (Appendix S1).

皮脂腺增生类型(组织学诊断)与考虑的每个皮肤镜特征之间的关系用皮尔逊卡方检验进行了研究。显著性阈值为0.05。所有分析均采用STATA 14.2软件进行。(附录S1)。

 

RESULTS

结果

A total of 34 lesions, 30 sebaceous hyperplasias (Figure 3), two sebaceous adenoma and two sebaceous epitheliomas were examined. Three of those lesions were mixed forms and were classified according to the main type of lesion found in percentage. Particularly, one sebaceous hyperplasia (composed of 70% sebaceous hyperplastic lobules and 30% adenoma), one sebaceous adenoma (composed of 80% adenoma and 20% sebaceous hyperplasia) and one sebaceous epithelioma (composed of epithelioma 65% and sebaceous hyperplasia 35% (Figure 4).

共检查34个病变，30个皮脂腺增生(图3)，2个皮脂腺腺瘤和2个皮脂腺上皮瘤。其中3例为混合型，根据所发现的主要病变类型百分比进行分类。特别是1例皮脂腺增生(由70%的皮脂腺增生小叶和30%的腺瘤组成)、1例皮脂腺腺瘤(由80%的腺瘤和20%的皮脂腺增生组成)和1例皮脂腺上皮瘤(由上皮瘤65%和皮脂腺增生35%组成)(图4)。

 

Dermoscopic features found in the lesions and the interobserver agreement are reported in Table 1. All additional descriptive terms proposed by the authors were variably present in the lesions.

病变的皮肤镜特征和观察者间的一致见表1。作者提出的所有其他描述性术语在病变中都是不同的。

 

In the majority of the lesions (91%), single or multiple, well-defined, white-yellowish, grouped ovoid clods were observed (Figures 3 and 5). Irregular linear and less commonly branching vessels were seen at the periphery of the clods in 93% of sebaceous hyperplasias (Figures 3 and 5) and in 50% of neoplastic lesions. Curved vessels were seen in only two sebaceous hyperplasias. Erosions were seen in 6.6% of sebaceous hyperplasias and in 50% of mixed forms (Figure 5). Brown/grey dots were present in 29.4% of the lesions.

在大多数病变(91%)中，可观察到单发或多发、边界清晰的黄白色成组卵圆形血块(图3和5)。在93%的皮脂腺增生(图3和5)和50%的肿瘤性病变中，血块周围可见不规则线状血管和较少见的分支血管。仅2例皮脂腺增生可见弯曲血管。6.6%的皮脂腺增生和50%的混合型皮脂腺增生可见糜烂(图5)。29.4%的皮脂腺增生可见棕色/灰色点。

 

Good interobserver agreement was found for white/ yellowish clods (k=0.75), yellow scales (k=0.83), brown/grey dots (k=0.80), erosions (k=0.82) and red/ brownish scales/crusts (k=0.75). Moderate agreement was achieved for fissures (k=0.48) and vessel-type arborising vessels (k=0.51) and irregular linear vessels (k=0.53).

观察者之间发现白色/黄色块(k=0.75)、黄色皮屑(k=0.83)、棕色/灰色点(k=0.80)、糜烂(k=0.82)和红色/棕色皮屑/结痂(k=0.75)的一致性很好。裂缝(k=0.48)、血管型树枝状血管(k=0.51)和不规则线性血管(k=0.53)的一致性中等。

 

Association between the dermoscopic parameters and type of sebaceous lesions was found for erosions and neoplastic lesions, and for blue/grey clods and multifocal hyperpigmentation.

皮肤镜参数与皮脂腺病变类型之间的关系被发现为糜烂和肿瘤病变，以及蓝色/灰色块和多灶性色素沉着。

 

DISCUSSION

讨论

To the best of the authors' knowledge, this is the first study describing dermoscopic findings of canine sebaceous hyperplasia and sebaceous skin neoplasias. We selected sebaceous lesions, in particular sebaceous hyperplasia, because these are common lesions in dogs that must be differentiated from other neoplasms particularly to warrant a conservative approach avoiding surgery. Thus, dermoscopic findings were assessed utilising histopathological examination as the gold standard diagnostic technique.

据作者所知，这是第一个描述犬皮脂腺增生和皮脂腺瘤的皮肤镜检查结果的研究。我们选择皮脂腺病变，特别是皮脂腺增生，因为这些是犬的常见病变，必须与其他肿瘤区分开来，特别是需要保守方法避免手术。因此，皮肤镜检查结果评估利用组织病理学检查作为金标准诊断技术。

 

The descriptive terminology as reported by Rosendhal was chosen as a reference for morphological analysis to establish the basis for sebaceous lesion description in dogs as well. Both metaphoric and descriptive language has been used in human dermoscopy. Metaphors are a special form of analogy, widely used in the human dermatology lexicon, that have been developed to aid the recognition and description of clinical and dermoscopic criteria. The term “chrysalis structures’ for example refer to shiny, bright white,orthogonal linear streaks observed with polarised-light dermoscopy in skin lesions with an increased amount of collagen. We opted for the descriptive terminology because it represents a more objective method of description and assessment of lesions, compared with the metaphoric language that lacks clear definitions, which might hinder the diagnostic repeatability of dermoscopy.

选择Rosendhal报告的描述性术语作为形态学分析的参考，并建立犬皮脂腺病变描述的基础。人皮肤镜中既有隐喻性语言，也有描述性语言。隐喻是一种特殊的类比形式，广泛应用于人类皮肤病学词汇中，用于帮助识别和描述临床和皮肤镜标准。例如，术语“蛹状结构”是指用偏振光皮肤镜在胶原蛋白含量增加的皮肤病变中观察到的有光泽的、明亮的白色正交（直角）线状条纹。与缺乏明确定义的隐喻性语言相比，描述性术语更能客观地描述和评估病变，可能会阻碍皮肤镜诊断的可重复性。

 

The main dermoscopic features observed in 91% of the lesions were white/yellowish clods and irregular linear vessels at the periphery of the lesions. These features are similar to those reported in humans and correspond to grouped dermal sebaceous lobules. In humans, the dermoscopic finding of yellow lobular-like structures has been described in sebaceous hyperplasia, sebaceous adenoma and nevus sebaceous of Jadassohn. Clusters of white-yellowish globules in the centre of the lesions and fine, nonarborising vessels (crown pattern) at the periphery are the hallmarks of these lesions.

91%的病变的主要皮肤镜特征是病变周围的白色/黄色块和不规则的线性血管。这些特征与在人类中报道的相似，并对应于分组的真皮皮脂腺小叶。在人类中，皮脂腺增生、皮脂腺瘤和Jadassohn皮脂腺痣的皮肤镜下发现黄色小叶样结构。病变中心呈白色-黄色的小球团，周围呈细小的非树突状血管(冠状模式)，是这些病变的特征。

 

Brown/grey dots and blue/grey clods (10 and two respectively) were observed in 12 lesions, all diagnosed as sebaceous hyperplasia. The association was found between blue/grey clods on dermoscopy and multifocal epidermal hyperpigmentation on histological examination. This might suggest that these features correspond to melanin deposition in the skin, yet as the numbers are very small and this finding was very infrequent, we are unable to draw conclusions from these data.

12个病变可见棕色/灰点和蓝色/灰块(分别为10个和2个)，均诊断为皮脂腺增生。皮肤镜检查发现蓝色/灰色块与组织学检查发现的多灶性表皮色素沉着之间存在关联。这可能表明这些特征与皮肤中的黑色素沉积相对应，但由于数量很少，而且这一发现非常罕见，因此我们无法从这些数据中得出结论。

 

Erosions and ulcerations were observed in four of 34 lesions; notably, two were sebaceous hyperplasia and two were mixed forms that, for analysis, were classified according to the predominant histopathological features and, thus, identified as one sebaceous epithelioma (65%) and one sebaceous adenoma (80%). Unlike what is reported in humans, where erosions and ulcerations are usually a sign of invasive growth and malignancy, self-trauma is a common cause of erosion and ulcerations in dogs and thus, it should not be considered as significant in veterinary medicine.

34个病变中有4个出现糜烂和溃疡;值得注意的是，两例为皮脂腺增生，两例为混合型，根据主要的组织病理学特征进行分类，因此确定为皮脂腺上皮瘤(65%)和皮脂腺瘤(80%)。与在人类中报道的不同，在人类中，糜烂和溃疡通常是侵袭性生长和恶性肿瘤的征兆，而在犬中，自我创伤是糜烂和溃疡的常见原因，因此，在兽医学中不应将其视为重要因素。

 

The evaluation of vessels through dermoscopy plays a key role in the correct recognition of skin tumours, infections and inflammatory diseases in humans, and the correct interpretation of the features of vascular structures is among the most important steps in the diagnostic pathway.

通过皮肤镜对血管的评估在正确识别人类皮肤肿瘤、感染和炎性疾病中起着关键作用，而对血管结构特征的正确解释是诊断途径中最重要的步骤之一。

 

Dermoscopic features of skin vessels in normal dogs have been reported by Zanna and co-workers. Authors described thin, arborising, red lines corresponding to vessels between follicular units visible at ×70 magnification. In our study, irregular linear vessels, some of them arborising, representing dermal vessels displaced by lobular-like structures, were clearly visible at ×10 magnification.

Zanna和同事已经报道了正常犬皮肤血管的皮肤镜特征。作者描述了在70倍放大镜下可见的细的、树枝状的、与毛囊单位之间的血管相对应的红线。在我们的研究中，不规则的线性血管，其中一些是树突状的，代表被小叶样结构取代的真皮血管，在10倍放大下清晰可见。

 

This finding suggested that in dogs and humans, handheld dermoscopy allows visualisation of the type and architecture of vessels in the lesion, adding unique information that cannot be obtained by histological examination.

这一发现表明，在犬和人类中，手持式皮肤镜检查可以可视化病变血管的类型和结构，增加了无法通过组织学检查获得的独特信息。

 

Good interobserver agreement was found for more than one dermoscopic feature. Regardless of their degree of experience, all observers recognised white/yellowish clods, yellow scales, brown/grey dots, erosions and red/brownish scales/crusts. Importantly, white/yellowish clods are features present in 91% of sebaceous lesions, suggesting that these also represent a useful and well-defined dermoscopic parameter in dogs.

在多个皮肤镜特征上发现了良好的观察者间一致性。不管他们的经验如何，所有的观察者都认出了白色/黄色的块、黄色的皮屑、棕色/灰色的点、糜烂和红色/棕色的皮屑/结痂。重要的是，91%的皮脂腺病变存在白色/黄色块，这表明这些也代表了犬的有用和明确的皮肤镜参数。

 

Moderate agreement was found for vessel type. This finding is likely to have been related to the less experienced observers not being able to clearly identify vessel type and arrangement and suggests that specific training is needed to reach a good level of competence in dermoscopic evaluation.

在血管类型上发现了适度的一致性。这一发现可能与经验不足的观察者不能清楚地识别血管类型和排列有关，这表明需要进行专门的培训，以达到良好的皮肤镜评估能力水平。

 

We tried to determine whether dermoscopic features could suggest the nature of the sebaceous lesion. Unfortunately, no association between dermoscopic parameters and type of lesions was found except for the correlation between erosions and the diagnosis of neoplastic lesions. However, ulceration in dogs may be caused, as observed previously, by self-trauma and thus was not considered a finding as significant as it is in humans.

我们试图确定皮肤镜下的特征是否可以提示皮脂腺病变的性质。不幸的是，除了糜烂和肿瘤病变的诊断之间的相关性外，皮肤镜参数和病变类型之间没有发现任何关联。然而，正如之前观察到的那样，犬的溃疡可能是由自我损伤引起的，因此不像在人类上那样被认为是一个重要的发现。

 

It would be of interest in future to compare the dermoscopic features, particularly vessel type, and arrangement, of benign and malignant sebaceous neoplasms.

将来比较皮脂腺良性和恶性肿瘤的皮肤镜特征，特别是血管类型和排列，将是很有意义的。

 

Cases included in the study were collected at one institution over a period of 5 years. Diagnoses were representative and mirrored the prevalence of canine cutaneous sebaceous lesions, with no sebaceous carcinomas included in the study, further highlighting how rare malignant forms are compared with benign forms.

研究中包括的病例是在一个机构收集的，为期5年。诊断具有代表性，反映了犬皮脂腺病变的患病率，研究中没有皮脂腺癌，进一步强调了罕见的恶性形式与良性形式的比较。

 

Three mixed forms (two sebaceous hyperplasia and adenoma, and one sebaceous hyperplasia and epithelioma) were diagnosed. This suggests that, unlike in humans, sebaceous hyperplasia in dogs might be a precursor of sebaceous neoplasia such as adenoma, epithelioma or, more rarely, adenocarcinoma.

诊断为3种混合型(2例皮脂腺增生混合腺瘤，1例皮脂腺增生混合上皮瘤)。这表明，与人类不同，犬的皮脂腺增生可能是皮脂腺瘤(如腺瘤、上皮瘤或更罕见的腺癌)的前兆。

 

Notably, the larger and multilobular nodules included in this study were sebaceous epithelioma. Studies with a higher number of lesions are needed to assess whether tumour size is a helpful element in discriminating between sebaceous hyperplasia and neoplasia, and between benign and malignant forms.

值得注意的是，本研究中较大的多小叶结节为皮脂腺上皮瘤。需要更多的研究来评估肿瘤大小是否是区分皮脂腺增生和瘤变、良性和恶性的有用因素。

 

CONCLUSIONS

结论

To summarise, the most consistent dermoscopic features observed in canine benign sebaceous lesions included single or multiple, well-defined, white-yellowish, grouped, ovoid clods and irregular linear vessels at the periphery of the lesion. Our results suggest that dermoscopy represents a useful and reproducible technique for diagnosing benign sebaceous proliferations, thereby reducing the need for biopsies.

综上所述，犬良性皮脂腺病变有最一致的皮肤镜特征，包括病变单个或多个、界限分明、白-黄色、成组、卵圆形块和不规则线状血管。我们的结果表明，皮肤镜是诊断良性皮脂腺增生的一种有用且可重复的技术，从而减少了活检的需要。

 

FIGURE 3 Dermoscopic findings in three cases of sebaceous hyperplasia. (a, c, d) Multiple, well-defined, white-yellowish, grouped, ovoid clods covering the entire surface are surrounded by irregular linear vessels at the periphery. (b) Histological findings for the lesion presented in (a); transversal section shows multiple enlarged sebaceous lobules corresponding to multiple grouped clods. Haematoxylin & eosin, ×10.

图3：3例皮脂腺增生的皮肤镜表现。(a, c, d)多灶性、边界清晰、白-黄色的、成组的卵圆形块，覆盖整个表面，周围被不规则的线性血管包围。(b) (a)中病变的组织学表现;横切面显示多个皮脂腺小叶增大，对应于多个组块。H&E，×10。

 

 

FIGURE 4 Dermoscopic findings in a mixed form (65% sebaceous epithelioma and 35% sebaceous hyperplasia). (a) Extensive ulceration and multiple, poorly defined white clods. (b) Histological findings for the lesion; transversal section shows multiple enlarged sebaceous lobules and a multiple, large irregular island of epithelial reserve cells. Haematoxylin & eosin, ×10.

图4皮肤镜检查结果为混合型(65%皮脂腺上皮瘤和35%皮脂腺增生)。(a)广泛溃疡和多处界限不清的白色块。(b)病变的组织学表现;横切面可见多个增大的皮脂腺小叶和多个不规则的大上皮储备细胞岛。H&E，×10。

 

 

TABLE 1 List of dermoscopic features observed in the 34 neoplastic and non-neoplastic sebaceous lesions, with their presence expressed as percentages in lesions and agreement among the three observers on each dermoscopic feature。

表1 34例皮脂腺肿瘤性和非肿瘤性皮脂腺病变的皮肤镜特征列表，以皮脂腺病变的百分比表示其存在，以及三位观察者对每个皮脂腺病变的一致看法。

 

 

FIGURE 5 Dermoscopic findings in a mixed form (a) (80% sebaceous adenoma and 20% sebaceous hyperplasia) and three sebaceous hyperplasias (b–d). (a) Ulceration and red/brownish scales/crusts, (b,c) yellow scales, white-yellowish clods, and irregular linear vessels at the periphery of the lesions and (d) ulceration, white-yellowish clods and irregular linear vessels at the periphery.

图5皮肤镜下混合型(a)(80%皮脂腺瘤和20%皮脂腺增生)和3个皮脂腺增生(b-d)。(a)溃疡和红色/棕色皮屑/结痂，(b,c)病变周围的黄色皮屑、白色-黄色块和不规则线性血管，(d)病变周围的溃疡、白色-黄色块和不规则线性血管。

 

 

 

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