RU2716811C1 - Method for early diagnosis of surface-propagating melanomas - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to oncology. For early diagnosis of early forms of melanoma on pigment formation with normal borderline skin by 1–2 cm brush dye picrofinin apply for 5 minutes, excess dye is removed with a cotton swab dipped in distilled water. By means of USB microscope connected with computer with diode illumination and increase of not less than 50x digital conversion of colored pigmented growth is performed. Image is transmitted to the monitor with the installed program of the "water mesh" and enlarged to the whole screen; visual interpretation of the enlarged and colored nevus pigment structures is performed by segments. Micromorphological trait (MMT) is scored, indicated in table 1, contained in the description. Points are summed up, and if the MMT values are 0 to 5 points, the benign formation is diagnosed; at MMT values from 5 to 6 – boundary new growth; at MMT values of 6 points and higher – malignant growth.

EFFECT: method provides higher effectiveness of early diagnostics of surface-spreading pigmented growths and detection of microstructures of early malignancy signs, and also enables to conduct online telemedicine consultation with leading specialists.

1 cl, 1 tbl, 7 dwg

Description

The present invention relates to medicine, in particular, crane diagnosis of early forms of melanoma, i.e. identification of the first signs of transformation of pigmented nevus into malignant. There is not a single person who would not have pigmented nevi less than 10.

The frequency of skin melanomas has almost doubled over the past decade, mainly among young people, due to the increased incidence of sunburn and an increase in the high incidence of neglected cases and 1 year mortality, respectively 10% and 19% - “Malignant neoplasms in Russia in 2017 (incidence and mortality). ” Ed. HELL. Kaprina, V.V. Starinsky, G.V. Petrova - M.: Moscow P.A. Herzen is a branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia.

According to several studies (for example, Fernandes NC The risk of cutaneous melanoma melanocytic nevi // An. Bras. Dermatol. 2013. Vol. 88. No. 2. P. 314-315.) Benign nevi are a transitional stage in the development of skin melanoma ( MK). Identification and monitoring of neoplasms, which are the precursors of MK, is an important component of the early diagnosis of MK. Even earlier it was shown that skin melanomas (MK) at the time of detection are superficially spreading - (37.9% - Kushnir V.A., Katilov A.V., Magdebura S.A. “Methodology for examining patients with nevus and skin melanoma” // Military Medical Clinical Center of the Central Region (Vinnitsa). Medical University named after N. I. Pirogov; 2015 52-54 pages).

However, according to the Novgorod Regional Oncology Center, nodular (nodal) forms of MK are more often recorded. In most cases, MK before its transformation into an exophytic aggressive tumor exists in the form of a pigment spot (from 3 to 10 years), representing the greatest difficulty for diagnosis, since a biopsy cannot be performed. Of critical importance in the opinion of these authors is the clinical dynamics of asymmetric changes in the age spots according to the anamnesis.

For the differential diagnosis of malignant pigmented neoplasms from benign, radioactive P ³² or Ga ⁶⁷ can be used, which accumulate many times higher in malignant tumors. However, the half-life of these radionuclides is short-lived and a special laboratory for their production and use is required.

The well-known "Method for the comprehensive diagnosis of skin melanoma" (RU No. 2322943, 04/27/2008). At the same time, digital video shooting of the patient’s skin, targeted photographing and fluorescence dermoscopy using 5-aminolevulinic acid in the form of 20% ointment is carried out, which is kept on the examined area for 2-6 hours. In this case, after digital video shooting, computer mapping is performed. The method, according to the authors, allows to obtain a glow of the active zones and to increase the effectiveness of dispensary observation in risk groups. However, as is known, 5-aminolevulinic acid refers to photosensitizers, the luminescence of which occurs when only a certain wave is induced, i.e. laser. In this connection, a special apparatus is required that stimulates fluorescence with optical radiation with a wavelength in the range 385-440 nm. at., which complicates the study in the general clinic.

A known method for the automated diagnosis of MK by digital mapping of skin tumors, representing the creation of a photo archive. At the first stage, an assessment of social factors is carried out, which allows to identify the patient's belonging to risk groups, for example, age, gender, environmental situation, medical and demographic characteristics, individual exogenous and endogenous factors. During the examination, a “map” of the human body is compiled, with a mark of suspicious areas. Then, automatic diagnosis of melanoma is carried out according to the standards of images of skin areas using a three-layer computer program such as “neural networks”, previously trained to distinguish skin melanoma (RU No. 2685469, 04/18/2019, Bull. No. 11 (2019).

However, this method has several disadvantages: 1) it takes a long study of the patient (more than 2 hours), which imposes a significant limitation. 2) Clinical examination of patients is carried out once a year. As the authors note, during this period new and rapidly changing pigmented neoplasms may appear, which can lead to late diagnosis. 3) It requires the accumulation of a database with MK standards, the creation of an automatic program, which is extremely difficult to provide clinics throughout Russia.

Another most common diagnostic method for MK is dermatoscopy, which usually allows a 10-fold increase in the morphological structure of the tumor, which increases the diagnostic capabilities. The doctor applies a special immersion oil to the mole, applies a dermatoscope to it. The light source is supplied from the side at an angle, as a result, some surface structures that are analyzed are reflected. This diagnostic method for MK is taken as a prototype.

The main disadvantages of this option of dermatoscopy are:

1. limited use of a dermatoscope with a large increase;

2. loss of image clarity of tissue structures due to the lack of their own lighting;

3. inspection by one specialist;

4. the impossibility of photo documentation;

5. the inability to conduct online telemedicine counseling with leading experts.

Known for not expensive portable USB microscope with magnification from 50x to 500x with built-in illumination for use in the educational process (in high school, as well as in the system of profile and additional education for studying small objects and insects, as well as soldering microcircuits) - info @ oktanta. ru.

VanGison stain is also known for morphological study of the structure of connective tissue. The dye is a mixture of acid fuchsin and picric acid (picrofuchsin). Moreover, fuchsin stains collagen fibers in a bright red color, forming diamond-shaped cells, and picrin adds yellow color to other tissue structures, which become chaotic or asymmetrically located during melanoma (see Jocelyn H. Bruce-Gregorios, MD: HistopathologicTechniques, JMC PressInc., Quezon City, Philippines, 1974; Wikipedia).

The objective of the invention is to increase the efficiency of early diagnosis of surface-spreading pigmented neoplasms and identify microstructures of early signs of malignancy.

This object is achieved by the fact that in a method for the early diagnosis of surface-spreading melanomas , including dermatoscopy, a picrofuxin dye is applied with a brush for 5 minutes on a pigmented neoplasm with a capture of normal border skin for 1-2 cm, the excess dye is removed with a cotton swab moistened with distilled water, using A USB-connected microscope with a diode illumination and a magnification of at least 50 x is digitally converted to a colored pigmented neoplasm, the image is not mounted on a monitor with the installed “water mesh” program and enlarged on the whole screen, then a visual interpretation of the enlarged and stained structures of the pigmented nevus is carried out by segments, and a point assessment of micromorphological signs (MMP) specified in table 1 in the description is carried out, the scores are summarized and with values of MMP from 0 to 5 points, a benign formation is diagnosed; with MMP values from 5 to 6, a borderline neoplasm is diagnosed; with values of MMP from 6 points and above, a malignant neoplasm is diagnosed.

The method is as follows. A picrofuchsin dye (used by histologists to detect connective and reticular tissue) is applied with a brush to a pigment spot with a capture of normal border skin for 1-2 cm for 5 min, then a cotton swab moistened with distilled water is removed. They turn on a portable USB microscope with diode illumination and magnification from 50x to 100x and more times, which interacts with a computer and a 10x10 cm black square appears on the screen. The diode light and a square with a picture of a pigmented nevus or other pathological focus turn on its natural color. The square is enlarged to full screen, for example 460x460 cm, depending on the computer or laptop. For the purpose of topographic assessment and interpretation by segments, we have created a subroutine of a “water grid” or 2 lines from one corner to another. The lines are superimposed on the photo after receiving it (see Fig. 1-7). Then conduct a visual interpretation of the pigmented nevus in segments. To objectify the assessment of signs of malignancy of pigmented skin tumors, use the mathematical sum of micromorphological signs (MMP), presented in table 1. The points are summarized and at a MMP from 0 to 5 points, a benign formation is diagnosed; with MMP values from 5 to 6, a borderline neoplasm is diagnosed; with values of MMP from 6 points and above, a malignant neoplasm is diagnosed.

Table 1 shows the signs or changes and their weight in the diagnosis of superficial pigmented lesions in points.

The method is illustrated by images:

FIG. 1 - General scheme of the method

FIG. 2. Border pigmented nevus with the first signs of transformation - the pigment network is unevenly dark in color in the center - 2; bright red structureless collagenosis.

around - 2; with asymmetric gaps in the upper segment - 2. Conclusion: a potentially malignant neoplasm. MMP = 2 + 2 + 2 = 6.

FIG. 3. Melanoma from the border nevus - asymmetric external shape - 2; with bluish-gray spots in 4 segments - 2; b) the lower segment of the main neoplasm - shown separately with a more pronounced bright red cliff and uneven collagen and connective fibers in the form of flames - 2.

MMP = 2 +2 + 2 = 6.

FIG. 4. Surface-spreading melanoma. MK with a different degree of pigmentation - 2 and irregular borders according to the type of Dubreil melanosis - 2; Bright red uneven collagen fibers and yellow connective in different segments - 2; connective tissue fibers form a chaotic network with sections of their cliff - 2, clumps of pigment, whitish spots mainly in the lower and left segments - 2. MMP = 2+ 2+ 2+ 2+ 2 = 10; Histology No. 30174 of 10.16.19. Diagnosis: Superficial spreading melanoma. The thickness of the pigmented neoplasm is 0.6 mm.

FIG. 5. Superficial achromatic melanoma. The arrangement of red structureless formations in the upper and left segments with uneven erased edges is 2. In the upper segment there are dark blotches, in the left segment are white and intensely red and white in the lower segment are 2. In the left segment, fibers of different thicknesses and colors, chaotic - 2 , in the right segment, the reticular network is uniform with unit points - 1. MMP = 2 + 2 + 2 + 1 = 7.

Fig 6. Pigmented neoplasm of the borderline nevus. Atypical globules with the appearance of reddish tones on both sides of the axis, randomly arranged-2; randomly located, their borders abruptly cut off - 2. The external shape is asymmetric - 2; Red collagen fibers are erased, break off and merge with gray-blue globules -2, which testify to the malignant process. MMP = (2 + 2 + 2 + 2) = 8 points.

FIG. 7. The edges of the pigmented neoplasms, after staining with picrofuxin: a) collagen fibers relatively evenly depart from the benign pigmented nevus; b) collagen fibers depart randomly, break off and form a ball with point inclusions, indicating the onset of satellite appearance.

The method improves the efficiency of early diagnosis of superficially spreading pigmented neoplasms and reveals microstructures of early signs of malignancy, and also allows online medical consultation with leading experts.

Table 1

Signs or changes and their weight in the diagnosis of superficial pigmented lesions in points

No. Signs of a pigmented neoplasm not On one side of the axis On both sides of the axis 1 Asymmetry and / or changes in the external contours of the entire nevus 0 1 2 2 Asymmetry of collagen and other fibers around the nevus 0 1 2 3 Asymmetry in color: blue-gray, black, beige, red, white 0 1 2 3 Bright red collagen cells are uneven in size and shape 0 1 2 4 Lack of skin pattern, structureless formations, sometimes the appearance of shine 0 1 2 5 The collagen fibers that form the partitions - by thickness and color intensity, abruptly break off along the periphery of the focus 0 1 2 6 Globular model. Globules of different sizes and colors, the appearance of gray-blue and / or reddish tones 0 1 2 7 Globules are randomly located, the borders break off sharply 0 1 2 8 The formation of blurry spots, dots, blots. Different color 0 1 2 9 The appearance of blacker globules on the periphery is a sign of nevus growth 0 1 2 10 Atypical collagen network with the formation of glomeruli and spots signs of the onset of satellite formation 0 1 2

Claims (1)

A method for early diagnosis of superficially spreading melanomas, including dermatoscopy, characterized in that the pigmented neoplasm with a capture of normal border skin 1-2 cm with a brush is applied with picrofuxin dye for 5 minutes, the excess dye is removed with a cotton swab moistened with distilled water using a computer A USB microscope with a diode backlight and a magnification of at least 50 x digitally converts the colored pigmented neoplasm, the image is transmitted to a monitor with With the help of the program “water grid” and increases to the whole screen, then a visual interpretation of the enlarged and stained structures of the pigmented nevus is carried out by segments, and a point assessment of micromorphological signs (MMP) indicated in table 1 in the description is carried out, the scores are summarized and at the values of MMP from 0 to 5 points diagnose a benign formation; with IMF values from 5 to 6 - a borderline neoplasm; with values of MMP from 6 points and above - malignant neoplasm.

Images