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Strategien zur nichtinvasiven Diagnostik des Melanoms

Strategies for the noninvasive diagnosis of melanoma

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Zusammenfassung

Bei fortgeschrittenen Melanomen gelingt eine Diagnosestellung meist durch eine Untersuchung mit dem bloßen Auge, gefolgt von einer chirurgischen Exzision und einer histopathologischen Befundung. Im Rahmen von Screeninguntersuchungen zwecks einer Melanomfrüherkennung, insbesondere bei Patienten mit sehr vielen Nävi, geht es jedoch um die Differenzierung atypischer, aber benigner Nävi von In-situ-Melanomen oder initial invasiven Melanomen. In dieser Situation besteht ein Bedarf an zusätzlichen, nichtinvasiven Untersuchungstechnologien, die den Dermatologen bei der Entscheidung für oder gegen eine Exzisionsbiopsie unterstützen. Die Dermatoskopie konnte ihren Zusatznutzen in Metaanalysen bestätigen und ist seit vielen Jahren ein fester Bestandteil in der dermatologischen Diagnostik. Ergänzend können dynamische Veränderungen oder eine Neuentstehung von Pigmentmalen mithilfe der sequenziellen digitalen Dermatoskopie oder der (automatisierten) Ganzkörperfotografie erfasst werden und so sinnvoll zur Melanomfrüherkennung beitragen. Neben diesen etablierten Untersuchungstechniken sind in den letzten Jahren zahlreiche Medizinprodukte durch die amerikanischen und europäischen Behörden für die nichtinvasive Diagnostik kutaner Neoplasien zugelassen worden. Diese Geräte basieren dabei auf physikalischen Verfahren wie der konfokalen Laserscanmikroskopie, der Multispektralanalyse, der elektrischen Impedanzspektroskopie oder der Raman-Spektroskopie. Weitere Technologien befinden sich noch auf dem Sprung von einer bisher mehr experimentellen hin zu einer klinischen Anwendung. Diese Arbeit gibt einen Überblick über die verschiedenen Technologien und beleuchtet deren Indikation und Zusatznutzen für den anwendenden Dermatologen.

Abstract

The diagnosis of advanced cutaneous melanoma may easily be made by the unaided eye, followed by excisional biopsy and histopathological examination. However, in the setting of melanoma screening examinations in high-risk patients with many nevi, dermatologists are challenged with the differentiation of atypical but benign nevi and early invasive or in situ melanomas. In this situation, there is a real need for additional, noninvasive examination techniques that may serve as an aide to decide for or against an excisional biopsy. Conventional dermoscopy is a well-established examination procedure and an increase in sensitivity was confirmed by two independent meta-analyses. Moreover, dynamic changes or newly developed pigmented lesions may be detected by sequential digital dermoscopy or (automated) total body photography, respectively. Over the past years, a number of medicinal products gained market access after licensing by American and European agencies for the noninvasive diagnosis of cutaneous neoplasms. These devices are based on technologies including in vivo reflectance confocal microscopy, multispectral analysis, electrical impedance spectroscopy, or Raman spectroscopy. Other technologies are still on the verge of becoming less experimental but more clinically applicable for diagnosing melanoma (in vivo multiphoton tomography, stepwise two-photon laser spectroscopy, infrared thermal image analysis, epidermal genetic information retrieval). This review provides a concise overview of general principles and sheds light on indication and added value for dermatologists.

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Authors and Affiliations

  1. Universitätshautklinik Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland

    C. Fink &  H. A. Haenssle

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Correspondence to H. A. Haenssle.

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H.A. Haenssle hat als Berater der Firma SciBase AB Honorare erhalten. H.A. Haenssle und C. Fink sind als Studienärzte an der Durchführung einer multizentrischen Studie zur klinischen Prüfung des Magnosco Dermatofluoroskops (Magnosco DFC 1) beteiligt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Fink, C., Haenssle, H.A. Strategien zur nichtinvasiven Diagnostik des Melanoms. Hautarzt 67, 519–528 (2016). https://doi.org/10.1007/s00105-016-3796-0

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