应用超声生物显微镜（UBM）联合常规超声对皮肤病变进行扫查，探讨各类皮肤病变的超声声像图特征，为皮肤病变的临床诊断和治疗提供影像学依据。

纳入2013年3月至2016年12月于北京同仁医院行手术切除并获得病理诊断的皮肤病患者124例，共136个病灶，其中良性105例117灶、恶性19例19灶。术前应用UBM联合常规超声对病灶进行超声扫查，对病灶UBM和常规超声声像图的11种征象进行评价分析：主体所在层次；内部性状；表皮层连续性有无中断；表皮层有无角化增厚；表面是否凹凸不平；形态；边界；内部回声；后方回声；内部血流状况；周边血流状况。

良性病变分析结果为：色素痣41灶，多局限于表皮和真皮层，形态规则，边界清晰，内部无或有少量血流；脂溢性角化26灶，多数表皮角化增厚，后方回声衰减，内部无或有少量血流；表皮样囊肿18灶，多位于真皮及皮下组织层，呈实性或囊实性，后方回声增强；蓝痣10灶，多位于真皮层，形态规则，边界清晰，内部无或少量血流；皮肤纤维瘤10灶，多局限于表皮和真皮层，也可累及皮下组织，形态规则，边界不清，内部无或有少量血流；血管瘤9灶，多局限于表皮和真皮层，也可累及皮下组织，实性或囊实性，后方回声无变化或有增强，内部血流丰富，周边无或有少量血流；脂肪瘤3灶，位于皮下组织层，多呈低或等回声，可伴后方回声增强，内部无血流。恶性病变分析结果为：基底细胞癌10灶，多局限于表皮和真皮层，少数可达皮下组织，表皮层连续性中断，可角化，表面凹凸不平，形态不规则，边界清晰，后方回声无变化或衰减，内部有中等或丰富的血流；鳞状细胞癌3灶，累及皮下组织，多数表皮层连续性中断，明显角化增厚，表面凹凸不平，形态不规则，边界不清，后方回声衰减，内部血流丰富；日光性角化3灶，局限于表皮和真皮层，表皮层连续完整，多有角化增厚，形态不规则，边界不清晰，后方回声衰减；Bowen病3灶，多累及表皮、真皮和皮下组织，表皮层连续完整，多有角化增厚，形态不规则，边界不清，后方回声无衰减，内部中等血流。

各类皮肤病变的超声表现既具共性，又各有特点。UBM联合常规超声检查有助于明确疾病分类或分型及鉴别病灶良恶性，对皮肤疾病的诊治具有重要的应用价值。

To investigate the sonographic manifestations of skin diseases, by means of combining an ultrasound biomicroscope (UBM) with a 50 MHz probe and a conventional ultrasound machine with a wide-band high frequency probe.

From March 2013 to December 2016, 124 patients with 136 skin lesions that were proven by surgical and pathological findings were enrolled in the study. Among them, 105 patients (117 lesions) had benign and 19 patients (19 lesions) had malignant lesions. Each case was scanned with a UBM and its 50 MHz probe, and the other conventional ultrasound machine and its 6-15 MHz probe. Eleven types of sonographic manifestations were described according to pathological classifications: layers of the skin lesion, internal character, continuity of the epidermis, keratinization of the epidermis, flatness of skin surface, shape, boundary, internal echo, posterior echo, internal blood flow, and peripheral blood flow.

Sonographic features of various benign and malignant skin lesions were demonstrated. Benign lesions: Pigmented nevus: A lesion located in the epidermis and dermis, with a regular shape, a clear boundary, and no or little blood flow; Seborrheic keratosis: A lesion causing the hyperkeratosis of the epidermis, with posterior attenuation and no or little blood flow; Epidermoid cyst: A lesion located in the dermis and subcutaneous layer, with solid or complex component, posterior attenuation, and no or little blood flow; Blue nevus: A lesion confined to the dermis, with an oval or round shape, a clear boundary, and no or some blood flow; Dermatofibroma: A lesion located in the epidermis and dermis, or infrequently involving subcutaneous tissues, with a regular shape, an unclear boundary, and no or little blood flow; Hemangioma: A lesion located in the epidermis and dermis, extending into subcutaneous tissues in some cases, with solid or complex component, posterior enhancement or not, and internal hypervascular supply with few peripheral vessels; Lipoma: A lesion located subcutaneously and appearing as high echogenicity, posterior enhancement, and no internal blood flow. Malignant lesions: Basal cell carcinoma: A tumor located in the epidermis and dermis, invading into the subcutaneous layer in some cases, with interruption of skin layers, epidermal hyperkeratosis, a rough surface, an irregular shape, a clear boundary, posterior attenuation or not, and some or abundant internal blood flow; Squamous cell carcinoma: An infiltrative tumor involving the subcutaneous tissue, with marked thickening of keratinized epidermis, a rough surface, an irregular shape, a clear boundary, posterior attenuation, internal hypervascular supply, and no continuity of the epidermis; Actinic keratosis: A change limited in the epidermis and the dermis, with epidermis hyperkeratosis, an irregular shape, an unclear boundary, posterior attenuation, and intact epidermis; Bowen's disease: A tumor invading the epidermis, dermis, and subcutaneous layer, with epidermis hyperkeratosis, an irregular shape, an ill-defined margin, posterior attenuation, some internal blood flow, and complete epidermis.

Various skin lesions not only share common sonographic manifestations but also have characteristic changes. UBM combined with conventional ultrasound examination is helpful for the classification and differentiation of skin diseases, and has important application value in the diagnosis and treatment of skin diseases.