Dermoscopy of Pigmented Seborrheic Keratosis

Abstract

To describe morphological features of seborrheic keratosis as seen by dermoscopy and to investigate their prevalence.Design: Prospective cohort study using macrophotography and dermoscopy for the documentation of seborrheic keratosis.Settings: Seborrheic keratoses were prospectively collected in 2 sites: a private practice in Plantation, Fla (site 1), and the Department of Dermatology at the University Hospital Geneva in Switzerland (site 2).Patients: A total of 203 pigmented seborrheic keratoses (from 192 patients) with complete documentation were collected (111 from site 1 and 93 from site 2).Interventions: Screening for new morphological features of seborrheic keratosis and evaluation of all lesions for the prevalence of these criteria. Main Outcome Measures: Identification of new morphological criteria and evaluation of frequency.Results: A total of 15 morphological dermoscopic criteria were identified. Standard criteria such as milialike cysts and comedolike openings were found in a high number of cases (135 and 144, respectively). We found network and networklike structures to be present in 94 lesions (46%). Using standard diagnostic criteria for seborrheic keratosis, 30 lesions would not have been diagnosed as such.Conclusions: The classic dermoscopic criteria for seborrheic keratosis (milialike cysts and comedolike openings) have a high prevalence but the use of additional dermoscopic criteria such as fissures, hairpin blood vessels, sharp demarcation, and moth-eaten borders improves the diagnostic accuracy. The proper identification of pigment network and networklike structures is important for the correct diagnosis.

Dermoscopy of Solitary Angiokeratomas

“…This technique allows for better visualization of structures within the epidermis, dermoepidermal junction, and superficial dermis. [12][13][14] Previous studies demonstrated that the use of dermoscopy improves the clinical accuracy in diagnosing melanomas 15,16 and other pigmented and vascular skin lesions [17][18][19][20][21] and may help in differentiating benign from malignant lesions. The objectives of this study were to describe the dermoscopic characteristics of a series of solitary angiokeratomas and to investigate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPP), and reproducibility of dermoscopic structures and patterns associated with solitary angiokeratomas.…”

Clonal Seborrheic Keratosis: A Dermoscopic Pitfall

“…here have been several recent reports of the apparently successful use of topical tacrolimus in the treatment of genital lichen sclerosus (LSc), [1][2][3][4] 2 of which have appeared in the Archives of Dermatology. 1,2 Genital squamous cell carcinoma is an established risk in the context of a chronic inflammatory scarring dermatosis such as LSc.…”

“…2,3 The clinical features and the additional dermoscopic observation of comedolike open- ings, few milialike cysts, and the jelly sign were all in favor of the diagnosis of seborrheic keratosis. 3,4 However, the presence of blue-gray ovoid nests raised the need for a histopathologic examination, which revealed a clonal seborrheic keratosis. As reported by Hirata et al, the bluegray ovoid nests corresponded histopathologically to multiple nests of pigmented basaloid cells within the epidermis (Figure 2).…”

Dermoscopy of pigmented papillated Bowen disease: A report of two cases

“…2,3 On the other hand, pigmented papillated Bowen disease shows no characteristic structures, such as milia-like cysts, comedo-like openings and a brainlike appearance, which are major components of seborrheic keratosis seen with dermoscopy, as in our two cases. 4,5 In conclusion, we describe the dermoscopic features of pigmented papillated Bowen disease and suggest that irregular fissures/ridges and structureless brown areas may be critical dermoscopic features of pigmented papillated Bowen disease to differentiate it from seborrheic keratosis.…”