“…SCC is also the main differential diagnosis in hyperkeratotic and irritated SKs. Dermoscopic predictors of SCC versus irritated SKs are dotted vessels, branched linear vessels, white structureless areas or white circles surrounding follicles, as recently reported by Papageorgiou and colleagues 15 . A distinctive pattern mainly characterised by sharp demarcation, central keratin and peripheral hairpin vessels in a radial arrangement was detected in almost 7% of lesions in our series (‘KA‐pattern’).…”
Section: Discussionsupporting
confidence: 82%
“…Dermoscopic predictors of SCC versus irritated SKs are dotted vessels, branched linear vessels, white structureless areas or white circles surrounding follicles, as recently reported by Papageorgiou and colleagues. 15 A distinctive pattern mainly characterised by sharp demarcation, central keratin and peripheral hairpin vessels in a radial arrangement was detected in almost 7% of lesions in our series ('KA-pattern'). These findings are analogous to those reported by Rosendahl and colleagues and Zalaudek and colleagues in their series of 43 and 24 KA, respectively.…”
Background: Clinical and dermoscopic recognition of seborrheic keratoses (SKs) is often straightforward, and biopsy might not be required. However, inflamed SKs (iSKs) can pose a diagnostic challenge. Dermoscopic features of iSKs have not yet been evaluated to date.Objectives: To assess the diagnostic ability of a group of dermatologists to diagnose iSKs by dermoscopy. To evaluate the dermoscopic findings of a long series of inflamed seborrheic keratoses.Methods: Clinical and dermoscopic images of 100 difficult-to-diagnose skin tumours, including 29 iSKs, were presented to 33 clinicians (24 dermatologists and 9 dermatology residents), who were blinded to the diagnosis. The dermoscopic features of a series of 219 iSKs were retrospectively analysed.Results: iSKs were correctly identified in a 37.6% of cases. Classic dermoscopic criteria were present in only 47% of iSKs. The most frequent dermoscopic feature in iSKs was the presence of vascularization (91.3%), but only a 44.5% showed predominance of hairpin vessels. A bluish hue was observed in 18.3% of lesions. Seven dermoscopic patterns were identified, based on the dermoscopic similarity to other tumours: seborrheic keratosis-like (28.8%); squamous cell carcinoma-like (25.6%); melanoma-like (17.8%); keratoacanthoma-like (6.8%); basal cell carcinoma-like (5.9%); verruca vulgaris-like (5.9%); nevus-like (2.3%).
Conclusions:The diagnosis of iSKs can be challenging even with dermoscopy. They may behave as authentic mimics of other cutaneous tumours, including squamous cell carcinoma or melanoma. For this reason, histopathological examination should be mandatory in these cases.
“…SCC is also the main differential diagnosis in hyperkeratotic and irritated SKs. Dermoscopic predictors of SCC versus irritated SKs are dotted vessels, branched linear vessels, white structureless areas or white circles surrounding follicles, as recently reported by Papageorgiou and colleagues 15 . A distinctive pattern mainly characterised by sharp demarcation, central keratin and peripheral hairpin vessels in a radial arrangement was detected in almost 7% of lesions in our series (‘KA‐pattern’).…”
Section: Discussionsupporting
confidence: 82%
“…Dermoscopic predictors of SCC versus irritated SKs are dotted vessels, branched linear vessels, white structureless areas or white circles surrounding follicles, as recently reported by Papageorgiou and colleagues. 15 A distinctive pattern mainly characterised by sharp demarcation, central keratin and peripheral hairpin vessels in a radial arrangement was detected in almost 7% of lesions in our series ('KA-pattern'). These findings are analogous to those reported by Rosendahl and colleagues and Zalaudek and colleagues in their series of 43 and 24 KA, respectively.…”
Background: Clinical and dermoscopic recognition of seborrheic keratoses (SKs) is often straightforward, and biopsy might not be required. However, inflamed SKs (iSKs) can pose a diagnostic challenge. Dermoscopic features of iSKs have not yet been evaluated to date.Objectives: To assess the diagnostic ability of a group of dermatologists to diagnose iSKs by dermoscopy. To evaluate the dermoscopic findings of a long series of inflamed seborrheic keratoses.Methods: Clinical and dermoscopic images of 100 difficult-to-diagnose skin tumours, including 29 iSKs, were presented to 33 clinicians (24 dermatologists and 9 dermatology residents), who were blinded to the diagnosis. The dermoscopic features of a series of 219 iSKs were retrospectively analysed.Results: iSKs were correctly identified in a 37.6% of cases. Classic dermoscopic criteria were present in only 47% of iSKs. The most frequent dermoscopic feature in iSKs was the presence of vascularization (91.3%), but only a 44.5% showed predominance of hairpin vessels. A bluish hue was observed in 18.3% of lesions. Seven dermoscopic patterns were identified, based on the dermoscopic similarity to other tumours: seborrheic keratosis-like (28.8%); squamous cell carcinoma-like (25.6%); melanoma-like (17.8%); keratoacanthoma-like (6.8%); basal cell carcinoma-like (5.9%); verruca vulgaris-like (5.9%); nevus-like (2.3%).
Conclusions:The diagnosis of iSKs can be challenging even with dermoscopy. They may behave as authentic mimics of other cutaneous tumours, including squamous cell carcinoma or melanoma. For this reason, histopathological examination should be mandatory in these cases.
“…In contrast, hairpin vessels, a diffuse regular vessel arrangement and multiple white halos surrounding vessels predict the diagnosis of irritated SK. 30 Figure 6 Irritated SK on the leg of a 76-year-old man. ( A ) Clinically the lesion is a large plaque with a partially keratotic surface, well-demarcated borders and color variegation from light brown to dark brown.…”
Section: Challenging Variants Of Skmentioning
confidence: 99%
“…In contrast, hairpin vessels, a diffuse regular vessel arrangement and multiple white halos surrounding vessels predict the diagnosis of irritated SK. 30 Regressing SK may show a lichenoid pattern similar to that of lichen planus like keratosis (LPLK). Actually, it has been proposed that lichenoid keratosis represents an immunological or regressive response to pre-existing epidermal lesions, usually solar lentigines or seborrheic keratoses.…”
Seborrheic keratoses are exceedingly common in the elderly and usually are easy to diagnose and do not require treatment. However, given their great variety of clinical presentation, they may give rise to false-positive cases, meaning that they may at times mimic melanoma, squamous cell carcinoma and basal cell carcinoma. On the other hand, melanoma may mimic seborrheic keratosis, leading to incorrect patient management. With this review, we would like to summarize the current knowledge about epidemiology, clinical, dermoscopic and reflectance confocal microscopy imaging of this common entity, and we also summarize the currently available treatment options.
“…They are used in dermoscopic scoring methods shown to improve clinical accuracy for distinguishing between SKs and SK-like melanomas [108,109]. A subgroup of these features, including hairpin vessels, a diffuse regular vessel arrangement, and 10% lesion coverage with white halos, can be used to differentiate irritated SK and SCC [110]. However, a global pattern has not been identified for atypical SKs.…”
Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.
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