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Dermoscopy of pigmented seborrheic keratosis: a morphological study
Ralph Peter Braun1, Harold S Rabinovitz, Joachim Krischer
1Pigmented Skin Lesion Clinic, Department of Dermatology, University Hospital Geneva, Switzerland. braun@melanoma.ch
Objectives:
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.