| Objective:Seborrheic keratosis is a kind of benign tumor within epidermal caused by slow maturation of keratinocytes, which known as senile wart, basal cell papilloma. It usually developed in the elderly, but in recent years, the incidence of the young people is rising. The etiology is not yet established. Seborrheic keratoses showed a considerable variety of clinical and histopathological appearances. It is often misdiagnosed as pigmented nevus, melanoma, actinic keratosis, and so on. Especially misdiagnosed as pigmented nevus. However the treatment and prognosis of the two diseases are not exactly the same. Therefore, seeking a noninvasive method is necessary. Dermoscopy is a valuable noninvasive technique that we can directly observe microstructure and pigment of the skin lesion. It is the ligament between the clinical dermatology and the dermatopathology. Some researches on the dermoscopy of SK had been published. But, it has no special reports about the dermoscopic manifestations of pigmented-nevus-like SK. The purpose of this study is to analyze the dermoscopic manifestation of pigmented-nevus-like SK. Thus laying the foundation for the differential diagnosis of pigmented nevus and pigmented-nevus-like SK.Methods:1 We collected 30 cases of skin lesions in the dermatology clinic of the Fourth Hospital of Hebei Medical University from April 2014 to January 2016. All of the cases we chosed were made a pathological diagnosis of SK, and the clinical diagnosis were pigmented nevus(patient’s sex, age, course of disease, location are not limited). The cases which do not meet the above standards were excluded. At the same time, we collected 30 patients(30 cases) with pathological diagnosis of pigmented nevus as control group. All of the cases we chosed were made a pathological and clinical diagnosis of pigmented nevus. The cases which did laser or other treatment were excluded.2 Statistical analysis: to collect data about the pigmented-nevus-like SK lesions location, shape, color, accompanying symptoms, the dermoscopic manifestation, the correspondence between clinical and pathological manifestation, and use the Chi square test to analyze whether there were statistical differences in the dermoscopic manifestation of the two diseases.Results: 1 In this study, we collected 30 patients and 30 cases of pigmented-nevus-like SK. The number of male and female cases were 18(60.00%) and 12(40.00%), the ratio was 1.5:1. The age ranged from 29 to 70 years old, with average age 51.27±10.79. The distribution of lesions was as follows: neck(10 cases, 33.33%), head(8 cases, 26.67%), trunk(7 cases, 23.33%), extremities(5 cases, 16.67%). There were 30 patients and 30 cases in the control group. The number of male and female cases were 11(36.67%) and 19(63.33%), the ratio was 1:1.72. The age ranged from 20 to 58 years old, with average age 34.90±10.74. The distribution of lesions was as follows: head(11 cases, 36.67%), trunk(8 cases, 26.67%),neck(7 cases, 23.33%), extremities(4 cases, 13.33%). 2 Histopathological type of pigmented-nevus-like SK: acanthosis type(22 cases, 73.33%), pigmented type(3 cases, 10.00%), mixed type(3 cases, 10.00%), reticulated type(2 cases, 6.67%). Histopathological type of the control group: intradermal nevus(20 cases, 66.67%), compound nevus(8 cases, 26.67%), junctional nevus(2 cases, 6.67%). 3 Morphology and color of pigmented-nevus-like SK: there were 3 shapes and 3 kinds of colors: circular/oval(23 cases, 76.67%), irregular(4 cases, 13.33%) and papilloma(3 cases, 10.00%). Dark brown/brown(22 cases, 73.33%), black(7 cases, 23.33%) and light brown(1 case, 3.33%). Morphology and color of the control group: there were 3 shapes and 3 kinds of colors: circular/oval(21 cases, 70%),papilloma(5 cases, 16.67%) and irregular(4 cases, 13.33%). Dark brown/brown(20 cases, 66.67%), black(7 cases, 23.33%), light brown(3 case, 10.00%). 4 The dermoscopic manifestation of pigmented-nevus-like SK: 4.1 General features: the grey-white burly mesh-like structure(19 cases, 63.33%), papilloma-like structure/ridges structure(7 cases, 23.33%), homogeneous pattern(1 case, 3.33%), fingerprint-like structure(1 case, 3.33%), mica-like structure(1 case, 3.33%),mesh-like structure(1 case, 3.33%). 4.2 Local features: there were 29 cases(96.67%) with local features, included milium-like cysts(20 cases, 66.67%), comedo-like opening(18 cases, 60.00%), vascular structures(14 cases, 46.67%), mouth-eaten border(1 case, 3.33%), pigmented point(1 case, 3.33%). 5 The dermoscopic manifestation of pigmented nevus: 5.1 General features: globular pattern(24 cases, 80.00%), the reticular pattern(3 cases, 10.00%), mesh-like pattern(3 cases, 10.00%). 5.2 Local features: pigmented ball(24 cases, 80.00%), pigmented point(15 cases, 50.00%), papilloma-like structure(5 cases, 16.67%), comedo-like opening(4 cases, 13.33%), pigmented network(3 cases, 10.00%), vascular structures(2 cases, 6.67%), milium-like cysts(2 cases, 6.67%). 6 The common dermoscopic manifestation of pigmented-nevus-like SK included milium-like cysts 20/30(66.67%), grey-white burly mesh-like structure 19/30(63.33%), comedo-like opening 18/30(60.00%), vascular structures 14/30(46.67%). And there were statistically significant differences between the two groups(p<0.05).Conclusions:1 The histopathological type of pigmented-nevus-like SK included acanthosis type, pigmented type, mixed type, reticulated type.2 The morphology of pigmented-nevus-like SK included circular/oval, irregular, papilloma.The color of it included dark brown/brown, black, light brown.3 General features of pigmented-nevus-like SK: grey-white burly mesh-like structure, papilloma-like structure, homogeneous pattern, fingerprint-like structures, mica-like structure, mesh-like structure. Local features of pigmented-nevus-like SK: milium-like cysts, comedo-like opening, vascular structures, mouth-eaten border, pigmented point.4 The common dermoscopic manifestation of pigmented-nevus-like SK included milium-like cysts, grey-white burly mesh-like structure, comedo-like opening, vascular structures. And they have high specificity in the identification of pigmented nevus and pigmented-nevus-like SK. |
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