Clinical And Pathological Analysis Of Actinic Keratosis And Seborrheic Keratosis

Objective:To discuss the differences of clinical and pathological features of actinic keratosis(AK)and seborrheic keratosis(SK),which provide an idea for the diagnosis,identification,treatment and prevention of two diseases.Methods:Collected the clinical and pathological data of 52 cases of AK patients and 80 cases of SK patients who were diagnosed after surgical resection and pathological biopsy in the Dermatology of Dalian Medical University second affiliated hospital during from2015 to 2017.Utilizing the retrospective analysis for clinical data,pathological classification,clinical and pathological diagnosis coincidence rate and the misdiagnosis rate.To discuss the differences of the pathogenic age,sex,department,skin manifestations,pathological classification of two diseases,and analyze the reasons of misdiagnosis.SPSS software was used to treat with the data,measurement data was analyzed by t-test,enumeration data was analyzed by chi-square test and Fisher precision test,P<0.05 was statistically significant.Results:Ⅰ.The age distribution of AK group was 33-90 years old,the average age was65.54±12.80.The age distribution of the SK group was 20-89 years old,the average age was 59.04±14.52.AK group is mainly elderly,SK group is mainly middle-aged andelderly.The pathogenic age of AK group was slightly later than SK group(P < 0.05).Ⅱ.In the AK group,there were 23 males and 29 females,the rate of male to female was 0.79:1.In the SK group,there were 43 males and 37 females,the rate of male to female was 1.16:1.There was no statistical difference in the gender composition of AK and SK(P >0.05).Ⅲ.In the AK group,there were 49 cases in the head、face and neck(94.2%),1 case in the trunk(1.9%),2 cases in the limbs(including hand and foot)(3.9%),and 0 case of others(including buttock and genital).In the SK group,there were 43 cases in the head、face and neck(53.75%),22 cases in the trunk(27.5%),7 cases in the extremities(including hand and foot)(8.75%),and 8 cases in the other(including buttock and genitals)(10.0%).The skin lesions of AK mainly occur in the exposed part of the body,such as head、face and neck.However,the lesions of SK can be found in all parts of the body such as head 、face and neck,trunk,limbs,buttock and genital(P < 0.05).Ⅳ.In the histopathological classification of AK group,there were 31 cases of atrophy type(59.6%),8 cases of hypertrophy type(15.4%),5 cases of mosses type(9.6%),4 cases of acantholysis type(7.7%),4 cases of pigmented type(7.7%),0 case of carcinoma in situ(0%).In the SK group,there were 32 cases of hyperkeratosis type(40%),30 cases of acanthosis type(37.5%),14 cases of denoid type(17.5%),2 cases of clone type(2.5%),2 cases of stimulus type(2.5%).The histopathological classification of AK group was mainly characterized by atrophy and hypertrophy.The histopathological classification of SK group was dominated by hyperkeratosis and acanthosis.Ⅴ.The coincidence rate of clinical diagnosis and pathological diagnosis of AK group was 25%,the misdiagnosis rate is 75%.AK was misdiagnosed as SK accounting for 25/39.The coincidence rate of clinical diagnosis and pathological diagnosis of SK group was 53.75%,the misdiagnosis rate was 46.25%,and SK was misdiagnosed as AK accounting for 4/37.The misdiagnosis rate of AK group was higher than that of SK group.Two kinds of diseases are easy to misdiagnose each other,and AK is more easily to be misdiagnosed as SK.Conclusion:Ⅰ.The pathogenic age of AK is slightly later than SK;there is no statistical difference in the gender composition of AK and SK;the skin lesions of SK can occur in each part of the body surface,however the lesions of AK mainly occur in the exposed part of the body,such as head、face and neck.Ⅱ.The misdiagnosis rate of AK group is higher than that of SK group.AK and SK are easy to misdiagnose each other,and AK is more likely to be misdiagnosed as SK.Ⅲ.The reasons of the misdiagnosis of AK and SK is the similarity of clinical manifestations of skin lesions,and some doctors are inexperienced.Ⅳ.The pathological diagnosis is the gold standard for the diagnosis of AK and SK,clinical diagnosis should be combined with pathological diagnosis.