| Part 1 New exploration of seborrheic keratosis under dermoscopyObjective:The purpose of this study was to analyze the difference of dermoscopic findings between misdiagnosed and missed cases of seborrheic keratosis(SK),to put forward a new dermoscopic mode and summarize rare dermoscopic findings,to supplement the existing SK dermoscopy expert consensus,to further explore the application value of dermoscopy in the diagnosis of SK.Methods:1.138 patients diagnosed as SK clinically were retrospectively analyzed.Dermoscopic examination was conducted firstly,follow by biopsy and histopathological examination.The consistency between dermoscopy and pathological examination was compared afterward.2.Count the cases whose dermoscopic performance does not meet the consensus of experts,and analyze the similarities and differences of their dermoscopic performance.The rare dermoscopic findings of SK were summarized and its relationship with pathology was analyzed.3.The cases of SK diagnosed by pathology were retrospectively analyzed and classified according to dermoscopy and histopathological features,and the relationship between dermoscopic pattern,dermoscopic manifestation and pathological classification was analyzed.According to the degree of inflammatory cell infiltration in the superficial dermis,the cases were divided into mild,moderate and heavy,and the relationship between pathological classification and the degree of inflammatory cell infiltration was analyzed.Compare the difference in the degree of inflammatory cell infiltration between exposed and non-exposed site.Results:1.The most common dermoscopic features were fissure(54%),papillary structure(41%),followed by cerebral gyrus structure(27%),hairpin-like vessel(21%),comedo-like opening(20%)and milia-like cyst(11%).In addition,broken glass-like keratin(8%),insect-like edges(7%)and pebble-like structure(7%),white stripes(9%)and network-like structures(5%)could also be observed.2.The rare dermoscopic manifestations of SK are black homogeneous structure(5%),blue-gray glomeruli(2%),blue-white curtain(2%),hair follicle horn plugs(2%),radial distribution of marginal brown stripes(1%),star burst pattern(2%),beaded blood vessels(1%),frog egg-shaped structure and pleomorphic blood vessels(1%).The black homogeneous structure corresponding histopathological features are the increase of a large number of pigment granules in the epidermis,blue-gray glomeruli corresponding histopathological features are nest-like changes,blue-white curtain corresponding histopathological features are hyperplastic and denatured collagen fibers in the superficial dermis,hair follicle horn plugs corresponding histopathological features are hyperkeratosis and keratocyst formation,frog egg-shaped structure corresponding histopathological features are papillomatous hyperplasia and beaded blood vessels corresponding histopathological features are telangiectasia.3.According to the histopathological findings,it can be divided into seven types:hyperkeratosis type(27%),spinous hypertrophy type(32%),clonal type(2%),irritant type(irritant type,21%),adenoid type(4%),mixed type(7%)and flat type(6%).There were 22 case with mild degree(18%),39 case with moderate degree(32%),60 case with heavy degree(50%),base on the degree of inflammatory cell infiltration level.4.The sensitivity and specificity of dermoscopy diagnosis were 94.2% and 76.5%respectively.The accuracy rate,the misdiagnosis rate and the rate of missed diagnosis were92%,23.5% and 5.8% respectively.Youden index was 0.71.The Kappa value of dermoscopic examination and pathological examinations was 0.66(P < 0.05),which suggesteded that there was a good consistency between dermoscopic examination and pathological examination.5.In this study,31 patients were diagnosed with SK based on 1 dermoscopic appearance,of which 28 case were correctly diagnosed,3 case were misdiagnosed,and 3case were missed based on 1 dermoscopic appearance,the diagnosis coincidence rate was82%(28/ 34);according to 2 dermoscopic findings,50 patients were diagnosed with SK,of which 49 case were correctly diagnosed,1 case was misdiagnosed,and there was no missed diagnosis,the diagnosis coincidence rate was 98%(49/ 50);while 35 patients were diagnosed with SK based on 3 or more dermoscopic findings,there was no misdiagnosis or missed diagnosis,the diagnosis coincidence rate was 100%(35/35);the difference in the above diagnosis coincidence rate was statistically significant(P < 0.05).6.According to the overall dermoscopic appearance,SK can be divided into four dermoscopic modes: patch type(26%),flat papule type(23%),verrucous hyperplasia type(27%)and velvet type(24%).There is not a one-to-one correspondence between dermoscopic mode and the pathological type,for the dermoscopic patch type,the most common pathological type is hyperkeratosis(35%),followed by spinous layer hypertrophy type(26%);for the dermoscopic flat papule type,the most common pathological type is spine hypertrophy(39%),followed by irritation type(29%);for the dermoscopic verrucous hyperplasia type,the most common pathological type is hyperkeratosis(48%),followed by irritation type(33%).The above difference is statistically significant(P < 0.05).7.There was a certain correlation between dermoscopic findings and pathological classification,and the difference was statistically significant(P < 0.05).The correlation coefficient was 0.52,indicating a good correlation.8.Different pathological types and the degree of inflammatory cell infiltration were different,and the difference was statistically significant(P < 0.05).9.There was no significant difference in pathological classification between exposed site and non-exposed site(P > 0.05);the degree of inflammatory cell infiltration in exposed site was different from that in non-exposed site,and the difference was statistically significant(P < 0.05);different sites of the lesions showed different dermoscopic appearances and the difference was statistically significant(P < 0.05);papillary structures,gyrus-like structures,insect-like edges,hairpin-like blood vessels,and network-like structures were commonly observed in exposed areas,while comedo-like openings and broken glass keratosis were commonly observed in non-exposed areas.Conclusions:1.The clinical manifestations of SK are various,when there are more than one dermoscopic findings at the same time,a higher diagnostic accuracy for SK could be achieved by dermoscopy.2.“Broken glass keratosis” can be used as a new term to describe SK dermoscopic term and it has a certain prompting effect on the diagnosis of SK..3.When there are black homogeneous structure,white stripes,blue-gray glomeruli,blue-white curtain,hair follicle horn plugs,radial distribution of marginal brown stripes,star burst pattern,beaded blood vessels,frog egg-shaped structure and pleomorphic blood vessels,the possibility of diagnosing SK needs to be considered.4.Dermoscopic manifestations of some skin tumors are similar to those of SK,which requires careful identification by clinicians to reduce misdiagnosis.Part 2 Study on the relationship between seborrheic keratosis and IL-6Objective:To explore the expression level of IL-6 in patitents with seborrheic keratosis(SK)and its correlation with inflammation and lesions site.Methods:The expression level of IL-6 in the lesion tissues of SK patients and normal healthy skin tissues was detected compared by immunohistochemical staining.Then the correlation between the expression level of IL-6 in the skin lesions of SK patients and the degree of inflammatory cell infiltration and the location of the lesion was further analyzed.Results:1.The positive rate of IL-6 in SK skin lesions was 73.3%,which was significantly higher than that in normal skin(P < 0.05).2.There was a positive correlation between the expression level of IL-6 in SK skin lesions and the degree of inflammatory cell infiltration(r = 0.51,P< 0.05).3.There was no significant difference in the expression level of IL-6 in SK skin lesions between exposed and non-exposed parts(P > 0.05).Conclusions:IL-6 may be involved in the development of SK,and it is dominated by inflammation. |
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