| Objective:Seborrheic keratosis(SK)is the most common benign epidermal tumor caused by delayed keratinization of keratinocytes in middle-aged and elderly people.In recent years,clinical studies have found that the incidence of seborrheic keratinosis(SK)is increasing among young people.Verruca plana(VP)is a benign proliferation of epidermal cells caused by papillomavirus(HPV)infection.It occurs in children and adolescents and can also affect people of all ages.It is easy to differentiate and diagnose typical seborrheic keratosis and verruca planae clinically,but some early or special types of seborrheic keratosis and verruca planae are not easy to be distinguished.Flat wart-like seborrheic keratosis(VP-like SK)[1]-a type of atypical seborrheic keratosis-has the similar location,shape,and color of the rash of flat warts..The clinical manifestations are similar,but the treatment and outcome are different.Skin biopsy can easily distinguish the two diseases,but the invasive feature of biopsy reduces the patient's compliance.Dermoscopy is a noninvasive tool that can observe the microscopic structure of the epidermis,epidermoid-dermal junction and dermal papilla,closely linking macroscopic dermatology with microscopic skin pathology.Typical SK and VP have their own dermoscopy characteristics.There are few reports of the differential diagnosis of VP-like SK and VP by dermoscopy..The purpose of this study was to observe and statistically analyze the dermoscopic manifestations of VP-like SK and VP of their diagnosis and differential diagnosis.MethodsWe collected 41 cases clinically diagnosed VP-like SK and VP from the Department of Dermatology from October 2019 to September 2020,which other objective conditions are not limited.All lesions were examined by dermoscopy and histopathology after clinical pictures were collected,and relevant data were retained.The clinical diagnosis and dermoscopic diagnosis are made by experienced dermatologists based on their clinical photos and dermatoscopy results.The specificity,sensitivity,Youden index and kappa value of dermoscopy in the diagnosis of VP-like SK and VP were analyzed based on histopathology.In the mean time,the incidence of each dermoscopic characteristics of VP-like SK and VP were statistically analyzed,and the characteristics of dermatoscopic diagnosis and differential diagnosis were further summarized.Results1.A total of 111 skin lesions were selected from 41 patients,including 15 patients with VP-like SK and 26 patients with VP.After pathological examination,23 cases were diagnosed as VP-like SK,7 males and 16 females.The episode age was 30-72 years old,with an average of(48.61 ± 13.354)years old;there were 13 lesions in the face and neck and 15 in the trunk.After pathological examination,18 cases were diagnosed as VP,6 males and 12 females.The age of onset was between 3-3 6 years old,and the average age is(25.47±10.134)years old;there were 12 lesions in the face and neck and 7 in the trunk.2.The pathological type of 23 cases of VP-like SK was mainly acanthosis type(69.57%),followed by hyperkeratosis(17.39%),adenoid(8.70%)and irritant type(4.35%).3.The Sensitivity,Specificity,Youden index and Kappa value of dermoscopic diagnose for VP-like SK were 91.3%,83.33%,74.63%and 0.751(>0.75),which means dermoscopic and pathological diagnosis for VP-like SK were higher consistency.4.The Sensitivity,Specificity,Youden index and Kappa value of dermoscopic diagnose for VP were 83.33%,91.3%,74.63%and 0.751(>0.75),which means dermoscopic and pathological diagnosis for VP were higher consistency.5.The most common dermoscopy patterns in VP-like SK were as follows:Clear boundary(58.46%),Comedo-like openings(40.00%),Cerebriform pattern(32.31%),Fat fingers(32.31%),Milia-like cyst(21.54%)and Fingerprint pattern(21.54%).6.The main dermoscopic features of VP were Yellow-white background(65.22%)or pinkbackground(34.78%),dot-like bleeding structure(80.43%),with most of the lesion boundaries blurred(60.87%).Conclusions:1.The incidence of VP-like SK and VP was mostly female.The former was more common in middle-aged people,while the latter was more common in young people.There were no differences in frequent location of VP-like SK,but VP mainly occurs in the face and neck.2.Dermoscopy has high sensitivity and specificity in the diagnosis of VP-like SK and VP,and their dermoscopic and histopathological diagnosis have good consistency.3.Both VP-like SK and VP have their characteristic dermoscopy signs,and the difference is obvious,which can be used for clinical differential diagnosis of them.4.The main pathological type of VP-like SK is acanthosis,followed by is hyperkeratosis. |
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