Cristina Carrera1, Sonia Segura2, Paula Aguilera1, Massimiliano Scalvenzi3, Caterina Longo4, Alicia Barreiro5, Paolo Broganelli6, Stefano Cavicchini7, Alex Llambrich8, Pedro Zaballos9, Luc Thomas10, Josep Malvehy1, Susana Puig1, Iris Zalaudek11. 1. Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain2Centre of Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. 2. Department of Dermatology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Department of Dermatology, University of Naples Federico II, Naples, Italy. 4. Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy6Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. 5. Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain. 6. Città della Salute e della Scienza, Turin, Italy. 7. Unità Operative (UO) Dermatologia Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 8. Dermatology, Hospital Son Llatzer, Palma Mallorca, Spain. 9. Dermatology Department, Hospital Sant Pau i Santa Tecla, Tarragona, Spain. 10. Department of Dermatology, Centre Hospitalier Lyon Sud, Lyon 1 University, Lyons Cancer Research Center (Pr Puisieux), Lyon, France. 11. Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria.
Abstract
Importance: Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas. Objective: To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology. Design, Setting, and Participants: This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014. Main Outcomes and Measures: Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated. Results: Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2.3), while dermoscopically SK-like melanomas achieved a total dermoscopy score of only 4.2 (1.3) and a 7-point checklist score of 2.0 (1.9), both in the range of benignity. The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network. Multivariate analysis found only the blue-black sign to be significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK-like melanomas. Conclusions and Relevance: Seborrheic keratosis-like melanomas can be dermoscopically challenging, but the presence of the blue-black sign, pigment network, pseudopods or streaks, and/or blue-white veil, despite the presence of other SK features, allows the correct diagnosis of most of the difficult melanoma cases.
Importance: Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas. Objective: To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology. Design, Setting, and Participants: This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014. Main Outcomes and Measures: Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated. Results: Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2.3), while dermoscopically SK-like melanomas achieved a total dermoscopy score of only 4.2 (1.3) and a 7-point checklist score of 2.0 (1.9), both in the range of benignity. The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network. Multivariate analysis found only the blue-black sign to be significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK-like melanomas. Conclusions and Relevance: Seborrheic keratosis-like melanomas can be dermoscopically challenging, but the presence of the blue-black sign, pigment network, pseudopods or streaks, and/or blue-white veil, despite the presence of other SK features, allows the correct diagnosis of most of the difficult melanoma cases.
Authors: Ralph Peter Braun; Harold S Rabinovitz; Joachim Krischer; Jürgen Kreusch; Margaret Oliviero; Luigi Naldi; Alfred W Kopf; Jean H Saurat Journal: Arch Dermatol Date: 2002-12
Authors: Yevgeniy Balagula; Ralph P Braun; Harold S Rabinovitz; Stephen W Dusza; Alon Scope; Tracey N Liebman; Ines Mordente; Katherine Siamas; Ashfaq A Marghoob Journal: J Am Acad Dermatol Date: 2011-10-24 Impact factor: 11.527
Authors: Veronica Rotemberg; Nicholas Kurtansky; Brigid Betz-Stablein; Liam Caffery; Emmanouil Chousakos; Noel Codella; Marc Combalia; Stephen Dusza; Pascale Guitera; David Gutman; Allan Halpern; Brian Helba; Harald Kittler; Kivanc Kose; Steve Langer; Konstantinos Lioprys; Josep Malvehy; Shenara Musthaq; Jabpani Nanda; Ofer Reiter; George Shih; Alexander Stratigos; Philipp Tschandl; Jochen Weber; H Peter Soyer Journal: Sci Data Date: 2021-01-28 Impact factor: 6.444