Braga Juliana Casagrande Tavoloni, Scope Alon, Klaz Itay, Mecca Patricia, Spencer Philip, Marghoob Ashfaq A
Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
J Am Acad Dermatol. 2008 May;58(5):875-80. doi: 10.1016/j.jaad.2007.12.011. Epub 2008 Mar 6.
Seborrheic keratosis is a common skin lesion that can usually be recognized either clinically or dermoscopically. However, melanomas mimicking seborrheic keratoses, as well as melanomas arising in association with seborrheic keratoses, have been described. We report the case of a patient with a lesion that initially revealed "classic" dermoscopic features of a seborrheic keratosis. However, during follow-up, changes in color developed within the center of the lesion that led the clinician to the correct diagnosis of melanoma. Upon retrospective evaluation of the baseline image of the lesion; the clinician was now able to "see" that which his brain could not appreciate on initial examination and to realize that the lesion had subtle features suspect for melanoma. This case represents a diagnostic pitfall due to errors in perception. Dermatologists should be cognizant of "errors in perception"; we suggest that a final dermoscopic judgment of a seborrheic keratosis be rendered by combining the gestalt diagnosis of the overall pattern, with deliberate dermoscopic analysis of all quadrants of the lesion.
脂溢性角化病是一种常见的皮肤损害，通常可通过临床或皮肤镜检查识别。然而，已有模仿脂溢性角化病的黑色素瘤以及与脂溢性角化病相关的黑色素瘤的报道。我们报告一例患者，其皮损最初表现出脂溢性角化病的“典型”皮肤镜特征。然而，在随访过程中，皮损中心出现颜色变化，从而使临床医生做出黑色素瘤的正确诊断。回顾性评估该皮损的基线图像时，临床医生现在能够“看到”他在初次检查时大脑未能察觉的情况，并意识到该皮损具有可疑黑色素瘤的细微特征。该病例代表了由于感知错误导致的诊断陷阱。皮肤科医生应认识到“感知错误”；我们建议通过结合整体模式的格式塔诊断与对皮损所有象限进行仔细的皮肤镜分析，对脂溢性角化病做出最终的皮肤镜诊断。
