Lin J, Han S, Cui L, Song Z, Gao M, Yang G, Fu Y, Liu X
Department of Dermatology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China.
J Eur Acad Dermatol Venereol. 2014 Jul;28(7):957-62. doi: 10.1111/jdv.12241. Epub 2013 Aug 24.
Although most seborrhoeic keratoses can be easily diagnosed with dermoscopy, some lesions mimic a number of other diseases and lack typical dermoscopic criteria. Validation of the diagnostic algorithm and further understanding about dermoscopy of seborrhoeic keratosis is necessary.
To evaluate the dermoscopic criteria, define dermoscopic patterns and optimize the diagnostic algorithm of seborrhoeic keratosis in a large series of cases.
An unselected consecutive series of 416 clinically suspected seborrhoeic keratoses from 412 patients were prospectively included. All the lesions were imaged with dermoscopy, analysed for dermoscopic patterns and features. An independent blinded histopathological diagnosis as well as dermoscopic diagnosis was made for each lesion.
A total of 416 lesions were analysed. Using histopathological diagnoses as the gold standard, the two-step algorithm achieved a sensitivity of 79.1, a specificity of 78.3% (P < 0.01) and a κ index of 0.223. An optimized algorithm that combined lack of blue-grey or blue-white colour, sharp demarcation, mica-like structure and yellowish colour with the two-step algorithm demonstrated a sensitivity of 95.7%, a specificity of 78.3% (P < 0.001) and a κ index of 0.594. Pattern analysis revealed 12 dermoscopic patterns. The elevated lesions mainly presented fissures/ridges pattern, exophytic papillary pattern, crypts pattern and mica-like pattern; the flat lesions mainly presented structureless pattern and coral-like pattern.
Seborrhoeic keratosis may present a variety of dermoscopic patterns and features. The combination of lack of blue-grey or blue-white colour, sharp demarcation, mica-like structure and yellowish colour with the two-step algorithm could improve its diagnostic accuracy.
尽管大多数脂溢性角化病通过皮肤镜检查可轻松诊断，但一些病变可模仿多种其他疾病且缺乏典型的皮肤镜标准。因此，验证诊断算法并进一步了解脂溢性角化病的皮肤镜检查是必要的。
在大量病例中评估脂溢性角化病的皮肤镜标准，定义皮肤镜模式并优化诊断算法。
前瞻性纳入了412例患者的416个临床疑似脂溢性角化病的连续非选择性系列病例。所有病变均进行皮肤镜成像，分析皮肤镜模式和特征。对每个病变进行独立的盲法组织病理学诊断以及皮肤镜诊断。
共分析了416个病变。以组织病理学诊断为金标准，两步算法的敏感性为79.1%，特异性为78.3%（P<0.01），κ指数为0.223。将缺乏蓝灰色或蓝白色、边界清晰、云母样结构和淡黄色与两步算法相结合的优化算法，敏感性为95.7%，特异性为78.3%（P<0.001），κ指数为0.594。模式分析揭示了12种皮肤镜模式。隆起性病变主要表现为裂隙/嵴模式、外生性乳头模式、隐窝模式和云母样模式；扁平病变主要表现为无结构模式和珊瑚样模式。
脂溢性角化病可能呈现多种皮肤镜模式和特征。将缺乏蓝灰色或蓝白色、边界清晰、云母样结构和淡黄色与两步算法相结合可提高其诊断准确性。
