Chen Tiffany Y, Morrison Annie O, Cockerell Clay J
Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri.
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Cutan Pathol. 2017 Sep;44(9):747-748. doi: 10.1111/cup.12975. Epub 2017 Jul 2.
Seborrheic keratosis (SK), a common and benign entity, is generally diagnosed clinically without the need for a biopsy. Given their variable appearance, SK may mimic cancer clinically and require biopsy for clinically equivocal cases. A clinician may also choose to perform biopsies on SK based on other circumstances, such as cosmetic reasons or SK being in an inconvenient and irritative location.
Dermatopathology samples from 2015 obtained from private and university locations were retrospectively assessed. Cases included in the study were those with "SK" or "ISK" (irritated seborrheic keratosis) and no other diagnosis in the clinical data. Cases with modifiers suggestive of malignancy such as "SK rule out others," changing, growing and so on were excluded. A total of 4361 eligible cases were identified and used for analysis.
Of the 4361 cases identified as only "SK" or "ISK" in the clinical data, 3759 (86.2%) were, in fact, SK or ISK. A total of 466 (10.7%) were an assortment of non-malignancy diagnoses such as dermatofibroma. There were 136 (3.1%) cases histologically diagnosed as malignancies. The majority (9/136 cases; 67%) were in situ or invasive squamous cell carcinoma; 24.3% (33/136) were basal cell carcinoma and 8.8% (12/136) were melanoma.
SK may mimic cancer even in clinically unsuspicious cases.
脂溢性角化病（SK）是一种常见的良性病变，通常通过临床诊断，无需活检。由于其外观多变，SK在临床上可能会与癌症相似，对于临床诊断不明确的病例需要进行活检。临床医生也可能基于其他情况选择对SK进行活检，如美容原因或SK位于不方便且易产生刺激的部位。
对2015年从私立和大学机构获取的皮肤病理学样本进行回顾性评估。纳入研究的病例为临床资料中诊断为“SK”或“ISK”（刺激性脂溢性角化病）且无其他诊断的病例。排除有提示恶性肿瘤修饰词的病例，如“SK排除其他病变”、病变有变化、增大等。共识别出4361例符合条件的病例并用于分析。
在临床资料中仅诊断为“SK”或“ISK”的4361例病例中，实际上3759例（86.2%）为SK或ISK。共有466例（10.7%）为各种非恶性诊断，如皮肤纤维瘤。有136例（3.1%）病例经组织学诊断为恶性肿瘤。大多数（9/136例；67%）为原位或浸润性鳞状细胞癌；24.3%（33/136）为基底细胞癌，8.8%（12/136）为黑色素瘤。
即使在临床无怀疑的病例中，SK也可能与癌症相似。
