Guo A, Chen J, Yang C, Ding Y, Zeng Q, Tan L
Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China.
Skin Res Technol. 2018 Nov;24(4):663-666. doi: 10.1111/srt.12582. Epub 2018 May 24.
Seborrheic keratosis (SK) is one of the most common skin tumors seen by dermatologists. It should be differentiated with many diseases, especially skin tumors. Reflectance confocal microscopy (RCM) has been applied for evaluation of SK. There are a few studies that describe the RCM of SK. The aim of the study was to find the challenge of diagnosing seborrheic keratosis by reflectance confocal microscopy.
A total of 390 patients with a clinical suspicious diagnosis of seborrheic keratosis were enrolled in this study, and lesions from each patient were imaged with RCM. Thirty-seven of these patients performed a biopsy in order to be given a histological diagnosis. We retrospectively analyzed the outcomes of RCM diagnosis and histological diagnosis, and then found the RCM characteristics of biopsy-proven lesions.
According to RCM images, 258 of 390 (66.2%) patients were diagnosed with SK, 97 of 390 (24.9%) patients could not be diagnosed by the dermatologist according to RCM. Of all 37 biopsied lesions, 23 were SK, 6 were actinic keratosis, 2 were basal cell carcinoma, and 2 were squamous cell carcinoma.
It is challenge to diagnose seborrheic keratosis by reflectance confocal microscopy. It may due to the variable clinical and RCM appearances of SK, and limited depth of RCM.
脂溢性角化病（SK）是皮肤科医生最常诊治的皮肤肿瘤之一。它需要与多种疾病进行鉴别，尤其是皮肤肿瘤。反射式共聚焦显微镜（RCM）已被应用于脂溢性角化病的评估。有少数研究描述了脂溢性角化病的RCM表现。本研究的目的是探寻反射式共聚焦显微镜诊断脂溢性角化病所面临的挑战。
本研究共纳入390例临床疑似脂溢性角化病的患者，对每位患者的皮损进行RCM成像。其中37例患者进行了活检以获得组织学诊断。我们回顾性分析了RCM诊断和组织学诊断的结果，进而发现经活检证实的皮损的RCM特征。
根据RCM图像，390例患者中有258例（66.2%）被诊断为SK，390例患者中有97例（24.9%）皮肤科医生根据RCM无法做出诊断。在所有37例活检皮损中，23例为SK，6例为光化性角化病，2例为基底细胞癌，2例为鳞状细胞癌。
通过反射式共聚焦显微镜诊断脂溢性角化病具有挑战性。这可能是由于SK的临床和RCM表现多样，以及RCM的成像深度有限所致。
