Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis

Cristina Carrera, Sonia Segura, Paula Aguilera, Massimiliano Scalvenzi, Caterina Longo, Alicia Barreiro, Paolo Broganelli, Stefano Cavicchini, Alex Llambrich, Pedro Zaballos, Luc Thomas, Josep Malvehy, Susana Puig, Iris Zalaudek

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)544-551
Number of pages8
JournalJAMA Dermatology
Volume153
Issue number6
DOIs
Publication statusPublished - Jun 1 2017

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Seborrheic Keratosis
Melanoma
Dermoscopy
Pseudopodia
Checklist
Austria
Skin Neoplasms
Keratins
Spain
Italy
France
Observational Studies

ASJC Scopus subject areas

  • Dermatology

Cite this

Carrera, C., Segura, S., Aguilera, P., Scalvenzi, M., Longo, C., Barreiro, A., ... Zalaudek, I. (2017). Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis. JAMA Dermatology, 153(6), 544-551. https://doi.org/10.1001/jamadermatol.2017.0129

Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis. / Carrera, Cristina; Segura, Sonia; Aguilera, Paula; Scalvenzi, Massimiliano; Longo, Caterina; Barreiro, Alicia; Broganelli, Paolo; Cavicchini, Stefano; Llambrich, Alex; Zaballos, Pedro; Thomas, Luc; Malvehy, Josep; Puig, Susana; Zalaudek, Iris.

In: JAMA Dermatology, Vol. 153, No. 6, 01.06.2017, p. 544-551.

Research output: Contribution to journalArticle

Carrera, C, Segura, S, Aguilera, P, Scalvenzi, M, Longo, C, Barreiro, A, Broganelli, P, Cavicchini, S, Llambrich, A, Zaballos, P, Thomas, L, Malvehy, J, Puig, S & Zalaudek, I 2017, 'Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis', JAMA Dermatology, vol. 153, no. 6, pp. 544-551. https://doi.org/10.1001/jamadermatol.2017.0129
Carrera, Cristina ; Segura, Sonia ; Aguilera, Paula ; Scalvenzi, Massimiliano ; Longo, Caterina ; Barreiro, Alicia ; Broganelli, Paolo ; Cavicchini, Stefano ; Llambrich, Alex ; Zaballos, Pedro ; Thomas, Luc ; Malvehy, Josep ; Puig, Susana ; Zalaudek, Iris. / Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis. In: JAMA Dermatology. 2017 ; Vol. 153, No. 6. pp. 544-551.
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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.",
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T1 - Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis

AU - Carrera, Cristina

AU - Segura, Sonia

AU - Aguilera, Paula

AU - Scalvenzi, Massimiliano

AU - Longo, Caterina

AU - Barreiro, Alicia

AU - Broganelli, Paolo

AU - Cavicchini, Stefano

AU - Llambrich, Alex

AU - Zaballos, Pedro

AU - Thomas, Luc

AU - Malvehy, Josep

AU - Puig, Susana

AU - Zalaudek, Iris

PY - 2017/6/1

Y1 - 2017/6/1

N2 - 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.

AB - 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.

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