Diagnosis Of Seborrheic Keratosis Research Articles

Correlation between Superoxide Dismutase (SOD) with Malondialdehyde (MDA) level in blood plasma of seborrheic keratosis

Introduction: Seborrheic keratosis (SK) is a benign tumor of the epidermis, its development is associated with various hypotheses, but none came out as the main culprit. A few study results regarding the oxidative stress strongly associated with skin tumors have been reported. Superoxide dismutase (SOD) is a potent protective enzymatic antioxidant. Malondialdehyde (MDA) is the end product of lipid peroxidation produced by free radicals in the body. Increased levels of MDA usually accompany low levels of antioxidants. Methods: This study was an observational analytic study with a cross-sectional method involving 42 seborrheic keratosis subjects based on inclusion and exclusion criteria. We recorded the gender, age, family history, and occupation of the subjects. Diagnosis of seborrheic keratosis was made based on history taking and clinical examination—measurement of SOD level by ELISA method and MDA levels by TBARS method. The Spearman correlation test was measured and was considered significant if the p-value was <0.05. Results: Seborrheic keratosis was more common in females (92.9%), with the most common age group being 40 ̶ 50 years old (57.1%), had a family history of SK (26.2%), and worked in agriculture, forestry, and fisheries (26.2%). The average blood plasma SOD level was 1.68 mmol/L, and the blood plasma MDA level was 181.19 U/L. The correlation coefficient between blood plasma SOD levels and blood plasma MDA levels was -0.393, with a significant value of p=0.01. This study showed that the lower the SOD level, the higher the MDA level in the blood plasma of seborrheic keratosis. Conclusion: There is a significant correlation between SOD and MDA levels in the blood plasma of seborrheic keratosis subjects.

Leser–Trélat syndrome: What does it hide?

Sir, Seborrheic keratoses (SKs) are common, benign, non-melanocytic epidermal tumors [1]. Still, they may be suspicious of other, more serious underlying conditions. Leser–Trélat syndrome may be considered a paraneoplastic condition characterized by the sudden onset of multiple SKs [2]. Herein, we report two cases of malignancy revealed by eruptive KS. The first case, an 83-year-old male with no notable pathological history, presented for two years with rapidly evolving lesions of the trunk over a six-month period. The patient also noticed for three months melena with transit disorders, justifying a consultation in which the diagnosis of sigmoid tumor was reached and the patient was referred for surgery. A clinical examination revealed multiple, sessile, exophytic tumors of round or oval appearance, 1 to 3 cm in diameter, well-delimited. The surface of the lesions was verrucous, brownish-black, with numerous, black, keratotic plugs (Fig. 1a). A dermoscopic examination revealed a cerebral appearance with pseudocysts and pseudocomedones (Fig. 1b). The diagnosis of seborrheic keratosis was thus reached.

On the peculiarities of seborrheic keratosis pigmentation

Seborrheic keratosis (SK) is a common benign epithelial skin tumor that exists in a variety of clinical op - tions. The color of the tumor varies from yellow to dark brown, which leads to diagnostic errors. There is аlittle data about pigmentation of the SK in the literature. There is no consensus on the content of melanocytes in the SK.Objective: to study the nature of the distribution of melanin in the SK and its relationship with the number of melanocytes.Materials and methods. An analysis of 130 histological preparations with a verified diagnosis of SK and immunohistochemistry (IHC) test with monoclonal antibodies to Melan A (clone A103 ready-to-use) have been performed. Material sampling was performed in 130 patients with SK at the age of 46–77. In 48.5 % of the material was taken from places that are easily exposed to sunlight, 51.5 % — from places that are often closed, less prone to exposure to UV-radiation.Results. As a result of histological examination, three types of pigmentation of the SK were identified, depending on the accumulation and location of pigment in the tumor. IHC test with monoclonal antibodies to Melan A in all cases of SK revealed a significant decrease in the content of melanocytes (0.7–5 %), compared with the unaffected epidermis (10.7–14.3 %) (р = 0.001). The greatest number of melanocytes (3–5 %) was recorded in SK, which were removed from places exposed to UV radiation.Conclusions. A significant decrease in the content of melanocytes (less than 3 % of tumor cells) in the most pigmented SK (p = 0.0003), the lack of activation of melanogenesis in the tumor under the influence of UV radiation indicates the accumulation of pigment due to its slow utilization, due to aging and a de - crease in metabolismtumor cells.

Evaluation of dermoscopic criteria for seborrheic keratosis on non‐polarized versus polarized dermoscopy

The two dermoscopic methods, polarized dermoscopy (PD) and non-polarized dermoscopy (NPD), use different types of light sources. Here, we aimed to explore the differences between these two methods in the diagnosis of seborrheic keratosis (SK). The images of 121 cases of SK taken by a digital camera equipped with NPD and PD were evaluated against 14 dermoscopic criteria of SK. The agreement levels between NPD and PD were fair to perfect against the dermoscopic criteria of SK. Perfect agreement was observed in fingerprint-like structures (κ=0.812) and linear irregular vessels (κ=0.807). Substantial agreement was determined in comedo-like openings (κ=0.640), hairpin vessels (κ=0.609), a moth-eaten border (κ=0.642), sharp demarcation (κ=0.637), network-like structures (κ=0.662), and a mica-like pattern (κ=0.639). Moderate agreement was found in milia-like cysts (κ=0.550), fissures and ridges (κ=0.554), dotted vessels (κ=0.496), and color variability (κ=0.438). Fair agreement was obtained only in comma vessels (κ=0.340). Based on our results, we cannot recommend an absolute dermoscopic method for the diagnosis of SK; rather, we suggest that the methods are complementary.

LCC: Towards efficient label completion and correction for supervised medical image learning in smart diagnosis

Smart technology brings convenience to our lives, and smart medical diagnosis plays a particularly important role in smart cities and the smart world. In smart diagnosis, high-quality image labels are essential for supervised medical image learning. The correctness of labels has a substantial influence on smart disease diagnosis. However, the labelling of disease images by professional doctors is a time-consuming and labour-intensive project; therefore, obtaining correct and high-quality labels is a difficult task. This paper proposes a deep convolutional neural network (CNN)-based label completion and correction method (LCC) for supervised medical image learning in smart diagnosis. We use a small number of labelled images in a dataset to train a model, and design a strategy to complement most of the unlabelled data and correct noise label data, and then use the results of completion and correction to continually modify the model to achieve better results. We take the diagnosis of Seborrheic Keratosis (SK) and Flat Wart (FW) as examples; the experimental results show that this strategy can use limited labelled data to complete the labels for most of the unlabelled data and correct some noise labels in the dataset, which improves the accuracy rate of the model to identify diseases.

Differential Diagnosis of Seborrheic Keratosis: Clinical and Dermoscopic Features.

<p>Seborrheic keratosis (SK) is a benign epidermal keratinocytic tumor that is extremely common, particularly in individuals over the age of 50. Most individuals with SK will have more than one lesion and the presence of over 10 lesions in the same person is not uncommon. Although the clinical morphology of most SK with their stuck-on, symmetric, keratotic, and waxy appearance makes them easy to identify, many manifest a morphology resembling melanoma or squamous cell carcinoma. One can argue that such cases will ultimately not prove to be problematic since a simple biopsy will easily reveal their benign nature and eliminate any concerns. However, the cost and morbidity associated with the biopsy of benign lesions should not be underestimated. Methods to improve our in vivo ability to correctly identify SK will prove beneficial not only to the health care system in general but to the individual patient specifically. The issue of greater concern resides with skin cancers that mimic SK or when skin cancers arise in association with SK. Needless to say, in vivo methods to help identify malignancy and differentiate them from benign lesions would be welcomed by all. Fortunately, we do now have in vivo imaging methods such as dermoscopy that can improve the clinician's diagnostic accuracy. In this article, we summarize the current knowledge regarding the clinical and dermoscopic features of SK, and provide clues to aid in their diagnosis.</p> <p><em>J Drugs Dermatol. 2017;16(9):835-842.</em></p>.

Seborrheic keratosis: clinical characteristics and an association with the β-genus human papillomavirus

Background : Seborrheic keratosis is a common benign tumor of unclear etiology . Aim : To study associations between clinical characteristics of seborrheic keratosis and its course with quantitative parameters of the β-genus human papillomavirus (β-HPV). Materials and methods : The main study group included 91 patients with seborrheic keratosis (29 male and 62 female), aged 40 to 75 years (mean ± SD, 59.2 ± 6.4 years). The control group included 30 healthy individuals persons aged 40 to 70 years (mean 57.6 ± 4.1 years). The diagnosis of seborrheic keratosis was confirmed by dermoscopy and pathomorphological assessment, with 100% of patients having the acanthotic type of seborrheic keratosis. HPV was identified by polymerase chain reaction with hybridization fluorescent detection in real time mode with use of three oligonucleotide systems for detection of HPV genus β1 (subtypes 5, 8, 12, 14, 19, 21, 25, 36, 47); β2 (subtypes 9, 15, 17, 22, 23, 37, 38, 80), and β3 (subtypes 49, 75, 76). Results: The most frequent clinical type of seborrheic keratosis was the maculopapular one (61/91 patients, 67%) localized mainly on head, neck, anterior and posterior trunk. β-HPV was found in 88.8% biopsy samples taken from the seborrheic keratosis areas in 24 of 27 patients and in 66.6% biopsy samples taken from the normal skin areas of the same patients (р = 0.04). This is significantly more frequent that the HPV contamination among healthy individuals, which was 28.7% (р = 0.02). Mixed association of β-HPV was also more frequent in the HPV-positive patients (21/24, or 83.3%; compared to the control group, р = 0,00001). The maximal (significant) viral load was found in the subgroup of seborrheic keratosis patients with the number of proliferative lesions of 10 and more (4.08 ± 0.3 lg/105 tо 5.7 ± 0,3 lg/105). Conclusion: The maculopapular type of seborrheic keratosis is characterized by mixed HPV β1, β2, β3 infection found in 77.7% of cases irrespective of the number of proliferative lesions. It could be hypothesized that multiple seborrheic keratosis (more than 10 lesions) develops in simultaneous presence of HPV β1, β2, β3 and is associated with a higher probability of new seborrheic keratosis lesions on intact skin.

Conjunctival Seborrheic Keratosis Mimicking Ocular Surface Squamous Neoplasia

Seborrheic keratosis is a benign epithelial neoplasia that commonly occurs on the face and eyelids of middle-aged individuals. Its occurrence on the conjunctiva is rare. We report a case of conjunctival seborrheic keratosis that clinically resembled an ocular surface squamous neoplasia (OSSN). A 77-year old male was referred with a right temporal juxta-limbal conjunctival mass. Based on its appearance, a clinical diagnosis of OSSN was made and a wide excisional biopsy, cryotherapy and amniotic membrane graft was performed. A diagnosis of seborrheic keratosis was confirmed by histopathology. Our case highlights the fact that conjunctival seborrheic keratosis, though rare, can mimic malignant lesions such as OSSN and should be considered in the differential diagnosis of conjunctival tumours.

Regression of seborrheic keratosis in a dermoscopic follow-up series

DERMOSCOPIC APPEARANCE The original dermoscopic examination clearly suggests seborrheic keratosis with pseudofollicular openings and horny pseudocysts (Fig 2, A). The two follow-up images beautifully capture the regression of the previous lesion (see Fig 2, B and C ). The diagnosis of seborrheic keratosis is still easily recognizable in the second image. Based on the last image with granular gray pigmentation, the exclusion of lentigo maligna is almost impossible; no dermoscopic structures typical for seborrheic keratosis are visible at this time.

Seborrheic keratosis: Reflectance confocal microscopy features and correlation with dermoscopy

Differentiation between seborrheic keratosis (SK) and skin cancers may be difficult. Reflectance confocal microscopy (RCM) enables noninvasive assessment of skin neoplasms at cellular-level resolution. We sought to describe RCM features of SK and to correlate these RCM findings with dermoscopic structures. Clinical, dermoscopic, and RCM images of 45 consecutive SK were obtained at a private and university dermatology clinic. Fourteen SK were biopsied because of equivocal clinical or dermoscopic features. With RCM, all SK displayed a regular honeycomb pattern of the epidermis and densely packed, round to polymorphous, well-circumscribed dermal papillae at the dermoepidermal junction, features suggestive of a benign neoplasm. RCM features indicating the diagnosis of SK were also observed, including epidermal projections (43/45 SK; 96%) and keratin-filled invaginations (36/45 SK; 80%) at the lesion surface; corneal pseudocysts at epidermal layers (19/45 SK; 42%); and melanophages (21/45 SK; 47%) and dilated round and linear blood vessels (21/45 SK; 47%) in the papillary dermis. Of biopsied SK, 93% (13/14) displayed at least 3 characteristic RCM findings in the absence of RCM features suggestive of malignancy. This was a limited study sample and retrospective study design. SK display a distinct set of RCM criteria despite their variable clinical and dermoscopic appearances.

Cockarde (Target-Like Lesion) Seborrheic Keratosis: An Unusual Clinical Pattern

Dear Editor: Seborrheic keratosis (SK) is the most common type of benign epidermal neoplasm, and has variable clinical presentation. Typically, SK first presents as yellowish, circumscribed papules, which later become more exophytic, brown and/or hyperpigmented. Greasy, adherent squamous material subsequently develops1. These lesions commonly present as round or oval keratotic papules or plaques with a classically papillomatous surface that is sprinkled with comedon-like openings. To the best of our knowledge, SK with a target-like morphology has not been previously reported. Herein, we report a case of SK with an uncommon target-like appearance, which we denominate 'cockarde (target-like lesion) SK'. A 57-year-old woman presented to our clinic with a several-year history of an asymptomatic lesion on her left thigh, which she reported to have gradually increased in size over the past several months. The patient denied any other relevant clinical past history, and all initial laboratory tests were within normal limits. Dermatologic examination revealed a sharply demarcated, slightly elevated, well-defined, darkly pigmented, target-shaped lesion on the left thigh. Additionally, the lesion contained a round black inner plaque measuring 0.5 cm in diameter, which was surrounded by a light brown arcuate patch, so that the diameter of the overall lesion was 1.5 cm (Fig. 1). Fig. 1 Targetoid seborrheic keratosis. Central black plaque surrounded by a brownish patch. A subsequent elliptical biopsy was performed containing the inner round plaque and a part of the surrounding patch (Asterisk: round black inner plaque. Black and white ... An elliptical biopsy including the inner round plaque and part of the surrounding patch was then performed, with the subsequent histopathological examination revealing generalized hyperkeratosis and acanthosis and a proliferation of sharply demarcated intraepithelial nests of large pale cells in the epidermis of the central lesion. The adjacent epidermis in the specimen was also noted to lie on a straight line. Given these histological features, a diagnosis of SK (clonal type) was reached (Fig. 2). Fig. 2 Histopathologic characteristics of seborrheic keratosis (clonal type). (A, B) Histopathological examination revealed generalized hyperkeratosis, acanthosis, and a proliferation of sharply demarcated intraepithelial nests of large pale cells in the epidermis ... In the dermatology literature, target-like lesions are most commonly associated with erythema multiforme, Stevens-Johnson's syndrome, toxic epidermal necrolysis2, cockarde nevus3, drug eruption, vasculitis, acute hemorrhagic edema of infancy, and various connective tissue and blistering diseases4. Therefore, when a patient complains of a target-like lesion, the above-mentioned diseases should be considered in the first instance. In many cases, SK can be readily diagnosed based on clinical presentation. However, Bryant5 reported that only 44.1% of cases of SK are correctly diagnosed by dermatologists. The report also suggests that SK in which lesions present with an unusual appearance is likely to be even more difficult to diagnose. Although SK is divided into many subtypes, its clinical variants are rare: these have been reported to be stucco keratosis, dermatosis papulosa nigra, and Leser-Trelat syndrome1. To the best of our knowledge, target-like SK or cockarde SK has not previously been reported in the literature. As such, we contend that this case is unique secondary to the presenting clinical features, and thus propose that 'cockarde SK' be recognized as an additional clinical variant of SK. Knowledge of this unusual variant of SK would be helpful in differentiating several target-shaped diseases, as well as in making a proper diagnosis of this rare condition.

Pigmented seborrheic keratoses of the vulva clinically mimicking a malignant melanoma: a clinical, dermoscopic-pathologic case study

The diagnosis of seborrheic keratosis is, in general, a clinical one, but in some cases, the differential diagnosis between pigmented seborrheic keratosis and malignant melanoma is difficult. Dermoscopy may improve the early diagnosis of vulvar melanoma and thus play a role in the preoperative classification of pigmented lesions at this particular site. We report the first case of a pigmented seborrheic keratosis of the vulva clinically mimicking a malignant melanoma, whose dermoscopic features have been investigated together with their pathologic correlates. Dermoscopically our case shows the absence of comedo-like openings and the presence of the pseudo-network. Dermoscopy is therefore a useful method for the differential diagnosis of pigmented lesions even in the vulva.

Dermoscopic diagnosis of seborrheic keratosis

Diagnosis of seborrheic keratosis is, in general, a clinical diagnosis, but in a certain percentage of cases, differential diagnosis between pigmented seborrheic keratosis and malignant melanoma might be difficult. According to the guidelines of the Consensus Net Meeting on Dermoscopy (held in Rome in February 2001), the diagnostic strategy includes two different steps. In the first step, one has to determine whether a lesion is of melanocytic or nonmelanocytic origin. For this decision, an algorithm using morphologic key criteria has been proposed. Once the lesion is identified to be of melanocytic origin, it must be categorized as benign, suspect, or malignant (second step). To accomplish this, four different approaches have been proposed: pattern analysis,1 the ABCD rule of Dermoscopy,2,3 the Menzies method,4,5 and the “seven-point checklist.”6,7 The recognition of dermoscopic criteria for seborrheic keratoses is important because in difficult cases, this may be the only in vivo way to determine whether the lesion is of nonmelanocytic origin (seborrheic keratosis) or of melanocytic origin (melanoma). The most common characteristics for seborrheic keratoses are comedolike openings and milialike cysts. The Board of the Consensus Net Meeting on Dermoscopy added fissures (brainlike appearance) and fingerprinting as additional criteria. The following dermoscopic criteria can be seen in seborrheic keratosis.

Seborrheic keratoses and cancer

The eruptive appearance of numerous seborrheic keratoses, the sign of Leser-Trélat, has been regarded as a reliable cutaneous marker of internal malignancy. We have evaluated the possible association of malignant disease and the sign in 1752 consecutive cases of seborrheic keratoses. First, the Swedish Cancer Registry was searched for records of malignancies in the study population (1958 to 1984), and the expected number of malignancies was calculated. Second, records of persons with malignancy within 1 year before or after the diagnosis of seborrheic keratosis were checked for the sign of Leser-Trélat. Third, a case control study was performed to evaluate the possibility of eruptive seborrheic keratoses among the noncancer patients in the study population. The results showed a slight increased risk of cancer in the study population (relative risk = 1.2; 95% confidence interval = 1.0 to 1.3), mainly because of an increased risk of cutaneous squamous cell carcinoma. In 62 patients with seborrheic keratoses, a malignancy (excluding skin) was diagnosed within 1 year before or after the diagnosis of seborrheic keratosis. Of these 62 patients, 6 were regarded as possibly having presented with the sign of Leser-Trélat. For every one of the 62 cases with seborrheic keratosis and malignancy within one year, an age- and sex-matched control patient without cancer was selected from the study population and the records were checked for sudden and eruptive seborrheic keratoses. Among the control patients, five were regarded as possibly having presented with the sign of Leser-Trélat. This study gives no evidence to support the opinion that eruptive seborrheic keratoses are related to internal cancer risk.