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A Morphological Study

Ralph Peter Braun, MD; Harold S. Rabinovitz, MD; Joachim Krischer, MD; Jürgen Kreusch, MD; Margaret Oliviero, ARNP; Luigi Naldi, MD; Alfred W. Kopf, MD; Jean H. Saurat, MD

Arch Dermatol. 2002;138:1556-1560.

Objectives  To describe morphological features of seborrheic keratosis as seen by dermoscopy and to investigate their prevalence.

Design  Prospective cohort study using macrophotography and dermoscopy for the documentation of seborrheic keratosis.

Settings  Seborrheic keratoses were prospectively collected in 2 sites: a private practice in Plantation, Fla (site 1), and the Department of Dermatology at the University Hospital Geneva in Switzerland (site 2).

Patients  A total of 203 pigmented seborrheic keratoses (from 192 patients) with complete documentation were collected (111 from site 1 and 93 from site 2).

Interventions  Screening for new morphological features of seborrheic keratosis and evaluation of all lesions for the prevalence of these criteria.

Main Outcome Measures  Identification of new morphological criteria and evaluation of frequency.

Results  A total of 15 morphological dermoscopic criteria were identified. Standard criteria such as milialike cysts and comedolike openings were found in a high number of cases (135 and 144, respectively). We found network and networklike structures to be present in 94 lesions (46%). Using standard diagnostic criteria for seborrheic keratosis, 30 lesions would not have been diagnosed as such.

Conclusions  The classic dermoscopic criteria for seborrheic keratosis (milialike cysts and comedolike openings) have a high prevalence but the use of additional dermoscopic criteria such as fissures, hairpin blood vessels, sharp demarcation, and moth-eaten borders improves the diagnostic accuracy. The proper identification of pigment network and networklike structures is important for the correct diagnosis.

From the Pigmented Skin Lesion Clinic, Department of Dermatology, University Hospital Geneva, Geneva, Switzerland (Drs Braun, Krischer, Naldi, and Saurat); Skin and Cancer Associates, Plantation, Fla, and Department of Dermatology, University of Miami School of Medicine, Miami, Fla (Dr Rabinovitz and Ms Oliviero); and Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York (Dr Kopf). Dr Kreusch is in private practice in Lübeck, Germany.

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