Studying Regression of Seborrheic Keratosis in Lichenoid Keratosis with Sequential Dermoscopy Imaging
Department of Dermatology, Hospital de Sant Pau i Santa Tecla, Tarragona, Spain. Dermatology
(Impact Factor: 1.57).
12/2009; 220(2):103-9. DOI: 10.1159/000265556
Lichenoid keratosis (LK) is a well-described entity that has been proposed to represent a regressive response to a pre-existent epidermal lesion.
To evaluate the natural evolution of a series of cases showing the intermediate stage of the regression of seborrheic keratosis in LK using sequential dermoscopy imaging over time.
A series of lesions with dermoscopic areas of seborrheic keratosis and LK in the same tumor were consecutively collected for over 3 years at the Dermatology Department of the Hospital de Sant Pau i Santa Tecla, Tarragona, Spain. Sequential dermoscopic images of each case were collected quarterly for 1 year. At the end of the follow-up, all the lesions were biopsied.
A total of 22 cases were collected. At the end of the follow-up, the LK part increased in all the lesions. In 11 cases (50%), the seborrheic keratosis part disappeared completely, and in another 5 cases (22.7%), seborrheic keratosis comprised only 10% of the remaining area.
These dermoscopic study findings support the proposal that LK represents a regressive response to a pre-existent epidermal lesion, in this case seborrheic keratosis.
Figures in this publication
Available from: Ana Elena
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ABSTRACT: REsUMEN Las queratosis seborreicas son neoplasias epidérmicas benignas y frecuentes, que por su variedad de presentación clínica requieren ser diferenciadas de otras lesiones pigmentadas y no pigmentadas, benignas y malignas. La dermatoscopia es una herramienta diagnóstica no invasiva, que en manos de médicos bien capacitados en esta técnica aumenta la certeza diagnóstica en 5 a 30%. Actualmente existen criterios bien establecidos para diagnosticar las queratosis seborreicas por dermatoscopia, como los quistes de milium, los tapones folicu-lares, las fisuras, las crestas y estructuras en huella digital, así como criterios adicionales (vasos en horquilla, borde apolillado, estructuras tipo red pigmentaria, etc.). Es importante conocer estos criterios, ya que por el polimorfismo de las lesiones (a pesar de ser consideradas lesiones "banales") éstas pueden confundirse clínicamente o coexistir con tumores malignos, como el carcinoma basocelular y el melanoma. Palabras clave: dermatoscopia, queratosis seborreica, quistes de milium, tapones foliculares, fisuras, crestas, estructuras en huella digital, vasos en horquilla. ABsTRACT Seborrheic keratosis are frequent, benign, epidermic tumors and due to their variety of clinical presentations they must be differentiated from other pigmented and non pigmented, benign and malignant lesions. Dermoscopy is a non-invasive, diagnostic tool that can increase the diagnostic accuracy from 5% to 30%. Today there are well established criteria to diagnose seborrheic keratosis with dermoscopy: millia-like cysts, comedo-like openings, fissures and ridges, fingerprint-like structures and additional criteria described (hairpin vessels, moth-eaten border, network-like structures), due to their polymorphic presentations, are considered banal lesions, and they could be misdiagnosed or coexist with some other malignant tumors, such as basal cell carcinoma or melanoma.
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ABSTRACT: Benign lichenoid keratoses (BLKs) are solitary skin lesions which have been proposed to represent a regressive form of pre-existent epidermal tumours such as solar lentigo or seborrhoeic keratosis. However, the genetic basis of BLK is unknown.
FGFR3, PIK3CA and RAS mutations have been shown to be involved in the pathogenesis of seborrhoeic keratosis and solar lentigo. We thus investigated whether these mutations are also present in BLK.
After manual microdissection and DNA isolation, 52 BLKs were screened for FGFR3, PIK3CA and RAS hotspot mutations using SNaPshot(®) multiplex assays.
We identified 6/52 (12%) FGFR3 mutations, 10/52 (19%) PIK3CA mutations, 6/52 (12%) HRAS mutations and 2/52 (4%) KRAS mutations. FGFR3 and RAS mutations were mutually exclusive. One BLK showed a simultaneous PIK3CA and HRAS mutation. In nine BLKs with a mutation, nonlesional control tissue from the epidermal margin and the dermal lymphocytic infiltrate were wild-type, indicating that these mutations are somatic. To demonstrate that these findings are specific, 10 samples of lichen planus were analysed without evidence for FGFR3, PIK3CA or RAS mutations.
Our results indicate that FGFR3, PIK3CA and RAS mutations are present in approximately 50% of BLKs. These findings support the concept on the molecular genetic level that at least a proportion of BLKs represents regressive variants resulting from former benign epidermal tumours such as seborrhoeic keratosis and solar lentigo.
Available from: Harald Kittler
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