Differentiating seborrheic keratosis from melanoma among lesions exhibiting blue-white veil: A retrospective study - 02/12/24

Doi : 10.1016/j.jaad.2024.10.070

Isabella N. Dana, BS ^a,^b, Nicholas R. Kurtansky, BS ^a, Larissa M. Pastore, BS ^a,^c, James R. Xu, BS ^d, Zaeem H. Nazir, MD ^a,^e, Stephen W. Dusza, DrPH ^a, Emmanouil Chousakos, MD ^f, Ofer Reiter, MD ^g, Cristian Navarrete-Dechent, MD ^h, Ralph P. Braun, MD ⁱ, Harold S. Rabinovitz, MD ^j, Ashfaq A. Marghoob, MD ^a,^⁎
^a Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
^b SUNY Downstate Health Sciences University College of Medicine, Brooklyn, New York
^c Cooper Medical School of Rowan University, Camden, New Jersey
^d Case Western Reserve University School of Medicine, Cleveland, Ohio
^e Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
^f Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
^g Dermatology Division, Rabin Medical Center, Petach Tikva, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
^h Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
ⁱ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
^j Skin and Cancer Associates, Plantation, Florida

^∗Correspondence to: Ashfaq A. Marghoob, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, 800 Veterans Memorial Highway, Second Floor, Hauppauge, NY 11788.Dermatology ServiceMemorial Sloan Kettering Cancer Center800 Veterans Memorial HighwaySecond FloorHauppaugeNY11788

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 02 December 2024

Abstract

Background

Differentiating melanoma (MM) from seborrheic keratosis (SK) containing a blue-white veil (BWV) remains challenging.

Objective

Identify dermoscopic features that can improve upon the differentiation between MMs and SKs exhibiting BWV.

Methods

Images from 110 MMs and 121 SKs containing BWV were aggregated, and 91 MMs and 62 SKs from this data set had complete agreement on the presence of BWV according to 3 expert dermoscopists. Independent readers recorded the presence or absence of dermoscopic structures using a web-based data collection instrument. Odds ratios were used to evaluate the association between features and diagnosis, and Fisher's exact test was used to determine the significance of associations.

Results

The combination of milia-like cysts and/or comedo-like openings (MCCO) within the BWV and BWV encompassing the entire lesion occurred in 56% of SKs and 0% of MM. All MMs had at least one MM-specific structure other than BWV or lacked MCCO.

Limitations

Agreement on dermoscopic feature prevalence was variable. The subset of lesions with complete agreement on the presence of BWV may not be representative of lesions encountered in an individual clinician's practice.

Conclusion

Lesions exhibiting BWV with MCCO and no additional MM-specific features suggest a benign diagnosis, as was not seen in any cases of MM.

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Key words : blue-white veil, dermoscopy, melanoma, seborrheic keratosis

Abbreviations used : BWV, MCCO, MM, NPD, PD, SK, SWS

Plan

Introduction

Methods

Results

Presence of features within BWV using PD and NPD

Feature prevalence differs between MM and SK that contain BWV

Combinations of features that suggest diagnosis of SK

Responses from individual readers

Discussion

	Funding sources: This study was supported in part by the NIH/NCI Cancer Center Support Grant P30 CA008748.
	Patient consent: Consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and included at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available.
	IRB approval status: 17-078.