Accuracy of dermoscopic criteria for the differential diagnosis between irritated seborrheic keratosis and squamous cell carcinoma

Long noncoding RNA MALAT1 in dermatologic disorders: a comprehensive review

Dermatologic disorders, affecting the integumentary system, involve diverse molecular mechanisms such as cell proliferation, apoptosis, inflammation and immune responses. Long noncoding RNAs, particularly Metastasis-Associated Lung Adenocarcinoma Transcript 1 (MALAT1), are crucial regulators of gene expression. MALAT1 influences inflammatory responses, immune cell function and signaling pathways, impacting various physiological and pathological processes, including dermatologic disorders. Dysregulation of MALAT1 is observed in skin conditions like psoriasis, atopic dermatitis and systemic lupus erythematosus. However, its precise role remains unclear. This review consolidates knowledge on MALAT1's impact on skin biology and pathology, emphasizing its potential diagnostic and therapeutic implications in dermatologic conditions.

Diagnosis of invasive cutaneous squamous cell carcinoma, imaging and staging

The assessment of patients with a lesion raising the suspicion of an invasive cutaneous squamous cell carcinoma (cSCC) is a frequent clinical scenario. The management of patients with cSCC is a multistep approach, starting with the correct diagnosis. The two main diagnostic goals are to differentiate from other possible diagnoses and correctly recognize the lesion as cSCC, and then to determine the tumor spread (perform staging), that is if the patient has a common primary cSCC or a locally advanced cSCC, or a metastatic cSCC (with in-transit, regional lymph nodal, or rarely distant metastasis). The multistep diagnostic approach begins with the clinical characteristics of the primary cSCC, it is complemented with features with dermoscopy and, if available, reflectance confocal microscopy and is confirmed with histopathology. The tumor spread is assessed by physical examination and, in some cases, ultrasound and/or computed tomography or magnetic resonance imaging, mainly to investigate for regional lymph node metastasis or for local infiltration into deeper structures. In the last step, the clinical, histologic and radiologic findings are incorporated into staging systems.

Seborrheic Keratosis: Report of a Rare Presentation and Reminder of the Current Knowledge of the Problem

A 75-year-old man presented with an abdominal enlarging painless tumor of the skin evolving over the last 30 years. His past medical history was unremarkable. Physical examination revealed a brownish pedunculated cutaneous mass which had an irregular keratotic warty surface with no discharge or ulceration. The mass was clinically presumed to be a melanocytic tumor, or a verrucous carcinoma. A monoblock excision of the mass was performed with a good outcome. The specimen was then sent to our pathology department to rule out malignancy. Macroscopic examination revealed a brownish tumor of 7.5 × 7 × 1.5 cm which had fissures and cauliflower-like appearance. Final histological report concluded to a giant seborrheic keratosis.

Electrical impedance dermography differentiates squamous cell carcinoma in situ from inflamed seborrheic keratoses

There are no currently available low-cost, noninvasive methods for discerning the depth of squamous cell carcinoma (SCC) invasion or distinguishing SCC from its benign mimics, such as inflamed seborrheic keratosis (SK). We studied 35 subjects with subsequently confirmed SCC or SK. Subjects underwent electrical impedance dermography measurements at six frequencies to assess the electrical properties of the lesion. Averaged greatest intrasession reproducibility values were 0.630 for invasive SCC at 128 kHz, 0.444 for SCC in situ at 16 kHz, and 0.460 for SK at 128 kHz. Electrical impedance dermography modeling revealed significant differences between SCC and inflamed SK in normal skin (P < 0.001) and also between invasive SCC and SCC in situ (P < 0.001), invasive SCC and inflamed SK (P < 0.001), and SCC in situ and inflamed SK (P < 0.001). A diagnostic algorithm classified SCC in situ from inflamed SK with an accuracy of 0.958, a sensitivity of 94.6%, and a specificity of 96.9%; it also classified SCC in situ from normal skin with an accuracy of 0.796, a sensitivity of 90.2%, and a specificity of 51.2%. This study provides preliminary data and a methodology that can be used in future studies to further advance the value of electrical impedance dermography and inform biopsy decision making in patients with lesions suspicious of SCC.

[The most common benign cutaneous neoplasms of the epidermis and appendages and their treatment]

Benign cutaneous neoplasms are well defined histologically with absence of all of the following features: architectural disorder, necrosis, cytologic atypia, and atypical mitotic figures. The clinical appearance of any neoplasm is a very important diagnostic factor. The classification of the lesion determines the therapeutic options. This article summarizes the clinical aspects and treatments of the most common benign tumors of the epidermis and its appendages.

Dermoscopy of inflamed seborrheic keratosis: A great mimic of malignancy

BACKGROUND

Clinical and dermoscopic recognition of seborrheic keratoses (SKs) is often straightforward, and biopsy might not be required. However, inflamed SKs (iSKs) can pose a diagnostic challenge. Dermoscopic features of iSKs have not yet been evaluated to date.

OBJECTIVES

To assess the diagnostic ability of a group of dermatologists to diagnose iSKs by dermoscopy. To evaluate the dermoscopic findings of a long series of inflamed seborrheic keratoses.

METHODS

Clinical and dermoscopic images of 100 difficult-to-diagnose skin tumours, including 29 iSKs, were presented to 33 clinicians (24 dermatologists and 9 dermatology residents), who were blinded to the diagnosis. The dermoscopic features of a series of 219 iSKs were retrospectively analysed.

RESULTS

iSKs were correctly identified in a 37.6% of cases. Classic dermoscopic criteria were present in only 47% of iSKs. The most frequent dermoscopic feature in iSKs was the presence of vascularization (91.3%), but only a 44.5% showed predominance of hairpin vessels. A bluish hue was observed in 18.3% of lesions. Seven dermoscopic patterns were identified, based on the dermoscopic similarity to other tumours: seborrheic keratosis-like (28.8%); squamous cell carcinoma-like (25.6%); melanoma-like (17.8%); keratoacanthoma-like (6.8%); basal cell carcinoma-like (5.9%); verruca vulgaris-like (5.9%); nevus-like (2.3%).

CONCLUSIONS

The diagnosis of iSKs can be challenging even with dermoscopy. They may behave as authentic mimics of other cutaneous tumours, including squamous cell carcinoma or melanoma. For this reason, histopathological examination should be mandatory in these cases.

Frequency of Publication of Dermoscopic Images in Inter-observer Studies: A Systematic Review

Research interest in dermoscopy is increasing, but the complete dermoscopic image sets used in inter-observer studies of skin tumours are not often shared in research publications. The aim of this systematic review was to analyse what proportion of images depicting skin tumours are published in studies investigating inter-observer variations in the assessment of dermoscopic features and/or patterns. Embase, MEDLINE and Scopus databases were screened for eligible studies published from inception to 2 July 2020. For included studies the proportion of lesion images presented in the papers and/or supplements was extracted. A total of 61 studies (53 original studies and 8 shorter reports (i.e. research letters or concise reports)). published in the period 1997 to 2020 were included. These studies combined included 14,124 skin tumours, of which 373 (3%) images were published. This systematic review highlights that the vast majority of images included in dermoscopy research are not published. Data sharing should be a requirement for future studies, and must be enabled and standardized by the dermatology research community and editorial offices.

Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses

Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.

Differential Diagnosis and Management on Seborrheic Keratosis in Elderly Patients

Seborrheic keratoses are exceedingly common in the elderly and usually are easy to diagnose and do not require treatment. However, given their great variety of clinical presentation, they may give rise to false-positive cases, meaning that they may at times mimic melanoma, squamous cell carcinoma and basal cell carcinoma. On the other hand, melanoma may mimic seborrheic keratosis, leading to incorrect patient management. With this review, we would like to summarize the current knowledge about epidemiology, clinical, dermoscopic and reflectance confocal microscopy imaging of this common entity, and we also summarize the currently available treatment options.