The Clinical Research Of Dermoscopy In The Diagnosis Of Seborrheic Keratosis, Actinic Keratosis, Basal Cell Carcinoma

ObjectivesSeborrheic keratosis(SK) is a benign skin tumor because of the slow maturation ofkeratinocytes. Actinic keratosis(AK) is a kind of precancerous disease caused by a long-termsunlight exposure of skin.Basal cell carcinoma(BCC) is one of the most common malignantskin tumors. We found that atypical clinical manifestations of SK, AK and BCC were easilyconfused with naked eye observation in clinical work, increasing the possibility ofmisdiagnosis and missed diagnosis,so we could not choose suitable treatment method forpatients, affecting the quality of life of patients. Dermoscopy as a diagnostic tool fornoninvasive is more easily accepted than the invasive pathological examination.by patients.The purpose of this study was to explore the correct rate, sensitivity, specificity and consstentwith the results of the pathological diagnosis of dermoscopy in the diagnosis of SK,AK,BCC,and then explore the specific dermoscopic features of SK,AK,BCC to assist differentialdiagnosis.Methods120patients who were suspected for SK,25patients who were suspected for AK and48patients who were suspected for BCC were enrolled in this study. The suspected lesions wereexamined by dermoscopy,and then saved clinical and dermoscopic pictures of patients. Twodoctors based on the dermoscopic diagnosis of SK,AK,BCC recommended by foreign scholars independently made a diagnosis according to the pictures from the dermoscopy.Again with the pathological diagnosis as the gold standard, we used the methods of diagnostictest to calculate the correct rate, sensitivity, specificity, the rate of misdiagnosis, the rate ofmissed diagnosis, Youden index, Kappa value, at the same time,to calculate the incidence ofeach dermoscopic features of SK,AK,BCC.Results1. In120patients,86patients were diagnosed SK according to pathological fingdings. Basedon the dermoscopic features,80cases were diagnosed as SK by the doctor A,and82by thedoctor B. Compared with the pathological diagnosis, the correct rate, sensitivity, specificity,the rate of misdiagnosis, the rate of missed diagnosis, Youden index, Kappa value of twodoctors’s diagnose were91.67%,90.70%,94.12%,5.89%,9.30%,84.81%,0.805and93.33%,93.02%,94.12%,5.88%,6.98%,87.14%,0.841.The two doctors diagnosed SK at the samelevel.Dermoscopic features of SK of the top five were furrow ridge structure (72.1%),comedo-like openings (61.6%), milia-like cysts (45.3%),punctate and globular vessels(33.7%), hairpin-like vessels (32.6%).2. In25patients,18patients were diagnosed AK according to pathological fingdings. Basedon the dermoscopic features,18cases were diagnosed as AK by the doctor A,and16by thedoctor B. Compared with the pathological diagnosis, the correct rate, sensitivity, specificity,the rate of misdiagnosis, the rate of missed diagnosis, Youden index, Kappa value of twodoctors’s diagnose were84%,88.89%,28.57%,11.11%,60.32%,0.6032and84%,83.33%,85.71%,14.29%,16.67%,69.04%,0.6350.The two doctors diagnosed AK at thesame level.Dermoscopic features of AK were consistent, showed the erythema or gray grid asthe backgroud,yellowish white scales,white halo around hair follicle openings,irregularboundary and line-like vessels.3. In48patients,36patients were diagnosed BCC according to pathological fingdings. Basedon the dermoscopic features,34cases were diagnosed as BCC by the doctor A,and38by thedoctor B. Compared with the pathological diagnosis, the correct rate, sensitivity, specificity,the rate of misdiagnosis, the rate of missed diagnosis, Youden index, Kappa value of two doctors’s diagnose were91.67%,91.67%,91.67%,8.33%,8.33%,83.34%,0.7895and91.67%,97.22%,75%,25%,2.78%,66.22%,0.7648.The two doctors diagnosed BCC at thesame level.The dermoscopic features of BCC of the top four were arborizing vessels(94%),comedo-like openings (61.6%), milia-like cysts (45.3%),punctate and globular vessels(33.7%), hairpin-like vessels (32.6%).large ovoid blue nests(83%),multiple blueglobules(83%) and ulcer structure(36%).Conlusions1. The correct rate, sensitivity, specificity, Youden index and Kappa value of dermoscopy inthe diagnosis of SK,AK,BCC were higher, which suggested that the authenticity of thisexperiment was high and the results of dermoscopic and pathological diagnosis wereconsistent.2. Comedo-like openings and milia-like cysts were more special in the dermoscopic featuresof SK;"strawberry pattern" generally appeared in dermoscopic features of AK; arborizingvessels,leaf-like areas,spoke-wheel areas were more special in the dermoscopic features ofBCC.3. SK, AK, BCC had their own relatively specific dermoscopic features, which was benefitfor the differential diagnosis.4. There were correlation between dermoscopic features and dermotopathological features inSK, AK, BCC.