How To Make Diagnosis Seborrheic Keratosis
Diagnosis obtained through history and physical examination and investigation in the form of histology. Not necessary laboratory tests and radiological examination.
• Usually asymptomatic, patients complain of a lump of black, feels uncomfortable.
• lesions can sometimes itchy, wanted carded or flops.
• Patients sometimes feels a lump growing slowly.
• Lesions can not heal themselves suddenly.
• The majority of cases there is a family history of inherited.
• Lesions can occur throughout the body except the palms and soles, and mucous membranes.
2. Physical Examination
Seborrheic keratosis lesions appear as papules or plaques form rather prominent, but can also be seen attached to the surface of the skin. The lesions usually have the same color pigment is brown, but sometimes also be found that are colored black or bluish black, round to oval shape, the size of a billion to lenticular even up to 35x15cm. the distribution of multiple lesions as skin folds.
Surface lesions usually bumpy. In lesions that have a smooth surface usually contained keratotic tissue that resemble grains of wheat. At the touch was soft and oily. Lesions usually appear at the age of 40 years and continues to increase with age. In some individual lesions can grow large and thick, but rarely off by itself. Trauma or scrubbing with harsh lesion can cause the top off, but it will grow back by itself. There is no tendency to change the direction of malignancy. However, melanoma, basal cell carcinoma, and sometimes grow in seborrheic keratosis lesions.
Investigations can be done such as histopathology. Seborrheic keratoses composition is basaloid cells with squamous cell mixture. Invagination and horn keratin cyst is characteristic. Squamous cell nests sometimes found, especially on the type of Irritated. One of three seborrheic keratoses appear hyperpigmentation on hematoxylin-eosin staining.
There are at least 5 known histology: acanthotic (solid), reticulated (adenoid), hyperkeratotic (papilomatous), clonal and Irritated. Picture of overlap is common.
1. acanthotic type column-column formed by basal cells with a mixture of horn cyst.
2. Type reticulated have thin strands braided picture of basal cells, often pigmented, and accompanied by a small cyst horn.
3. Type hyperkeratotic looks exophilic with various levels of hyperkeratotis, papilomatosis and acanthosis. There basaloid cell and squamous cell.
4. Type clonal has intraepidermal nests basaloid cells.
5. In type Irritated, there infiltrates of inflammatory cells undergoing severe, with lichenoid picture on the upper dermis. Apoptotic cells contained in the base of the lesion which illustrates the immunological regression on seborrheic keratosis. Sometimes there are infiltrates of inflammatory cells undergoing weight without lichenoid, rarely found in the excessive neutrophil infiltrates.
On examination using electron microscopy showed that the small basaloid cells associated with cells in the basal cell layer of the epidermis. Melanososm groups that often limit the membrane can be found in the cell.
Differential Diagnosis Seborrheic Keratosis
Here are some of the differential diagnosis of seborrheic keratosis:
1. Malignant melanoma
Initially in the form of a mole that changes in color, size, ranging symptoms (burning, itching, pain), elevation of the lesion occurs, the development of satellite lesions.
American Academy of Dermatology says the importance of the evaluation of pigmented lesions, namely:
A = asymmetry
B = border irregularity
C = color variegation
D = diameter is more than 0.6 mm.
2. pigmented basal cell epithelioma
Predilection especially on the face, rarely on the arms, hands, badang, legs and feet.
The lesions can be small papules or nodules less than 2 cm in diameter with raised edges and black or brown. Shiny surface, often found teleangiektasia and sometimes there are subtle scaling or thin crust.
3. Nevus pigmentosus
Pigmentosus nevus can occur in all places, including the mucous membranes near the surface of the body. Lesions can be flat, papuler, or papulomatosa usually measuring 2-4mm. demarcated papules and shiny with a bit slippery surfaces, usually hairy.
4. Senile keratosis
Lesions initially brownish macules or plaques are round or irregular, can be solitary or multiple, sharply demarcated, telangiectasia with a rough surface, dry and scaly attached.