Evaluación de la Dermatoscopia en el diagnóstico de las queratosis seborreicas
Palabras clave:
queratosis seborreicas, dermatoscopia, epiluminiscencia, microscopio de superficieResumen
La dermatoscopia ha demostrado que aumenta la agudeza del diagnóstico clínico del melanoma maligno y de otras lesiones pigmentadas de la piel. El propósito de este estudio es determinar el valor de la dermatoscopia en el diagnóstico de las queratosis seborreicas, utilizando como prueba de oro el estudio histopatológico. Ciento seis lesiones pigmentadas, que histológicamente correspondían a 44 queratosis seborréicas y 62 lesiones diagnósticos diferenciales de éstas, fueron evaluadas mediante el dermatoscopio, entre 1996 y 1997. Se realizó un análisis estadístico para definir la especificidad y sensibilidad de cada una de las características dermatoscópicas de las queratosis seborreicas, demostrando que las características más específicas eran la presencia de pseudocomedones y pseudoquistes córneos, del 75.8% (Intervalo de Confianza95%: 63-85.4) y 72.6% (IC95%: 59.6- 82.8), respectivamente. La sensibilidad del diagnóstico clínico de las queratosis seborreicas fue del 90.9% (IC95%: 68.3-89.2) y la especificidad fue del 69.4% (IC95%: 56.2-80.1), las cuales, al utilizar los criterios dermatoscópicos, aumentaron al 95.5% (ICw; 68.3-89.2) y 80.6% (IC95%: 83.3-99.2), respectivamente.
Biografía del autor/a
Ana Patricia Jaramillo Ramírez, Universidad CES
R III Dermatología, CES, Medellín.
Juan Guillermo Hoyos Gaviria, Universidad de Antioquia
Profesor Dermatología, Universidad de Antioquia, Medellín.
Susana Restrepo Gutiérrez, Clínica SOMA
Patóloga, Clínica SOMA, Medellín.
Referencias bibliográficas
1. Fernández MA, Ortega RM, Serrano S. Microscopía de epiluminiscencia en el diagnóstico de los tumores pigmentados. Piel 1995;10:69-75.
2. Bahmer A et al. Terminology in surface microscopy. J Am Acad Dermatol 1990; 23: 1159-1162.
https://doi.org/10.1016/S0190-9622(08)80916-4
3. Nachbar F et al. The ABCD rule of dermatoscopy. J Am Acad Dermatol 1994; 30:551-559.
https://doi.org/10.1016/S0190-9622(94)70061-3
4. Pehamberger H, Steiner A, Wolff K. In vivo epiluminiscence microscopy of pigmented skin lesions. l. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol 1987; 17:571-583.
https://doi.org/10.1016/S0190-9622(87)70239-4
5. Menzies W, Crotty A, McCarthy WH. The Morphologic Criteria of the Pseudopod in Surface Microscopy. Arch Dermatol 1995; 131:436-440.
https://doi.org/10.1001/archderm.1995.01690160064010
6. Yadav S et al. Histopathologic Correlates of Structures seen on Dermatoscopy (Epiluminicence Microscopy). Am J Dermatophatol 1993; 15:297-305.
https://doi.org/10.1097/00000372-199308000-00001
7. Fernández MA, Ortega RM, Serrano S. Microscopía de epiluminiscencia en el diagnóstico de los tumores pigmentados (11). Piel 1995; 10:322-325.
8. Steiner A et al. Pigmented Spitz nevi: lmprovement of the diagnostic accuracy by epiluminiscence microscopy. J Am Acad Dermatol 1992; 27:697-700.
https://doi.org/10.1016/0190-9622(92)70240-G
9. Steiner A et al. Statistical evaluation of epiluminis cence microscopy criteria for melanocytic pigmented skin lesions. J Am Acad Dermatol 1993; 29:581-588.
https://doi.org/10.1016/0190-9622(93)70225-I
10. Steiner A, Pehamberger H, Wolff K. In vivo epiluminiscence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Am Acad Dermatol 1987; 17:584-591.
https://doi.org/10.1016/S0190-9622(87)70240-0
11. Kenet RO et al. Clinical Diagnosis of Pigmented Lesions Using digital Epiluminiscence Microscopy. Arch Dermatol 1993; 129:1157-1174.
https://doi.org/10.1001/archderm.1993.01680230041005
12. Kenet RO. Trends in Dermatology: Differential Diagnosis of Pigmented lesions Using Epiluminiscence Microscopy. En: Saber AJ and Fitzpatrick TB (eds). Year Book of Dermatology. St. Louis, Mosby, 1992:xxi-xxxi.
13. Soyer HP, Kerl H. Surface Microscopy of Cutaneous Pigmented Tumors. Ann Dermatol Venereol 1993; 120:15-20.
14. Kreusch J, Rassner G. Epiluminiscence Microscopic Analysis of Structures in Pigmented Melanocytic Nevi: Review and Personal Experiencie. Hautarzt 1990; 27-33.
15. Schulz H. Epiluminescence Microscopy Score for the Differential Diagnosis of Dysplastic Nevi. Hautarzt 1992; 43:487-490.
16. Saida T, Oguchi S, lshihara Y. In Vivo Observation of Magnified Features of Pigmented Lesions on Volar Skin Using Video Microscope. Usefulness of Epiluminiscence Techniques in Clinical Diagnosis. Arch Dermatol 1995; 131:298-304.
https://doi.org/10.1001/archderm.1995.01690150062013
17. Puppin D, Saloman D, Saurat JH. Amplified surface microscopy. Preliminary evaluation of a 400-fold, magnification in the surface microscopy of cutaneous melanocytic lesions. J Am Acad Dermatol 1993; 28:923-927.
https://doi.org/10.1016/0190-9622(93)70131-C
18. Binder M et al. Epiluminiscence Microscopy. A useful Tool for the Diagnosis of pigmented Skin Lesions for formally Trained Dermatologists. Arch Dermatol 1995; 131:286-291.
https://doi.org/10.1001/archderm.1995.01690150050011
19. CY Ho V, Mcleand D. Begin Epithelial Tumors. Seborrhoeic Keratosis. En: Fitzpatrick TB. et al (eds). Dermatology in General Medicine. 4a. Ed. New York, McGraw-Hill, 1993; 855-858.
20. Maize JC, Snider RL. Nonmelanoma skin Cancers in Association with Seborrheic Keratosis. Clínicopathologic Correlations. Dermatol Surg 1995; 21:960- 962.
https://doi.org/10.1016/1076-0512(94)00241-X
21. Stolz W et al. Color Atlas of Dermatoscopy. Oxford, Blackwell Science Ltd., 1994.
22. Marghoob A, Kopf AW. Persistent nevus: An exception to the ABCD rule of dermatoscopy. J Am Acad Dermatol 1997; 36:474-475.
https://doi.org/10.1016/S0190-9622(97)80230-7
23. Guillad JF et al. Epiluminescence videomicroscopy: Black dots and brown globules revisited by stripping the stratum corneum. J Am Acad Dermatol 1997; 36:371-377.
https://doi.org/10.1016/S0190-9622(97)80211-3
24. Benelli C et al. Melanoma with dermatoscopic features of seborrheic keratosis. Eur J Dermatol 1996; 6:246-247.
25. Tsambaos D et al. Detection of human papillomavirus DNA in nongenital seborrheic keratosis. Arch Dermatol Res 1995; 287:612-615.
https://doi.org/10.1007/BF00374085
26. Rady PL et al. Herpes virus-like DNA sequences in non-Kaposi's sarcoma skin lesions of transplant patients. Lancet 1995; 345:1339-1340.
https://doi.org/10.1016/S0140-6736(95)92538-4
27. Caballero MJ et al. Malignant melanoma appearing in a seborrheic keratosis. Br J Dermatol 1995; 133:1016-18.
https://doi.org/10.1111/j.1365-2133.1995.tb06953.x
28. Kirkham N. Tumors and Cyst of the Epidermis. En: Elder David. Lever's Histopathology of the skin, 8a. ed., Philadelphia, Lippincott-Raven Publishers, 1997; 685-746.
29. Varela CI, Alencar-Ponte D. Terminología básica en dermatoscopia. Rev Col Dermatol 1998; 6:14-18.
2. Bahmer A et al. Terminology in surface microscopy. J Am Acad Dermatol 1990; 23: 1159-1162.
https://doi.org/10.1016/S0190-9622(08)80916-4
3. Nachbar F et al. The ABCD rule of dermatoscopy. J Am Acad Dermatol 1994; 30:551-559.
https://doi.org/10.1016/S0190-9622(94)70061-3
4. Pehamberger H, Steiner A, Wolff K. In vivo epiluminiscence microscopy of pigmented skin lesions. l. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol 1987; 17:571-583.
https://doi.org/10.1016/S0190-9622(87)70239-4
5. Menzies W, Crotty A, McCarthy WH. The Morphologic Criteria of the Pseudopod in Surface Microscopy. Arch Dermatol 1995; 131:436-440.
https://doi.org/10.1001/archderm.1995.01690160064010
6. Yadav S et al. Histopathologic Correlates of Structures seen on Dermatoscopy (Epiluminicence Microscopy). Am J Dermatophatol 1993; 15:297-305.
https://doi.org/10.1097/00000372-199308000-00001
7. Fernández MA, Ortega RM, Serrano S. Microscopía de epiluminiscencia en el diagnóstico de los tumores pigmentados (11). Piel 1995; 10:322-325.
8. Steiner A et al. Pigmented Spitz nevi: lmprovement of the diagnostic accuracy by epiluminiscence microscopy. J Am Acad Dermatol 1992; 27:697-700.
https://doi.org/10.1016/0190-9622(92)70240-G
9. Steiner A et al. Statistical evaluation of epiluminis cence microscopy criteria for melanocytic pigmented skin lesions. J Am Acad Dermatol 1993; 29:581-588.
https://doi.org/10.1016/0190-9622(93)70225-I
10. Steiner A, Pehamberger H, Wolff K. In vivo epiluminiscence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Am Acad Dermatol 1987; 17:584-591.
https://doi.org/10.1016/S0190-9622(87)70240-0
11. Kenet RO et al. Clinical Diagnosis of Pigmented Lesions Using digital Epiluminiscence Microscopy. Arch Dermatol 1993; 129:1157-1174.
https://doi.org/10.1001/archderm.1993.01680230041005
12. Kenet RO. Trends in Dermatology: Differential Diagnosis of Pigmented lesions Using Epiluminiscence Microscopy. En: Saber AJ and Fitzpatrick TB (eds). Year Book of Dermatology. St. Louis, Mosby, 1992:xxi-xxxi.
13. Soyer HP, Kerl H. Surface Microscopy of Cutaneous Pigmented Tumors. Ann Dermatol Venereol 1993; 120:15-20.
14. Kreusch J, Rassner G. Epiluminiscence Microscopic Analysis of Structures in Pigmented Melanocytic Nevi: Review and Personal Experiencie. Hautarzt 1990; 27-33.
15. Schulz H. Epiluminescence Microscopy Score for the Differential Diagnosis of Dysplastic Nevi. Hautarzt 1992; 43:487-490.
16. Saida T, Oguchi S, lshihara Y. In Vivo Observation of Magnified Features of Pigmented Lesions on Volar Skin Using Video Microscope. Usefulness of Epiluminiscence Techniques in Clinical Diagnosis. Arch Dermatol 1995; 131:298-304.
https://doi.org/10.1001/archderm.1995.01690150062013
17. Puppin D, Saloman D, Saurat JH. Amplified surface microscopy. Preliminary evaluation of a 400-fold, magnification in the surface microscopy of cutaneous melanocytic lesions. J Am Acad Dermatol 1993; 28:923-927.
https://doi.org/10.1016/0190-9622(93)70131-C
18. Binder M et al. Epiluminiscence Microscopy. A useful Tool for the Diagnosis of pigmented Skin Lesions for formally Trained Dermatologists. Arch Dermatol 1995; 131:286-291.
https://doi.org/10.1001/archderm.1995.01690150050011
19. CY Ho V, Mcleand D. Begin Epithelial Tumors. Seborrhoeic Keratosis. En: Fitzpatrick TB. et al (eds). Dermatology in General Medicine. 4a. Ed. New York, McGraw-Hill, 1993; 855-858.
20. Maize JC, Snider RL. Nonmelanoma skin Cancers in Association with Seborrheic Keratosis. Clínicopathologic Correlations. Dermatol Surg 1995; 21:960- 962.
https://doi.org/10.1016/1076-0512(94)00241-X
21. Stolz W et al. Color Atlas of Dermatoscopy. Oxford, Blackwell Science Ltd., 1994.
22. Marghoob A, Kopf AW. Persistent nevus: An exception to the ABCD rule of dermatoscopy. J Am Acad Dermatol 1997; 36:474-475.
https://doi.org/10.1016/S0190-9622(97)80230-7
23. Guillad JF et al. Epiluminescence videomicroscopy: Black dots and brown globules revisited by stripping the stratum corneum. J Am Acad Dermatol 1997; 36:371-377.
https://doi.org/10.1016/S0190-9622(97)80211-3
24. Benelli C et al. Melanoma with dermatoscopic features of seborrheic keratosis. Eur J Dermatol 1996; 6:246-247.
25. Tsambaos D et al. Detection of human papillomavirus DNA in nongenital seborrheic keratosis. Arch Dermatol Res 1995; 287:612-615.
https://doi.org/10.1007/BF00374085
26. Rady PL et al. Herpes virus-like DNA sequences in non-Kaposi's sarcoma skin lesions of transplant patients. Lancet 1995; 345:1339-1340.
https://doi.org/10.1016/S0140-6736(95)92538-4
27. Caballero MJ et al. Malignant melanoma appearing in a seborrheic keratosis. Br J Dermatol 1995; 133:1016-18.
https://doi.org/10.1111/j.1365-2133.1995.tb06953.x
28. Kirkham N. Tumors and Cyst of the Epidermis. En: Elder David. Lever's Histopathology of the skin, 8a. ed., Philadelphia, Lippincott-Raven Publishers, 1997; 685-746.
29. Varela CI, Alencar-Ponte D. Terminología básica en dermatoscopia. Rev Col Dermatol 1998; 6:14-18.
Cómo citar
1.
Jaramillo Ramírez AP, Hoyos Gaviria JG, Restrepo Gutiérrez S. Evaluación de la Dermatoscopia en el diagnóstico de las queratosis seborreicas. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de junio de 2000 [citado 19 de abril de 2024];8(2):129-38. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/679
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2000-06-01
Cómo citar
1.
Jaramillo Ramírez AP, Hoyos Gaviria JG, Restrepo Gutiérrez S. Evaluación de la Dermatoscopia en el diagnóstico de las queratosis seborreicas. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de junio de 2000 [citado 19 de abril de 2024];8(2):129-38. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/679
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Sección
Investigación Epidemiológica
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