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Cristina Carrera, MD; Sonia Segura, MD; Josep Palou, MD; Susana Puig, MD; Jordi Segura, MD; Rosa M. Martí, MD; Josep Malvehy, MD

Arch Dermatol. 2007;143(3):373-376.

Background  Seborrheic keratosislike melanoma could be one of the most problematic melanoma simulators, and it may be incorrectly treated by electrocautery or cryotherapy. Dermoscopic examination of pigmented tumors improves the diagnostic accuracy in these challenging lesions. In these tumors, numerous comedolike openings are present.

Observations  A 34-year-old man was seen for a conspicuous pigmented lesion on his back that clinically resembled a seborrheic keratosis because of the presence of multiple comedolike openings. Findings from dermoscopic examination showed distinct melanoma criteria (atypical pigmented network, asymmetric globules and dots, and a blue-whitish veil), in addition to multiple comedolike openings. Histopathological examination confirmed a peculiar melanoma variant characterized by prominent folliculotropism and minimal radial spreading. This tumor was not associated with chronic sun-damaged skin.

Conclusion  Dermoscopy was useful in identifying a particular case of seborrheic keratosislike melanoma with folliculotropism, thus avoiding incorrect treatment.

Author Affiliations: Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Carrera, S. Segura, Palou, Puig, J. Segura, and Malvehy); and Department of Dermatology, Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain (Dr Martí).

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