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Figure 1 – Large SK of the trunk
Note the numerous surrounding smaller SK
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Figure 2 – Close up of a SK
Note the greasy looking surface and ‘stuck-on’ appearance.
Close inspection also reveals milia-like cysts (black arrow) and comedo-like openings (red arrow)
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Figure 3 – Dermoscopic appearance of figure 2
Milia-like cysts show up as bright white dots (black arrow) and comedo-like openings (red arrow)
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Figure 4 – SK
The lesion has a very ‘greasy’ appearance
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Figure 5 – Dermoscopic appearance of figure 4
Large numbers of comedo-like openings
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Figure 6 – SK right shoulder
This large lesion was curetted and sent for histology
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Figure 7 – SK right shoulder
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Figure 8 - SK
The differential diagnosis included a benign melanocytic naevus and melanoma
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Figure 9 – Dermoscopic appearance of figure 8 confirms a SK
Large numbers of milia-like cysts (black arrows) and comedo-like openings (red arrows)
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Figure 10 – SK
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Figure 11 – Dermoscopic appearance of figure 10
Note the gyri and sulci that give it a brain-like appearance
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Figure 12 – SK right temple
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Figure 13 – Dermoscopic appearance of figure 12
Note the milia-like cysts (black arrow) and comedo-like openings (red arrows)
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Figure 14 - Collision tumour
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Figure 15 - Dermoscopic apperance of figure 14
This tumour is made up of two lesions - a melanocytic naevus on the left and a seborrhoeic keratosis on the right
(copied with kind permission of Dr Stephen Hayes)
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Figure 16 - Collision tumour (dermosopic apperanance)
This tumour is made up of two lesions - a seborrhoeic keratosis, and a small angioma at one o'clock
(copied with kind permission of Dr Stephen Hayes)
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Figure 17 – Collision tumour
Seborrhoeic keratosis (purple arrow) and BCC (black arrow)
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Figure 18 – Dermoscopic appearance of figure 17
Milia-like cysts of the seborrhoeic keratosis (purple arrow) and arborising vessels of the BCC (black arrow)
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Figure 19 – A thin SK
/>Close inspection still gives the impression of a ‘stuck-on’ appearance
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Figure 20 – Thin SK on the shin
The lesion lacked the scale, and was a lot smoother than if this had been a patch of Bowen’s disease
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Figure 21 – Dermoscopic appearance of figure 18
Large number of milia-like cysts
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Figure 22 – Thin SK (black arrow)
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Figure 23 – Dermoscopic appearance of figure 20
Thin lesions can lack the classical features seen in most SK, although close inspection of the edge (black arrow) of this lesion reveals a 'moth-eaten' border
As with all skin lesions, the dermatoscope should be used in conjunction with the history and naked eye examination. In cases of diagnostic uncertainty the patient should be referred or have the lesion excised with a 2mm clear margin
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Figure 24 - SK right forehead
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Figure 25 - Dermoscopic appearance of figure 24
This shows a frogspawn-like appearance
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Figure 26 - SK right forehead
Much of the lesion 'dropped off' before the appointment. This is quite a common feature of seborrhoeic keratoses
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Figure 27 - Dermoscopic appearance of figure 26
The rather grey, granular structures are where the lesion has come away. These structures are not disimilar to those seen in lentigo maligna - the reassuring aspect in such cases is the history of a lesion that has come away
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