Seborrheic keratosis: Reflectance confocal microscopy features and correlation with dermoscopy

Verena Ahlgrimm-Siess, Theresa Cao, Margaret Oliviero, Martin Laimer, Rainer Hofmann-Wellenhof, Harold S. Rabinovitz, Alon Scope

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Background: Differentiation between seborrheic keratosis (SK) and skin cancers may be difficult. Reflectance confocal microscopy (RCM) enables noninvasive assessment of skin neoplasms at cellular-level resolution. Objective: We sought to describe RCM features of SK and to correlate these RCM findings with dermoscopic structures. Methods: Clinical, dermoscopic, and RCM images of 45 consecutive SK were obtained at a private and university dermatology clinic. Fourteen SK were biopsied because of equivocal clinical or dermoscopic features. Results: With RCM, all SK displayed a regular honeycomb pattern of the epidermis and densely packed, round to polymorphous, well-circumscribed dermal papillae at the dermoepidermal junction, features suggestive of a benign neoplasm. RCM features indicating the diagnosis of SK were also observed, including epidermal projections (43/45 SK; 96%) and keratin-filled invaginations (36/45 SK; 80%) at the lesion surface; corneal pseudocysts at epidermal layers (19/45 SK; 42%); and melanophages (21/45 SK; 47%) and dilated round and linear blood vessels (21/45 SK; 47%) in the papillary dermis. Of biopsied SK, 93% (13/14) displayed at least 3 characteristic RCM findings in the absence of RCM features suggestive of malignancy. Limitations: This was a limited study sample and retrospective study design. Conclusions: SK display a distinct set of RCM criteria despite their variable clinical and dermoscopic appearances.

Original languageEnglish (US)
Pages (from-to)120-126
Number of pages7
JournalJournal of the American Academy of Dermatology
Issue number1
StatePublished - Jul 2013
Externally publishedYes


  • dermoscopy
  • histopathology
  • in vivo reflectance confocal microscopy
  • seborrheic keratoses
  • solar lentigo

ASJC Scopus subject areas

  • Dermatology


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