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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">INTRODUCTION</span><p id="par0005" class="elsevierStylePara elsevierViewall">Seborrheic keratoses &#40;SK&#41; are one of the most common benign cutaneous neoplasms encountered in ambulatory dermatology practice&#44; estimated to affect at least 20&#37; of the adult population&#44; especially older adults&#46; In a review made by Jackson et al&#46;&#44; &#40;2015&#41; dermatologists report they diagnose an average of 155 patients per month with SK with 33&#37; with more than 15 SK lesions and 67&#37; with 15 or fewer SK lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> SK look as numerous sharply delineated&#44; round or oval&#44; flesh-colored or brown-black warty plaques with a greasy texture&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> They may appear in the hair-bearing skin&#44; invariably sparing the mucosal surfaces and the palms and the soles&#46; SK can appear on the head and neck&#44; extremities&#44; and trunk&#44; especially the upper back and submammary region&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis of SK is readily made by clinical and dermoscopic examination in the majority of cases&#44; nevertheless&#44; it is possible to find atypical SK which have none of the specific dermoscopic criteria or have typical findings commonly associated to melanocytic proliferations&#46; In some instances&#44; it can be hard to distinguish these lesions from melanocytic nevus&#44; basal cell carcinoma&#44; verruca vulgaris&#44; malignant melanoma and Bowen&#39;s disease&#44; even with the support of dermoscopy&#46; The most widely used dermoscopic algorithm for SK was the two-step procedure proposed in 2001 on the Consensus Net Meeting on Dermoscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This method includes a first step in which the presence of dermatoscopic findings of melanocytic lesions such as pigment network&#44; aggregated globules&#44; branched streaks&#44; homogeneous blue pigmentation or parallel pattern has to be excluded&#46; In the second step&#44; essential for SK diagnosis&#44; multiple milia-like cysts&#44; comedo-like openings&#44; fissures&#47;ridges &#40;brain-like appearance&#41; and light-brown fingerprint-like structures should be found&#46; In 2002&#44; Braun et al&#46; evaluated the dermoscopic features of 203 pigmented seborrhoeic keratoses and added other criteria such as fissures&#44; hairpin blood vessels&#44; sharp demarcation and moth-eaten borders&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Malvehy et al&#46; Reported crypts&#44; exophytic papillary structures and a jelly sign as additional dermoscopic signs&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The aim of our study was to evaluate the most represented dermoscopic feature&#40;s&#41;&#47;global dermoscopic pattern in a group of atypical SK in order to simplify diagnosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">PATIENTS AND METHODS</span><p id="par0015" class="elsevierStylePara elsevierViewall">72 SK excised from September 2014 up to September 2017 were examined&#46; All lesions were excised to rule out malignant neoplasms&#46; The two-step algorithm procedure was used considering&#44; as first step&#44; the absence of features typical of melanocytic lesion such as pigment network&#44; aggregated globules&#44; branched streaks&#44; homogeneous blue pigmentation or parallel pattern&#46; We then evaluated specific criteria for SK such as multiple milia-like cysts&#44; comedo-like openings&#44; fissures&#47;ridges&#44; hairpin vessels&#44; moth-eaten border&#44; opaque-brown pigmentation&#44; Mika-like structure&#44; yellowish color&#44; vascular structure&#44; sharp demarcation&#44; focal hemorrhage&#44; grape-like vessels&#44; coral-like structure&#44; globule-like structure and network-like structure&#46; Afterward&#44; we considered dermatoscopic global aspect recognizing eight different patterns &#40;see in results&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">All SK were examined by dermatologists&#44; who are co-authors with experience in dermoscopy&#46; Polarized dermoscopic images were obtained using a dermoscope &#40;DermLite 3Gen LLC&#44; Dana Point California&#41; at 10-fold magnification and documentation of dermoscopic findings was performed for every lesion using DermLite photo equipment &#40;3Gen LLC&#41; at 20-to 50-fold magnification&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">RESULTS</span><p id="par0025" class="elsevierStylePara elsevierViewall">72 atypical SK were excised between September 2014 and September 2017&#46; The differential diagnosis included&#58; melanoma in 48 patients &#40;66&#46;7&#37;&#41;&#44; squamous cell carcinoma in 15 cases &#40;20&#46;9&#37;&#41;&#44; Clark or traumatized nevus in 6 patients &#40;8&#46;3&#37;&#41; and basal cell carcinoma in 3 individuals &#40;4&#46;2&#37;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">About the location 23 SK &#40;32&#37;&#41; were located on the arms&#44; 8 &#40;11&#44;1&#37;&#41; on the shoulders&#44; 14 &#40;19&#46;4&#37;&#41; on the face&#44; 11&#40;15&#46;2&#37;&#41; on abdomen&#44; 8 &#40;11&#44;1&#37;&#41; on the chest and 8 &#40;11&#44;1&#37;&#41; on legs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">During the first step of the two-step algorithm elements suggestive for melanocytic lesion were found in 79&#46;2&#37; of all lesions&#58; 39 SK &#40;54&#46;2&#37;&#41; presented a pigment network&#44; 3 &#40;4&#46;2&#37;&#41; aggregated globules&#44; 9 &#40;12&#46;5&#37;&#41; branched streaks&#44; 6 &#40;8&#46;3&#37;&#41; homogeneous blue pigmentation and 0 &#40;0&#46;0&#37;&#41; parallel pattern&#46; In the second step&#44; an average of 4&#46;04 out of 15 dermoscopic specific criteria for SK was found &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; milia-like cysts were found in 18 SK &#40;25&#46;0&#37;&#41;&#44; comedo-like openings in 12 &#40;16&#46;6&#37;&#41;&#44; fissures&#47;ridges in 9 lesions &#40;12&#46;5&#37;&#41;&#44; hairpin vessels in single unit in 6 &#40;8&#46;3&#37;&#41;&#44; clustered hairpin vessels &#40;also known as grape-like vessels&#41; in 0 &#40;0&#44;0&#37;&#41;&#44; demarcated scalloped borders &#40;also known as moth-eaten borders&#41; in 3 &#40;4&#46;2&#37;&#41;&#44; opaque-brown pigmentation in 6 &#40;8&#46;3&#37;&#41;&#44; hyperkeratotic structures &#40;also known as mika-like structures&#41; in 21 &#40;29&#46;1&#37;&#41;&#44; yellowish color in 6 &#40;8&#46;3&#37;&#41;&#44; vascular structure in 21 &#40;29&#46;1&#37;&#41;&#44; sharp demarcation in 36 &#40;50&#46;0&#37;&#41;&#44; focal hemorrhage in 6 &#40;8&#46;3&#37;&#41;&#44; thick pigmented lines in a coral geometry &#40;also known coral-like structure&#41; in 3 SK &#40;4&#46;2&#37;&#41;&#44; network-like structure in 30 &#40;41&#46;7&#37;&#41;&#44; globule-like structure in 3 &#40;4&#46;2&#37;&#41;&#46; Additional criteria not included in the two-step algorithm but found in our report were blue-whitish veil &#40;found in 3 SK&#44; 4&#46;2&#37;&#41;&#44; polymorphous vessels &#40;18 SK&#44; 25&#37;&#41;&#44; blotch&#47;globules &#40;6 SK&#44; 8&#46;3&#37;&#41; shiny white streaks &#40;3 lesions&#44; 4&#46;2&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">8 main patterns were described by our study group &#40;see <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#58; A&#41; Reticular pattern &#40;27 SK&#44; 37&#46;5&#37;&#41;&#58; pattern made by lines straight and arranged in such a manner that they intersect each other nearly at right angles at regular intervals to form a net-like structure&#46; In the reticulated type of SK&#44; thin tracts of basaloid tumor cells extend from the epidermis to the dermis forming a reticular architecture&#59; B&#41; Not specific pattern &#40;15 SK&#44; 20&#46;9&#37;&#41;&#58; pattern in which no particular dermoscopic structures are distinguishable&#46; C&#41; Vascular pattern &#40;9 SK&#44; 12&#46;5&#37;&#41;&#58; pattern made not by pigmented lines but by vessels&#59; D&#41; Multicomponent pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#58; lesions in which two or more patterns are discernable&#59; E&#41; Homogeneous blue-like pattern &#40;6 SK&#44; 8&#46;3&#37;&#41;&#58; blue color uniformly distributed or concentrated in some areas&#44; characterized pathologically&#44; by increased large&#44; dendritic&#44; melanin-rich melanocytes throughout the tumor with hyperkeratosis and papillomatosis of the epidermis&#59; F&#41; Bowenoid patterns &#40;3 SK&#44; 4&#46;2&#37;&#41;&#58; with glomerular vessels&#44; dotted vessels or a combination of both&#59;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">G&#41; Hyperkeratotic pattern &#40;6 SK&#44; 8&#46;3&#37;&#41;&#58; pattern formed mainly by scales &#40;Mica-like structure&#41; or by hyperkeratotic area&#44; usually central&#46; Hyperkeratosis and papillomatosis of the epidermis are pronounced in the hyperkeratotic type of SK&#59; H&#41; Lichenoid pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#58; with brownish-grey&#44; bluish-grey or whitish-grey coarse granules widespread throughout the lesion&#46; In some cases&#44; regression areas were also found&#46; Histopathologically characterized by a lichenoid reaction&#44; namely&#44; band-like infiltration of inflammatory cells in the upper dermis&#44; pigment incontinence and individual degenerated keratinocytes in the epidermis&#46; &#40;To see the complete correlation between dermatoscopic global aspect and histopathologic features see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">DISCUSSION</span><p id="par0050" class="elsevierStylePara elsevierViewall">Aim of our study was to evaluate the most represented dermoscopic feature&#40;s&#41;&#47;global dermoscopic pattern in a group of atypical SK in order to simplify diagnosis&#46; Sharp demarcation &#40;50&#46;0&#37;&#41; and network-like structure &#40;41&#46;7&#37;&#41; resulted to be the more prevalent dermoscopic features in our group of study &#40;see Tab&#46;1&#41;&#46; These results are in accordance with other studies on the matter&#46; In our opinion&#44; is too simplistic and risky hanging the challenging diagnosis of atypical SK on the sharp demarcation&#44; feature non-exclusive of benign lesions&#46; The same goes for the presence of network-like structure&#58; this feature couldn&#8217;t be a reliable finding considering that often is difficult to establish boundaries between network-like and a true network typical for melanocytic lesions&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our data are in accordance with previous studies emphasizing the dermoscopic-variability of SK&#46; On the entire group of SK&#44; 66&#46;7&#37; were excised to rule out a melanoma&#46; This is due to the fact that 57 of 72 lesions evaluated using a two-step algorithm showed dermoscopic criteria typical of melanocytic lesion&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Comparing our data with those from a prospective study by Lin&#44; respectively&#44; several differences are recognizable such as&#58; a&#41; comedo-like openings in 16&#46;6&#37; cases versus 39&#46;2&#37;&#59; b&#41; fissures&#47; ridge 12&#46;5&#37; versus 59&#46;8&#37;&#59; c&#41; network-like structure&#58; 41&#44;7&#37; versus 2&#46;0&#37;&#46; Such discrepancies are probably linked to our over-selected population in which typical SK were not excised&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Additional criteria founded in our study population were&#58; blue-whitish veil found in 3 SK &#40;4&#46;2&#37;&#41;&#44; polymorphous vessels in 18 SK &#40;25&#37;&#41;&#44; blotch&#47;globules in 6 SK &#40;8&#46;3&#41; and shiny white Streaks in 3 lesions &#40;4&#46;2&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Eight main global dermoscopic patterns were described&#58; the most represented was reticular pattern &#40;37&#46;5&#37;&#41;&#44; followed by not-specific pattern &#40;20&#46;8&#37;&#41;&#44; vascular pattern &#40;12&#46;5&#37;&#41;&#44; hyperkeratotic pattern &#40;8&#46;3&#37;&#41;&#44; Homogeneous blue-like pattern &#40;8&#46;3&#37;&#41;&#44; lichenoid pattern &#40;4&#46;2&#37;&#41;&#44; multicomponent pattern &#40;4&#46;2&#37;&#41; and bowenoid pattern &#40;4&#46;2&#37;&#41;&#46; These findings are in accordance with a previous paper written by Squillace et al&#46;&#44; &#40;2016&#41;&#58; in this retrospective study the authors defined 10 repetitive global dermatoscopic patterns comparable to ours except &#8220;keratoacanthoma-like pattern&#8221;&#44; &#8220;clonal pattern&#8221; and &#8220;spitzoid pattern&#8221;&#44; this latter described also by Minagawa&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> On the other side&#44; we described two patterns not described by previously mentioned authors&#44; namely &#8220;not specific pattern&#8221; &#40;20&#46;9&#37; of all lesion examined&#41; and &#8220;vascular pattern&#8221; &#40;12&#46;5&#37; of all lesion examined&#41;&#46; These two patterns are usually described in melanocytic lesions and therefore are not reliable for a definite diagnosis of SK&#44; suggesting a surgical excision&#46; Finally&#44; despite these findings&#44; no specific feature or global pattern&#44; statistically significant for dermoscopic diagnosis of challenging SK have been found&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">According to the two-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion&#44; SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking seborrheic keratoses&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a> This latter form&#44; in particular&#44; represents the maximum risk in the evaluation of a SK with a non-convincing aspect&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Concerning the location of 72 SK analyzed&#44; as said before&#44; 23 SK &#40;32&#37;&#41; were located on the arms&#44; 8 &#40;11&#44;1&#37;&#41; on the shoulders&#44; 14 &#40;19&#46;4&#37;&#41; on the face&#44; 11&#40;15&#46;2&#37;&#41; on abdomen&#44; 8 &#40;11&#44;1&#37;&#41; on the chest and 8 &#40;11&#44;1&#37;&#41; on legs&#46; No differences concerning location were detected between our data and analogous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> With the exception of the leg where the global patterns most represented were three &#40;specific&#44; vascular and reticular followed by hyperkeratotic and lichenoid&#41; all the other body areas have been characterized by the increased expression of the reticular pattern&#58; 35&#37; of the all lesions on the arms&#44; 50&#37; on the face&#44; 36&#46;3&#37; on the abdomen&#44; 37&#46;5&#37; on the shoulders&#44; 37&#46;5&#37; on the chest&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">CONCLUSION</span><p id="par0085" class="elsevierStylePara elsevierViewall">Considering the high prevalence of SKs in the general population&#44; dermatologists are regularly challenged with the diagnosis of this benign skin tumor&#46; Dermoscopy permits a rapid and dependable diagnosis in most cases&#46; Despite this&#44; in case of unclear dermoscopic features&#44; a biopsy remains mandatory for those cases that cannot be clearly distinguished from common skin malignancies&#46;</p></span></span>"
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            0 => "Dermoscopy"
            1 => "Seborrheic keratoses"
            2 => "Melanoma&#44; atypical"
            3 => "Seborrheic keratoses"
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            0 => "Dermatoscopia"
            1 => "Queratosis seborreica"
            2 => "Melanoma at&#237;pico"
            3 => "Queratosis seborreica"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Seborrheic keratoses &#40;SK&#41; are easily recognizable by clinical and dermoscopic approach&#44; nevertheless&#44; some lesions act as a simulator of different skin conditions lacking typical clinical and dermoscopic criteria&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of our study was to find specific dermoscopic features or a global pattern to improve diagnostic skills for challenging SK&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We examined 72 atypical SK excised from September 2014 up to September 2017 by using the 2-step algorithm modified by Malvehy &#40;2002&#41; and Argenziano &#40;2003&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our study population&#44; an average of 4&#46;04 out of 15 dermoscopic specific criteria for SK was found &#40;for example&#44; multiple milia-like cysts&#41;&#46; Additional criteria not included in 2-step algorithm were blue-whitish veil &#40;found in 3 SK&#59; 4&#46;2&#37;&#41;&#44; polymorphous vessels &#40;18 SK&#59; 25&#37;&#41;&#44; blotch&#47;globules &#40;6 SK&#59; 8&#46;3&#37;&#41;&#44; shiny white streaks &#40;3 lesions&#59; 4&#46;2&#37;&#41;&#46; The most represented global patterns were reticular &#40;27 SK&#59; 37&#46;5&#37;&#41; and not specific &#40;15 SK&#59; 20&#46;8&#37;&#41;&#46; All lesions exhibited peculiar findings of SK&#44; furthermore elements suggestive for melanocytic lesion were found in 79&#46;2&#37; of all lesions&#46; Comparing the literature and our results&#44; we found 3 significant differences&#58; a&#41; the less prevalence of SK specific criteria in our study population&#59; b&#41; the description of findings usually not related to SK&#44; among which blue-whitish veil&#44; polymorphous vessels&#44; blotch&#47;globules and shiny white streaks&#44; and c&#41; 2 patterns not previously defined represented by &#8220;not specific pattern&#8221; &#40;20&#46;9&#37; of all lesions examined&#41; and &#8220;vascular pattern&#8221; &#40;12&#46;5&#37; of all lesions examined&#41; were also described&#46; No specific feature or global pattern&#44; statistically significant for dermoscopic diagnosis of difficult-to-diagnose SK have been found&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nevertheless the useful findings&#44; no specific feature or global pattern statistically significant for dermoscopic diagnosis of challenging SK have been found&#46; According to the 2-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion&#44; SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking SK&#46;</p></span>"
        "secciones" => array:5 [
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            "titulo" => "Background"
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            "identificador" => "abst0015"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las queratosis seborreicas &#40;QS&#41; son reconocidas con facilidad a trav&#233;s de una aproximaci&#243;n cl&#237;nica y dermatosc&#243;pica&#44; sin embargo&#44; algunas lesiones presentan un comportamiento que simula distintas afecciones de la piel que carecen de criterios cl&#237;nicos y dermatosc&#243;picos t&#237;picos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue encontrar caracter&#237;sticas dermatosc&#243;picas espec&#237;ficas o un patr&#243;n general que permita mejorar las habilidades diagn&#243;sticas en los casos de QS complejas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudiamos 72 casos de QS at&#237;picas extirpadas entre septiembre del 2014 y septiembre del 2017 utilizando para ello el algoritmo en 2 pasos modificado por Malvehy &#40;2002&#41; y Argenziano &#40;2003&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En nuestra poblaci&#243;n de estudio&#44; encontramos una media de 4&#44;04 de los 15 criterios espec&#237;ficos dermatosc&#243;picos de QS &#40;por ejemplo&#44; m&#250;ltiples puntos similares a quistes tipo <span class="elsevierStyleItalic">milium</span>&#41;&#46; Se identificaron los siguientes criterios adicionales no incluidos en el algoritmo en 2 pasos&#58; velo azul-blanquecino &#40;en 3 QS&#59; 4&#44;2&#37;&#41;&#44; patr&#243;n vascular polimorfo &#40;18 QS&#59; 25&#37;&#41;&#44; manchas&#47;gl&#243;bulos &#40;6 QS&#59; 8&#44;3&#37;&#41;&#44; manchas blancas brillantes &#40;3 lesiones&#59; 4&#44;2&#37;&#41;&#46; Los patrones generales m&#225;s representados fueron el patr&#243;n reticular &#40;27 QS&#59; 37&#44;5&#37;&#41; y no espec&#237;fico &#40;15 QS&#59; 20&#44;8&#37;&#41;&#46; Todas las lesiones exhibieron hallazgos peculiares de QS&#59; adem&#225;s&#44; en el 79&#44;2&#37; de todas las lesiones estudiadas se identificaron elementos indicativos de lesi&#243;n melanoc&#237;tica&#46; Cuando comparamos la literatura con nuestros resultados&#44; encontramos 3 diferencias significativas&#58; a&#41; una menor prevalencia de los criterios espec&#237;ficos de QS en nuestra poblaci&#243;n de estudio&#59; b&#41; la identificaci&#243;n de hallazgos generalmente no relacionados con la QS&#44; como el velo azul-blanquecino&#44; el patr&#243;n vascular polimorfo&#44; las manchas&#47;gl&#243;bulos y las manchas blancas brillantes&#44; y c&#41; tambi&#233;n se describieron 2 patrones no definidos previamente representados por &#171;patr&#243;n no espec&#237;fico&#187; &#40;20&#44;9&#37; de todas las lesiones examinadas&#41; y &#171;patr&#243;n vascular&#187; &#40;12&#44;5&#37; de todas las lesiones examinadas&#41;&#46; No se encontr&#243; ninguna caracter&#237;stica espec&#237;fica o patr&#243;n general estad&#237;sticamente significativo para el diagn&#243;stico dermatosc&#243;pico de QS de diagn&#243;stico dif&#237;cil&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A pesar de los hallazgos&#44; no hemos encontrado ning&#250;n patr&#243;n espec&#237;fico o general estad&#237;sticamente significativo para el diagn&#243;stico dermatosc&#243;pico de la QS de diagn&#243;stico dif&#237;cil&#46; Conforme al algoritmo en 2 pasos y el sistema de puntuaci&#243;n dermatosc&#243;pica para lesiones melanoc&#237;ticas y no melanoc&#237;ticas&#44; las QS con uno o varios hallazgos dermatosc&#243;picos t&#237;picos de lesi&#243;n melanoc&#237;tica deber&#237;an ser extirpados quir&#250;rgicamente para excluir el melanoma cl&#225;sico o el melanoma que simula una QS&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mazzeo M&#44; Manfreda V&#44; Diluvio L&#44; Dattola A&#44; Bianchi L&#44; Campione E&#46; An&#225;lisis dermatosc&#243;pico de 72 queratosis seborreicas &#171;at&#237;picas&#187;&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;366&#8211;371&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Composit of 8 main patterns described by our study&#58; A&#46; Reticular pattern &#40;27 SK&#44; 37&#46;5&#37;&#41;&#59; B&#46; Not specific pattern &#40;15 SK&#44; 20&#46;9&#37;&#41;&#58; C&#46; Vascular pattern &#40;9 SK&#44; 12&#46;5&#37;&#41;&#59; D&#46; Multicomponent pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#59; E&#46; Homogeneous blue-like pattern &#40;6 SK&#44; 8&#46;3&#37;&#41;&#59; F&#46; Bowenoid patterns &#40;3 SK&#44; 4&#46;2&#37;&#41;&#59; G&#46; Hyperkeratotic pattern &#40;6 SK&#44; 8&#46;3&#37;&#41; and F&#58; Lichenoid pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#46;</p>"
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            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Melanocytic features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; In which the characteristic was observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non melanocytic features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; In which the characteristic was observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pigment network&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milia-like cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aggregated globules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comedo-like openings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branched streaks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fissures&#47;ridges&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Homogeneous blue pigmentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hairpin vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parallel pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clustered hairpin vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blue-whitish veil &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Demarcated scalloped borders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polymorphous vessels &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opaque-brown pigmentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blotch&#47;globules &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperkeratotic structures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shiny white streaks &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yellowish colour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular structure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sharp demarcation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal hemorrhage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thick pigmented lines in a coral geometry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Network like structure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Globule like structure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049327.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">List of melanocytic and the non-melanocytic features with percentage of presentation in our population study&#46; The asterisks mark additional criteria not included in the two-step algorithm but found in our report&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Histopathological correlation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reticular pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by thin tracts of basaloid tumor cells extending from the epidermis to the dermis forming a reticular architecture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specific pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by tracts of basaloid tumor cells extending from the epidermis to the dermis forming a reticular architecture&#46; Whorls of maturing squamous epithelium &#40;squamous eddies&#41; were detectable in one-third of all the seborrheic keratoses with no specific pattern&#46; Two lesions showing this pattern exhibited irregular squamous nests and cords of cells extending into a desmoplastic stroma &#40;the desmoplastic variant of seborrheic keratosis&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by acanthosis with increased vascular component&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Homogeneous blue like pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by increased large&#44; dendritic&#44; melanin-rich melanocytes throughout the tumor with hyperkeratosis and papillomatosis of the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bowenoid pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by acanthosis with dilated vessels and by grouped melanophages only observable in the papillary dermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperkeratotic pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by hyperkeratosis and papillomatosis of the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lichenoid pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by lichenoid reaction&#44; namely&#44; band-like infiltration of inflammatory cells in the upper dermis&#44; pigment incontinence and individual degenerated keratinocytes in the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multicomponent pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by a combination of two or more of the previous features see above&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Summary table concerning the correlation between our dermatoscopic findings and histopathologic features&#46;</p>"
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Original Article
Dermoscopic Analysis of 72 “Atypical” Seborrheic Keratoses
Análisis dermatoscópico de 72 queratosis seborreicas «atípicas»
M. Mazzeo
Autor para correspondencia
mauromazzeo@hotmail.it

Corresponding author.
, V. Manfreda, L. Diluvio, A. Dattola, L. Bianchi, E. Campione
Departamento de Dermatología, Universidad de Tor Vergata, Roma, Lazio, Italia
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invariably sparing the mucosal surfaces and the palms and the soles&#46; SK can appear on the head and neck&#44; extremities&#44; and trunk&#44; especially the upper back and submammary region&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis of SK is readily made by clinical and dermoscopic examination in the majority of cases&#44; nevertheless&#44; it is possible to find atypical SK which have none of the specific dermoscopic criteria or have typical findings commonly associated to melanocytic proliferations&#46; In some instances&#44; it can be hard to distinguish these lesions from melanocytic nevus&#44; basal cell carcinoma&#44; verruca vulgaris&#44; malignant melanoma and Bowen&#39;s disease&#44; even with the support of dermoscopy&#46; The most widely used dermoscopic algorithm for SK was the two-step procedure proposed in 2001 on the Consensus Net Meeting on Dermoscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This method includes a first step in which the presence of dermatoscopic findings of melanocytic lesions such as pigment network&#44; aggregated globules&#44; branched streaks&#44; homogeneous blue pigmentation or parallel pattern has to be excluded&#46; In the second step&#44; essential for SK diagnosis&#44; multiple milia-like cysts&#44; comedo-like openings&#44; fissures&#47;ridges &#40;brain-like appearance&#41; and light-brown fingerprint-like structures should be found&#46; In 2002&#44; Braun et al&#46; evaluated the dermoscopic features of 203 pigmented seborrhoeic keratoses and added other criteria such as fissures&#44; hairpin blood vessels&#44; sharp demarcation and moth-eaten borders&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Malvehy et al&#46; Reported crypts&#44; exophytic papillary structures and a jelly sign as additional dermoscopic signs&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The aim of our study was to evaluate the most represented dermoscopic feature&#40;s&#41;&#47;global dermoscopic pattern in a group of atypical SK in order to simplify diagnosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">PATIENTS AND METHODS</span><p id="par0015" class="elsevierStylePara elsevierViewall">72 SK excised from September 2014 up to September 2017 were examined&#46; All lesions were excised to rule out malignant neoplasms&#46; The two-step algorithm procedure was used considering&#44; as first step&#44; the absence of features typical of melanocytic lesion such as pigment network&#44; aggregated globules&#44; branched streaks&#44; homogeneous blue pigmentation or parallel pattern&#46; We then evaluated specific criteria for SK such as multiple milia-like cysts&#44; comedo-like openings&#44; fissures&#47;ridges&#44; hairpin vessels&#44; moth-eaten border&#44; opaque-brown pigmentation&#44; Mika-like structure&#44; yellowish color&#44; vascular structure&#44; sharp demarcation&#44; focal hemorrhage&#44; grape-like vessels&#44; coral-like structure&#44; globule-like structure and network-like structure&#46; Afterward&#44; we considered dermatoscopic global aspect recognizing eight different patterns &#40;see in results&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">All SK were examined by dermatologists&#44; who are co-authors with experience in dermoscopy&#46; Polarized dermoscopic images were obtained using a dermoscope &#40;DermLite 3Gen LLC&#44; Dana Point California&#41; at 10-fold magnification and documentation of dermoscopic findings was performed for every lesion using DermLite photo equipment &#40;3Gen LLC&#41; at 20-to 50-fold magnification&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">RESULTS</span><p id="par0025" class="elsevierStylePara elsevierViewall">72 atypical SK were excised between September 2014 and September 2017&#46; The differential diagnosis included&#58; melanoma in 48 patients &#40;66&#46;7&#37;&#41;&#44; squamous cell carcinoma in 15 cases &#40;20&#46;9&#37;&#41;&#44; Clark or traumatized nevus in 6 patients &#40;8&#46;3&#37;&#41; and basal cell carcinoma in 3 individuals &#40;4&#46;2&#37;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">About the location 23 SK &#40;32&#37;&#41; were located on the arms&#44; 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hairpin vessels in single unit in 6 &#40;8&#46;3&#37;&#41;&#44; clustered hairpin vessels &#40;also known as grape-like vessels&#41; in 0 &#40;0&#44;0&#37;&#41;&#44; demarcated scalloped borders &#40;also known as moth-eaten borders&#41; in 3 &#40;4&#46;2&#37;&#41;&#44; opaque-brown pigmentation in 6 &#40;8&#46;3&#37;&#41;&#44; hyperkeratotic structures &#40;also known as mika-like structures&#41; in 21 &#40;29&#46;1&#37;&#41;&#44; yellowish color in 6 &#40;8&#46;3&#37;&#41;&#44; vascular structure in 21 &#40;29&#46;1&#37;&#41;&#44; sharp demarcation in 36 &#40;50&#46;0&#37;&#41;&#44; focal hemorrhage in 6 &#40;8&#46;3&#37;&#41;&#44; thick pigmented lines in a coral geometry &#40;also known coral-like structure&#41; in 3 SK &#40;4&#46;2&#37;&#41;&#44; network-like structure in 30 &#40;41&#46;7&#37;&#41;&#44; globule-like structure in 3 &#40;4&#46;2&#37;&#41;&#46; Additional criteria not included in the two-step algorithm but found in our report were blue-whitish veil &#40;found in 3 SK&#44; 4&#46;2&#37;&#41;&#44; polymorphous vessels &#40;18 SK&#44; 25&#37;&#41;&#44; blotch&#47;globules &#40;6 SK&#44; 8&#46;3&#37;&#41; shiny white streaks &#40;3 lesions&#44; 4&#46;2&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">8 main patterns were described by our study group &#40;see <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#58; A&#41; Reticular pattern &#40;27 SK&#44; 37&#46;5&#37;&#41;&#58; pattern made by lines straight and arranged in such a manner that they intersect each other nearly at right angles at regular intervals to form a net-like structure&#46; In the reticulated type of SK&#44; thin tracts of basaloid tumor cells extend from the epidermis to the dermis forming a reticular architecture&#59; B&#41; Not specific pattern &#40;15 SK&#44; 20&#46;9&#37;&#41;&#58; pattern in which no particular dermoscopic structures are distinguishable&#46; C&#41; Vascular pattern &#40;9 SK&#44; 12&#46;5&#37;&#41;&#58; pattern made not by pigmented lines but by vessels&#59; D&#41; Multicomponent pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#58; lesions in which two or more patterns are discernable&#59; E&#41; Homogeneous blue-like pattern &#40;6 SK&#44; 8&#46;3&#37;&#41;&#58; blue color uniformly distributed or concentrated in some areas&#44; characterized pathologically&#44; by increased large&#44; dendritic&#44; melanin-rich melanocytes throughout the tumor with hyperkeratosis and papillomatosis of the epidermis&#59; F&#41; Bowenoid patterns &#40;3 SK&#44; 4&#46;2&#37;&#41;&#58; with glomerular vessels&#44; dotted vessels or a combination of both&#59;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">G&#41; Hyperkeratotic pattern &#40;6 SK&#44; 8&#46;3&#37;&#41;&#58; pattern formed mainly by scales &#40;Mica-like structure&#41; or by hyperkeratotic area&#44; usually central&#46; Hyperkeratosis and papillomatosis of the epidermis are pronounced in the hyperkeratotic type of SK&#59; H&#41; Lichenoid pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#58; with brownish-grey&#44; bluish-grey or whitish-grey coarse granules widespread throughout the lesion&#46; In some cases&#44; regression areas were also found&#46; Histopathologically characterized by a lichenoid reaction&#44; namely&#44; band-like infiltration of inflammatory cells in the upper dermis&#44; pigment incontinence and individual degenerated keratinocytes in the epidermis&#46; &#40;To see the complete correlation between dermatoscopic global aspect and histopathologic features see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">DISCUSSION</span><p id="par0050" class="elsevierStylePara elsevierViewall">Aim of our study was to evaluate the most represented dermoscopic feature&#40;s&#41;&#47;global dermoscopic pattern in a group of atypical SK in order to simplify diagnosis&#46; Sharp demarcation &#40;50&#46;0&#37;&#41; and network-like structure &#40;41&#46;7&#37;&#41; resulted to be the more prevalent dermoscopic features in our group of study &#40;see Tab&#46;1&#41;&#46; These results are in accordance with other studies on the matter&#46; In our opinion&#44; is too simplistic and risky hanging the challenging diagnosis of atypical SK on the sharp demarcation&#44; feature non-exclusive of benign lesions&#46; The same goes for the presence of network-like structure&#58; this feature couldn&#8217;t be a reliable finding considering that often is difficult to establish boundaries between network-like and a true network typical for melanocytic lesions&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our data are in accordance with previous studies emphasizing the dermoscopic-variability of SK&#46; On the entire group of SK&#44; 66&#46;7&#37; were excised to rule out a melanoma&#46; This is due to the fact that 57 of 72 lesions evaluated using a two-step algorithm showed dermoscopic criteria typical of melanocytic lesion&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Comparing our data with those from a prospective study by Lin&#44; respectively&#44; several differences are recognizable such as&#58; a&#41; comedo-like openings in 16&#46;6&#37; cases versus 39&#46;2&#37;&#59; b&#41; fissures&#47; ridge 12&#46;5&#37; versus 59&#46;8&#37;&#59; c&#41; network-like structure&#58; 41&#44;7&#37; versus 2&#46;0&#37;&#46; Such discrepancies are probably linked to our over-selected population in which typical SK were not excised&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Additional criteria founded in our study population were&#58; blue-whitish veil found in 3 SK &#40;4&#46;2&#37;&#41;&#44; polymorphous vessels in 18 SK &#40;25&#37;&#41;&#44; blotch&#47;globules in 6 SK &#40;8&#46;3&#41; and shiny white Streaks in 3 lesions &#40;4&#46;2&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Eight main global dermoscopic patterns were described&#58; the most represented was reticular pattern &#40;37&#46;5&#37;&#41;&#44; followed by not-specific pattern &#40;20&#46;8&#37;&#41;&#44; vascular pattern &#40;12&#46;5&#37;&#41;&#44; hyperkeratotic pattern &#40;8&#46;3&#37;&#41;&#44; Homogeneous blue-like pattern &#40;8&#46;3&#37;&#41;&#44; lichenoid pattern &#40;4&#46;2&#37;&#41;&#44; multicomponent pattern &#40;4&#46;2&#37;&#41; and bowenoid pattern &#40;4&#46;2&#37;&#41;&#46; These findings are in accordance with a previous paper written by Squillace et al&#46;&#44; &#40;2016&#41;&#58; in this retrospective study the authors defined 10 repetitive global dermatoscopic patterns comparable to ours except &#8220;keratoacanthoma-like pattern&#8221;&#44; &#8220;clonal pattern&#8221; and &#8220;spitzoid pattern&#8221;&#44; this latter described also by Minagawa&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> On the other side&#44; we described two patterns not described by previously mentioned authors&#44; namely &#8220;not specific pattern&#8221; &#40;20&#46;9&#37; of all lesion examined&#41; and &#8220;vascular pattern&#8221; &#40;12&#46;5&#37; of all lesion examined&#41;&#46; These two patterns are usually described in melanocytic lesions and therefore are not reliable for a definite diagnosis of SK&#44; suggesting a surgical excision&#46; Finally&#44; despite these findings&#44; no specific feature or global pattern&#44; statistically significant for dermoscopic diagnosis of challenging SK have been found&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">According to the two-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion&#44; SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking seborrheic keratoses&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a> This latter form&#44; in particular&#44; represents the maximum risk in the evaluation of a SK with a non-convincing aspect&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Concerning the location of 72 SK analyzed&#44; as said before&#44; 23 SK &#40;32&#37;&#41; were located on the arms&#44; 8 &#40;11&#44;1&#37;&#41; on the shoulders&#44; 14 &#40;19&#46;4&#37;&#41; on the face&#44; 11&#40;15&#46;2&#37;&#41; on abdomen&#44; 8 &#40;11&#44;1&#37;&#41; on the chest and 8 &#40;11&#44;1&#37;&#41; on legs&#46; No differences concerning location were detected between our data and analogous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> With the exception of the leg where the global patterns most represented were three &#40;specific&#44; vascular and reticular followed by hyperkeratotic and lichenoid&#41; all the other body areas have been characterized by the increased expression of the reticular pattern&#58; 35&#37; of the all lesions on the arms&#44; 50&#37; on the face&#44; 36&#46;3&#37; on the abdomen&#44; 37&#46;5&#37; on the shoulders&#44; 37&#46;5&#37; on the chest&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">CONCLUSION</span><p id="par0085" class="elsevierStylePara elsevierViewall">Considering the high prevalence of SKs in the general population&#44; dermatologists are regularly challenged with the diagnosis of this benign skin tumor&#46; Dermoscopy permits a rapid and dependable diagnosis in most cases&#46; Despite this&#44; in case of unclear dermoscopic features&#44; a biopsy remains mandatory for those cases that cannot be clearly distinguished from common skin malignancies&#46;</p></span></span>"
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            0 => "Dermoscopy"
            1 => "Seborrheic keratoses"
            2 => "Melanoma&#44; atypical"
            3 => "Seborrheic keratoses"
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            0 => "Dermatoscopia"
            1 => "Queratosis seborreica"
            2 => "Melanoma at&#237;pico"
            3 => "Queratosis seborreica"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Seborrheic keratoses &#40;SK&#41; are easily recognizable by clinical and dermoscopic approach&#44; nevertheless&#44; some lesions act as a simulator of different skin conditions lacking typical clinical and dermoscopic criteria&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of our study was to find specific dermoscopic features or a global pattern to improve diagnostic skills for challenging SK&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We examined 72 atypical SK excised from September 2014 up to September 2017 by using the 2-step algorithm modified by Malvehy &#40;2002&#41; and Argenziano &#40;2003&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our study population&#44; an average of 4&#46;04 out of 15 dermoscopic specific criteria for SK was found &#40;for example&#44; multiple milia-like cysts&#41;&#46; Additional criteria not included in 2-step algorithm were blue-whitish veil &#40;found in 3 SK&#59; 4&#46;2&#37;&#41;&#44; polymorphous vessels &#40;18 SK&#59; 25&#37;&#41;&#44; blotch&#47;globules &#40;6 SK&#59; 8&#46;3&#37;&#41;&#44; shiny white streaks &#40;3 lesions&#59; 4&#46;2&#37;&#41;&#46; The most represented global patterns were reticular &#40;27 SK&#59; 37&#46;5&#37;&#41; and not specific &#40;15 SK&#59; 20&#46;8&#37;&#41;&#46; All lesions exhibited peculiar findings of SK&#44; furthermore elements suggestive for melanocytic lesion were found in 79&#46;2&#37; of all lesions&#46; Comparing the literature and our results&#44; we found 3 significant differences&#58; a&#41; the less prevalence of SK specific criteria in our study population&#59; b&#41; the description of findings usually not related to SK&#44; among which blue-whitish veil&#44; polymorphous vessels&#44; blotch&#47;globules and shiny white streaks&#44; and c&#41; 2 patterns not previously defined represented by &#8220;not specific pattern&#8221; &#40;20&#46;9&#37; of all lesions examined&#41; and &#8220;vascular pattern&#8221; &#40;12&#46;5&#37; of all lesions examined&#41; were also described&#46; No specific feature or global pattern&#44; statistically significant for dermoscopic diagnosis of difficult-to-diagnose SK have been found&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nevertheless the useful findings&#44; no specific feature or global pattern statistically significant for dermoscopic diagnosis of challenging SK have been found&#46; According to the 2-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion&#44; SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking SK&#46;</p></span>"
        "secciones" => array:5 [
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            "titulo" => "Background"
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          2 => array:2 [
            "identificador" => "abst0015"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las queratosis seborreicas &#40;QS&#41; son reconocidas con facilidad a trav&#233;s de una aproximaci&#243;n cl&#237;nica y dermatosc&#243;pica&#44; sin embargo&#44; algunas lesiones presentan un comportamiento que simula distintas afecciones de la piel que carecen de criterios cl&#237;nicos y dermatosc&#243;picos t&#237;picos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue encontrar caracter&#237;sticas dermatosc&#243;picas espec&#237;ficas o un patr&#243;n general que permita mejorar las habilidades diagn&#243;sticas en los casos de QS complejas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudiamos 72 casos de QS at&#237;picas extirpadas entre septiembre del 2014 y septiembre del 2017 utilizando para ello el algoritmo en 2 pasos modificado por Malvehy &#40;2002&#41; y Argenziano &#40;2003&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En nuestra poblaci&#243;n de estudio&#44; encontramos una media de 4&#44;04 de los 15 criterios espec&#237;ficos dermatosc&#243;picos de QS &#40;por ejemplo&#44; m&#250;ltiples puntos similares a quistes tipo <span class="elsevierStyleItalic">milium</span>&#41;&#46; Se identificaron los siguientes criterios adicionales no incluidos en el algoritmo en 2 pasos&#58; velo azul-blanquecino &#40;en 3 QS&#59; 4&#44;2&#37;&#41;&#44; patr&#243;n vascular polimorfo &#40;18 QS&#59; 25&#37;&#41;&#44; manchas&#47;gl&#243;bulos &#40;6 QS&#59; 8&#44;3&#37;&#41;&#44; manchas blancas brillantes &#40;3 lesiones&#59; 4&#44;2&#37;&#41;&#46; Los patrones generales m&#225;s representados fueron el patr&#243;n reticular &#40;27 QS&#59; 37&#44;5&#37;&#41; y no espec&#237;fico &#40;15 QS&#59; 20&#44;8&#37;&#41;&#46; Todas las lesiones exhibieron hallazgos peculiares de QS&#59; adem&#225;s&#44; en el 79&#44;2&#37; de todas las lesiones estudiadas se identificaron elementos indicativos de lesi&#243;n melanoc&#237;tica&#46; Cuando comparamos la literatura con nuestros resultados&#44; encontramos 3 diferencias significativas&#58; a&#41; una menor prevalencia de los criterios espec&#237;ficos de QS en nuestra poblaci&#243;n de estudio&#59; b&#41; la identificaci&#243;n de hallazgos generalmente no relacionados con la QS&#44; como el velo azul-blanquecino&#44; el patr&#243;n vascular polimorfo&#44; las manchas&#47;gl&#243;bulos y las manchas blancas brillantes&#44; y c&#41; tambi&#233;n se describieron 2 patrones no definidos previamente representados por &#171;patr&#243;n no espec&#237;fico&#187; &#40;20&#44;9&#37; de todas las lesiones examinadas&#41; y &#171;patr&#243;n vascular&#187; &#40;12&#44;5&#37; de todas las lesiones examinadas&#41;&#46; No se encontr&#243; ninguna caracter&#237;stica espec&#237;fica o patr&#243;n general estad&#237;sticamente significativo para el diagn&#243;stico dermatosc&#243;pico de QS de diagn&#243;stico dif&#237;cil&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A pesar de los hallazgos&#44; no hemos encontrado ning&#250;n patr&#243;n espec&#237;fico o general estad&#237;sticamente significativo para el diagn&#243;stico dermatosc&#243;pico de la QS de diagn&#243;stico dif&#237;cil&#46; Conforme al algoritmo en 2 pasos y el sistema de puntuaci&#243;n dermatosc&#243;pica para lesiones melanoc&#237;ticas y no melanoc&#237;ticas&#44; las QS con uno o varios hallazgos dermatosc&#243;picos t&#237;picos de lesi&#243;n melanoc&#237;tica deber&#237;an ser extirpados quir&#250;rgicamente para excluir el melanoma cl&#225;sico o el melanoma que simula una QS&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mazzeo M&#44; Manfreda V&#44; Diluvio L&#44; Dattola A&#44; Bianchi L&#44; Campione E&#46; An&#225;lisis dermatosc&#243;pico de 72 queratosis seborreicas &#171;at&#237;picas&#187;&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;366&#8211;371&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Composit of 8 main patterns described by our study&#58; A&#46; Reticular pattern &#40;27 SK&#44; 37&#46;5&#37;&#41;&#59; B&#46; Not specific pattern &#40;15 SK&#44; 20&#46;9&#37;&#41;&#58; C&#46; Vascular pattern &#40;9 SK&#44; 12&#46;5&#37;&#41;&#59; D&#46; Multicomponent pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#59; E&#46; Homogeneous blue-like pattern &#40;6 SK&#44; 8&#46;3&#37;&#41;&#59; F&#46; Bowenoid patterns &#40;3 SK&#44; 4&#46;2&#37;&#41;&#59; G&#46; Hyperkeratotic pattern &#40;6 SK&#44; 8&#46;3&#37;&#41; and F&#58; Lichenoid pattern &#40;3 SK&#44; 4&#46;2&#37;&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Melanocytic features&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; In which the characteristic was observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non melanocytic features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; In which the characteristic was observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pigment network&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milia-like cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aggregated globules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comedo-like openings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branched streaks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fissures&#47;ridges&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Homogeneous blue pigmentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hairpin vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parallel pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clustered hairpin vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blue-whitish veil &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Demarcated scalloped borders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polymorphous vessels &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opaque-brown pigmentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blotch&#47;globules &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperkeratotic structures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shiny white streaks &#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yellowish colour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular structure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sharp demarcation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal hemorrhage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thick pigmented lines in a coral geometry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Network like structure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Globule like structure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049327.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">List of melanocytic and the non-melanocytic features with percentage of presentation in our population study&#46; The asterisks mark additional criteria not included in the two-step algorithm but found in our report&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Histopathological correlation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reticular pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by thin tracts of basaloid tumor cells extending from the epidermis to the dermis forming a reticular architecture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specific pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by tracts of basaloid tumor cells extending from the epidermis to the dermis forming a reticular architecture&#46; Whorls of maturing squamous epithelium &#40;squamous eddies&#41; were detectable in one-third of all the seborrheic keratoses with no specific pattern&#46; Two lesions showing this pattern exhibited irregular squamous nests and cords of cells extending into a desmoplastic stroma &#40;the desmoplastic variant of seborrheic keratosis&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by acanthosis with increased vascular component&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Homogeneous blue like pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by increased large&#44; dendritic&#44; melanin-rich melanocytes throughout the tumor with hyperkeratosis and papillomatosis of the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bowenoid pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by acanthosis with dilated vessels and by grouped melanophages only observable in the papillary dermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperkeratotic pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by hyperkeratosis and papillomatosis of the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lichenoid pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by lichenoid reaction&#44; namely&#44; band-like infiltration of inflammatory cells in the upper dermis&#44; pigment incontinence and individual degenerated keratinocytes in the epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multicomponent pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathologically this pattern is characterized by a combination of two or more of the previous features see above&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Summary table concerning the correlation between our dermatoscopic findings and histopathologic features&#46;</p>"
        ]
      ]
    ]
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