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Seborrhoeic Keratosis — SCE Dermatology MCQ

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HardSkin CancerSeborrhoeic KeratosisSCE Dermatology

A 55-year-old man has multiple seborrhoeic keratoses on his trunk. One lesion on his back has recently become darker and more irregular. Dermoscopy shows comedo-like openings, milia-like cysts, and a gyrated/brain-like pattern. What dermoscopic feature would be most concerning for melanoma rather than seborrhoeic keratosis?

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Correct answer: B — Blue-white veil or irregular pigment network

The best answer is “Blue-white veil or irregular pigment network”. NICE bases melanoma diagnosis, excision margins and nodal assessment on complete histology, Breslow thickness, ulceration and clinical stage, with specialist review of suspicious or changing lesions. The alternatives “Comedo-like openings (crypts), after specialist assessment”, “Fat fingers (fissures and ridges)”, “Fingerprint-like structures, within an appropriate UK pathway”, “Milia-like cysts, after clinicopathological correlation” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE NG14 melanoma recommendations: https://www.nice.org.uk/guidance/ng14/chapter/Recommendations