title: Melanoma mimicking seborrheic keratosis: an error of perception precluding correct dermoscopic diagnosis.
abstract: Seborrheic keratosis is a common skin lesion that can usually be recognized either clinically or dermoscopically. However, melanomas mimicking seborrheic keratoses, as well as melanomas arising in association with seborrheic keratoses, have been described. We report the case of a patient with a lesion that initially revealed "classic" dermoscopic features of a seborrheic keratosis. However, during follow-up, changes in color developed within the center of the lesion that led the clinician to the correct diagnosis of melanoma. Upon retrospective evaluation of the baseline image of the lesion; the clinician was now able to "see" that which his brain could not appreciate on initial examination and to realize that the lesion had subtle features suspect for melanoma. This case represents a diagnostic pitfall due to errors in perception. Dermatologists should be cognizant of "errors in perception"; we suggest that a final dermoscopic judgment of a seborrheic keratosis be rendered by combining the gestalt diagnosis of the overall pattern, with deliberate dermoscopic analysis of all quadrants of the lesion.
authors.affiliation: Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
authors.forename: Juliana Casagrande Tavoloni
authors.initials: JC
authors.lastname: Braga
authors.forename: Alon
authors.initials: A
authors.lastname: Scope
authors.forename: Itay
authors.initials: I
authors.lastname: Klaz
authors.forename: Patricia
authors.initials: P
authors.lastname: Mecca
authors.forename: Philip
authors.initials: P
authors.lastname: Spencer
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
mesh_terms: D000368:Aged; D046169:Dermoscopy; D003951:Diagnostic Errors; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D017492:Keratosis, Seborrheic / Q000175:diagnosis*; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D010465:Perception; D012878:Skin Neoplasms / Q000175:diagnosis*