Clinical and dermoscopic features associated with lichen planus-like keratoses that undergo skin biopsy: A single-center, observational study

Abstract

Background/objectives: Lichen planus-like keratoses (LPLK) are benign skin lesions that can mimic malignancy; the clinical and dermoscopic features distinguishing lichen planus-like keratoses from skin tumors have not been extensively studied. The objective of this study was to identify dermoscopic features that may prevent unnecessary biopsies of lichen planus-like keratoses.

Methods: Retrospective, single-center, observational study of biopsied skin lesions at a tertiary center. We compared 355 lichen planus-like keratoses to 118 non-lichen planus-like keratoses lesions with lichen planus-like keratosis in the differential diagnosis biopsied from August 1, 2015, to December 31, 2016. The investigators were blinded to the diagnosis of the lesions.

Results: Lichen planus-like keratoses were most frequently non-pigmented (61.7%), truncal (52.1%), and on sun-damaged skin (69.6%); the majority occurred in Whites (95.5%) and females (62.8%). Dermoscopically, lichen planus-like keratoses were more likely than non-lichen planus-like keratoses to have scale (42.5% vs 31.4%, P = 0.03) and orange colour (8.2% vs 0.9%, P = 0.01). Among lesions with peppering (n = 76; 63 lichen planus-like keratoses and 13 non-lichen planus-like keratoses), coarse ± fine peppering (73% vs 38.5%, P = 0.02) and peppering as the only feature (34.9% vs 0%, P = 0.01) were associated with lichen planus-like keratoses.

Conclusions: Lichen planus-like keratoses can be challenging to distinguish from benign and malignant skin tumors. The presence of dermoscopic scale and orange colour may aid in the recognition of lichen planus-like keratosis. Coarse peppering and the presence of peppering as the only dermoscopic feature may further aid the identification of pigmented lichen planus-like keratoses.

Keywords: BLK; LPLK; benign lichenoid keratosis; dermoscopy; lichen planus-like keratosis; lichenoid keratosis.

Figure 1.

Methodology and data classification.

Figure 2.. Lichen planus-like keratosis.

Representative dermoscopic images of non-pigmented LPLKs (A-B) that demonstrate scale and orange color and pigmented lichen planus-like keratosis (C-D) that show coarse peppering and peppering as the only dermoscopic feature.

Figure 3.. Lichen planus-like keratosis and mimickers.

Non-pigmented LPLK (A) and basal cell carcinoma (B) with a similar dermoscopic appearance. Pigmented LPLK (C) and melanoma (D) with a similar dermoscopic appearance.