Tesis

Uji Diagnostik Dermoskopi Pada Pasien Fibroma Mole dan Keratosis Seboroik Bertangkai = Accuracy of Dermoscopy in Diagnosing Acrochordons and Pedunculated Seborrheic Keratoses.

Latar belakang: Fibroma mole (FM) dan keratosis seboroik (KS) bertangkai sering sulit dibedakan secara klinis, namun etiopatogenesis dan implikasi medisnya berbeda. Konfirmasi diagnosis dengan pemeriksaan histopatologi untuk membedakan FM dan KS bertangkai dianggap tidak cost-effective dan invasif sehingga kurang disukai pasien. Dermoskopi merupakan alat bantu diagnosis yang dikatakan mampu meningkatkan akurasi diagnosis klinis pada berbagai lesi tumor jinak. Namun, hingga saat ini belum ada konsensus struktur dermoskopi FM dan belum ada penelitian sebelumnya yang membandingkan gambaran dermoskopi pada FM dan KS bertangkai. Tujuan: Untuk mengetahui nilai diagnostik dermoskopi sebagai alat bantu diagnosis FM dan KS bertangkai dibandingkan dengan pemeriksaan histopatologi. Metode: Penelitian ini merupakan uji diagnostik potong lintang. Sampel merupakan papul bertangkai yang diduga fibroma mole dan keratosis seboroik. Seluruh subjek penelitian telah menjalani anamnesis, pemeriksaan fisik, dermoskopi, dan histopatologi. Analisis statistik uji diagnostik dilakukan dengan menentukan nilai sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, positive likelihood ratio, negative likelihood ratio, dan akurasi. Hasil: Terdapat 28 subjek penelitian dengan total 86 lesi (64 lesi FM dan 22 lesi KS bertangkai) yang diikutsertakan dalam penelitian ini. Dermoskopi memiliki nilai diagnostik yang tinggi dalam mendiagnosis fibroma mole (sensitivitas 100%, spesifisitas 76,9%, akurasi 93,0%) dan keratosis seboroik bertangkai (sensitivitas 86,9%, spesifisitas 100%, akurasi 96,5%). Perbedaan gambaran dermoskopi antara FM dan KS bertangkai yaitu pada FM ditemukan gambaran irregular epidermal projections dan telangiectasia, sedangkan pada KS bertangkai ditemukan fissures and ridges, comedo-like opening, cerebriform dan scales. Kesimpulan: Dermoskopi merupakan alat penapis non-invasif yang baik bila pemeriksaan histopatologi pada FM dan KS bertangkai sulit untuk dilakukan. Pemeriksaan dermoskopi dapat membantu membedakan diagnosis FM dan KS bertangkai sehingga dapat dilakukan tata laksana yang lebih paripurna pada pasien.
Kata kunci: fibroma mole , keratosis seboroik bertangkai, dermoskopi, histopatologi


Background: Acrochordon and pedunculated seborrheic keratosis (PSK) are often difficult to distinguish upon clinical examination despite their etiopathogenesis and medical implication being different. Diagnostic confirmation using histopathology is usually not preferred as it is invasive and not cost-effective. Dermoscopy is a diagnostic tool that can help to increase diagnosis accuracy in benign tumors. However, to date, there has been no consensus on dermoscopic structures for acrochordons and no data on accuracy of dermoscopy on acrochordons and PSK. Objective: Assessing the diagnostic value of dermoscopy as a diagnostic tool for acrochordon and PSK in comparison to histopathology. Methods: This is a cross-sectional diagnostic study. The subjects were lesions that were clinically diagnosed as acrochordon and PSK. Each subject underwent anamnesis, clinical, dermoscopy, and histopathology examinations. Diagnostic test analysis was then performed on the results of these examinations. Results: There were 28 patients with a total of 86 lesions (64 acrochordons and 22 PSK). The diagnostic values of dermoscopy in diagnosing acrochordon had sensitivity 100%, specificity 76,9%, accuracy 93.0%, whereas in PSK had sensitivity 86,9%, specificity 100%, and accuracy 96,5%. The differences of dermoscopic structures found between these two were irregular epidermal projections and telangiectasia that were found on acrochordons, whereas fissures and ridges, comedo-like opening, cerebriform and scales were found on PSK. Conclusion: Dermoscopy is a good screening tool for diagnosing acrochordons and PSK despite histopathology remaining to be the gold standard. Dermoscopy examination can help to differentiate acrochordons and PSK, thus allowing patients to be further treated accordingly.
Keyword: acrochordons, pedunculated seborrheic keratosis, dermoscopy, histopathology