Dermoscopic Features of Early Facial Seborrheic Keratosis and Verruca Plana: A Retrospective Cross-Sectional Study

Objective: To compare the patient-level dermoscopic feature of early facial seborrheic keratosis (SK) and verruca plana (VP) and to identify patterns that may assist their differentiation. Methods: This retrospective cross-sectional study included 118 patients with early facial SK (280 lesions) and 61 patients with facial VP (252 lesions) evaluated between December 2021 and May 2025.A patient was classified as positive for a dermoscopic feature if it was present in at least one evaluated lesion. Between-group comparisons were performed using two-sided Fisher’s exact tests, with Benjamini-Hochberg false discovery rate adjustment for 16 comparisons. Results: The most frequent dermoscopic features in the SK group were moth-eaten borders (66.9%), light brown pigmentation (58.5%), fingerprint-like structures (41.5%), and a homogeneous pseudo-network (39.8%). In the VP group, dotted vessels (95.1%), a pinkish background (91.8%) predominated, followed by a skin-colored to light brown background (49.2%), a dermatoglyphic pattern (44.3%), grayish-white structureless zones (42.6%), and pale yellow structureless areas (32.8%). After false discovery rate adjustment, all evaluated features differed significantly between groups except hairpin vessels (adjusted P=0.052; all other adjusted P< 0.01) Conclusion: Early facial SK and VP showed distinct patient-level dermoscopic profiles in this cohort. Combined assessment of border, pigment, vascular, and background features may aid differentiation when interpreted with clinical findings. Our research has demonstrated that dermoscopy is a valuable tool differentiating these two entities, which can be particularly challenging to distinguish by clinical manifestation alone in their initial stages.