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Dr Ackerman is right in that there was somehow an error in the comparison. However, my main point still stands that dermatologists seek pathologic confirmation in most instances because of difficult problems in clinical differentiation.Porokeratosis would rarely be confused with inflammatory linear verrucous epidermal nevus, and, in most instances, seborrheic keratosis would rarely be confused with that of eccrine poroma. Therefore, the biopsy arriving at the pathologist's desk would rarely consider both in the differential, even though they might appear similar histologically. It is in those rare instances where the clinical appearance and the histologicappearance are similar, that the skills of one such as Dr Ackerman are really needed, since the slides are often sent to him for a second opinion!
Millikan LE. Differential Diagnosis in Dermatopathology-Reply. JAMA. 1983;249(7):882. doi:10.1001/jama.1983.03330310018009
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