Updated: 12/14/2019

Seborrheic Keratosis

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Snapshot
  • A 66-year-old man comes to his primary care physician concerned about melanoma. He notes that over the past several years, several greasy moles have cropped up on his back. His cousin had died of melanoma and he is scared that these moles are melanomas. On exam, the moles appeared flat, greasy, and dark with a “stuck on” appearance. He is reassured that these are not melanomas and do not have malignancy potential.
Introduction
  • Common, benign persistent epidermal proliferations with variable appearances
  • Can mimic malignancies, especially melanoma
  • Genetics
    • can be inherited
  • Epidemiology
    • rare before 30-years-old
    • one of the most common benign growths
  • Associated conditions
    • underlying GI or lymphyoid malignancies
      • Leser-Trélat sign: sudden appearance of multiple seborrheic keratoses may indicate underlying malignancy
    • NOT related to actinic keratosis or seborrheic dermatitis (despite the similarity in name)
Presentation
  • Symptoms
    • asymptomatic
    • patients can often scratch off a lesion
  • Physical exam
    • usually multiple lesions
    • typically at any site except lips, palms, soles
      • common on trunk, face, extremities
    • variable appearance  
      • flat or raised
      • smooth, velvety, or verrucous
      • color ranges from white, pink, brown, or black
      • even within a single lesion, color may vary
    • “stuck on” waxy, greasy appearance
    • inflammed seborrheic keratoses may have edema, erythema, hemorrhage
Evaluation
  • If clinically mimicking skin cancer (e.g., with very dark pigmentation suspicious of melanoma)
    • skin biopsy
Differential
  • Melanoma
    • can be mistaken for melanoma
  • Visceral malignancy
    • Leser–Trélat sign (sudden onset of multiple seborrheic keratosis) could suggesting underlying malignancy 
Treatment
  • Typically not treated unless for cosmetic reasons
    • for flat lesions, liquid nitrogen (cryotherapy)
    • for raised lesions, curettage
Prognosis, Prevention, and Complications
  • Prognosis
    • persistent, grows slowly
    • no risk for progression to malignancies
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