Hyperplasia
Seborrheic Keratosis
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Seborrheic Keratosis
, Seborrheic Keratoses, Stucco Keratoses, Leser-Trelat Sign
Epidemiology
Most common benign epithelial tumor
Occurs in patients over age 30 years old
Number of lesions increase with age
Men and women affected equally
Autosomal Dominant
inheritance
Pathophysiology
Common benign, hereditary tumor
Hyperkeratotic epidermal lesion
Signs
Characteristics
Early (Flat lesions)
Small (<3mm)
Slightly elevated
Variable hyperpigmented coloration
Late (Raised pigmented lesions)
Large
Plaque
(1 to 6 cm)
May feel greasy, velvety or warty
Keratotic (warty) appearance
Appears "stuck-on" like clay
Rough surface
Yellow, tan, brown or black pigmentation
Sharp well-circumscribed border
Distribution (typically multiple are present)
Trunk (most common location)
Face
Scalp
Upper extremities
Associated lesions
Horn cysts
Milia
-like cysts
Variants
Stucco Keratoses
Numerous small white, dry scaly lesions on extremity
Dermatosis Papulosa
Small, dark
Papule
s on face seen in darker skin
Leser-Trelat Sign (paraneoplastic sign)
Sudden onset and increase in number of keratoses
Requires thorough evaluation for malignancy
Seborrheic Keratoses often resolve with malignancy treatment and reappear with cancer recurrence
Associated with underlying adenocarcinoma
Stomach Cancer
Colon Cancer
Breast Cancer
Differential Diagnosis
Early Seborrheic Keratosis (Flat)
Solar Lentigo
Spreading pigmented
Actinic Keratosis
Malignant
Melanoma
Late Seborrheic Keratosis (Raised pigmented)
Pigmented
Basal Cell Carcinoma
Malignant
Melanoma
Management
Indications for excision
Cosmesis
Local irritation due to recurrent
Trauma
Malignancy suspected (
Excisional Biopsy
needed)
Techniques
Curettage with light Electrocautery
Inject
Local Anesthesia
first
Lesion easily rubs off
Lightly cauterize base to prevent recurrence
Cryotherapy
with
Liquid Nitrogen
May not be effective in very thick lesions
Excision
Shave Excision
Excisional Biopsy
(if possible
Melanoma
)
Topical Corticosteroid
s
Indicated for irritated Seborrheic Keratoses
References
Fitzpatrick (1999) Color Atlas Dermatology
Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
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