seborrheic keratosis
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Epidemiology
- very common hereditary skin neoplasm
- generally appear after age 30 with continued occurrence over a lifetime.
- slightly more common with more extensive involvement in males
Pathology
- proliferation of keratinocytes & melanocytes
- formation of horn cysts
- atypia of keratinocytes may occur (these lesions should be excised)
Genetics
- autosomal dominant
- overexpression of kallikrein-8
Clinical manifestations
- lesion starts as a macule, light tan with gradual increase in pigmentation
- lesions evolve into waxy, verrucous papules & plaques with multiple plugged follicles, varying in color from light tan to black
- 'stuck on' appearance[3]
- 1 to 6 cm in size
- appearance after age 30
- extent varies from a few scattered lesions to thousands in the elderly
- predilection of lesions for face, trunk & upper extremities
- can be found anywhere on the body except palms, soles & mucous membranes[3]
- lesions are rarely pruritic, but may occasionally itch or bleed[3]
- may become tender if secondarily infected
- rapid development of many prurutic seborrheic keratosis is the sign of Leser-Trelat associated with malignancy (GI adenocarcinoma)[3]
Diagnostic procedures
- dermoscopy may be helpful
- biopsy generally not necessary but may be needed if diagnosis is in question[3]
Differential diagnosis
- solar lentigo (macular, sun-exposed skin, extremities, rarely on trunk)
- actinic keratosis
- basal cell carcinoma
- malignant melanoma
- dysplastic melanocytic nevus
- verruca vulgaris
Management
- observation
- electrocautery
- facilitates the lesion to be rubbed off
- light cauterization of base prevents recurrence
- cryotherapy with liquid nitrogen
- recurrences are more frequent than with electrocautery
- curettage after cryotherapy
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 318-319
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 166
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 Seborrheic keratoses (image) American Academy of Dermatology https://www.aad.org/public/diseases/bumps-and-growths/seborrheic-keratoses
- ↑ 5.0 5.1 Balin AK, James WD (images) Medscape: Seborrheic Keratosis http://emedicine.medscape.com/article/1059477-overview
- ↑ 6.0 6.1 DermNet NZ. Seborrhoeic keratoses (images) http://www.dermnetnz.org/lesions/seborrhoeic-keratosis.html
- ↑ Noiles K, Vender R. Are all seborrheic keratoses benign? Review of the typical lesion and its variants. J Cutan Med Surg. 2008 Sep-Oct;12(5):203-10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18845088
- ↑ Ranasinghe GC, Friedman AJ. Managing seborrheic keratoses: evolving strategies for optimizing patient outcomes. J Drugs Dermatol. 2017;16:1064-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29141054
- ↑ Moscarella E, Brancaccio G, Briatico G, et al. Differential diagnosis and management on seborrheic keratosis in elderly patients. Clin Cosmet Investig Dermatol. 2021;14:395-406. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33953590