A seborrheic keratosis is a non-cancerous (

benign Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...

) skin tumour that originates from cells, namely

keratinocytes Keratinocytes are the primary type of cell found in the epidermis, the outermost layer of the skin. In humans, they constitute 90% of epidermal skin cells. Basal cells in the basal layer (''stratum basale'') of the skin are sometimes refer ...

, in the outer layer of the skin called the

epidermis The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and Subcutaneous tissue, hypodermis. The epidermal layer provides a barrier to infection from environmental pathogens and regulates the ...

. Like

liver spot Liver spots (also known as age spot, solar lentigo, "lentigo senilis", "old age spot", "senile freckle") are wikt:blemish, blemishes on the skin associated with aging and exposure to ultraviolet, ultraviolet radiation from the sun. They range in c ...

s, seborrheic keratoses are seen more often as people age. The tumours (also called

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by injury or diseases. The term ''Lesion'' is derived from the Latin meaning "injury". Lesions may occur in both plants and animals. Types There is no de ...

s) appear in various colours, from light tan to black. They are round or oval, feel flat or slightly elevated, like the scab from a healing wound, and range in size from very small to more than across. They are often associated with other skin conditions, including

basal cell carcinoma Basal-cell carcinoma (BCC), also known as basal-cell cancer, basalioma, or rodent ulcer, is the most common type of skin cancer. It often appears as a painless, raised area of skin, which may be shiny with Telangiectasia, small blood vessels ru ...

. Sometimes, seborrheic keratosis and basal cell carcinoma occur at the same location. At clinical examination, a

differential diagnosis In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...

considers

wart Warts are non-cancerous viral growths usually occurring on the hands and feet but which can also affect other locations, such as the genitals or face. One or many warts may appear. They are distinguished from cancerous tumors as they are caus ...

s and

melanoma Melanoma is the most dangerous type of skin cancer; it develops from the melanin-producing cells known as melanocytes. It typically occurs in the skin, but may rarely occur in the mouth, intestines, or eye (uveal melanoma). In very rare case ...

s. Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a "pasted-on" appearance. Some dermatologists refer to seborrheic keratoses as "seborrheic warts", because they resemble warts, but strictly speaking, the term "warts" refers to lesions that are caused by the

human papillomavirus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...

Cause

The cause of seborrheic keratosis is not known. The only definitive association is that its

prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...

increases with age.

Diagnosis

Visual diagnosis is made by the "stuck on" appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be challenging to distinguish from nodular melanomas. Furthermore, thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with

dermatoscopy Dermatoscopy, also known as dermoscopy or epiluminescence microscopy, is the examination of skin lesions with a dermatoscope. It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The ...

. Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and

s can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful to differentiate them. On the penis and genital skin, condylomas and seborrheic keratoses can be difficult to differentiate, even on biopsy. A study examining over 4,000 biopsied skin lesions identified clinically as seborrheic keratoses showed 3.1% were malignancies. Two-thirds of those were

squamous cell carcinoma Squamous-cell carcinoma (SCC), also known as epidermoid carcinoma, comprises a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

. To date, the

gold standard A gold standard is a backed currency, monetary system in which the standard economics, economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the ...

in the diagnosis of seborrheic keratosis is represented by the histolopathologic analysis of a

skin biopsy Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 day ...

Subtypes

Seborrheic keratoses may be divided into the following types:

Differential diagnoses

Dermatosis papulosa nigra Dermatosis papulosa nigra (DPN) is a condition of many small, benign skin lesions on the face, a condition generally presenting on dark-skinned individuals. DPN is extremely common, affecting up to 30% of Black people in the US.Grimes PE, Arora S, ...

(DPN) is a condition of many small, benign

skin lesion A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...

s on the face, a condition generally presenting on darker-skinned individuals. DPN is extremely common, affecting up to 30% of black people in the United States.

Treatment

Medical reasons for removing seborrheic keratoses include irritation and bleeding. They may also be removed for cosmetic reasons. Generally, lesions can be treated with

electrodesiccation and curettage Electrodesiccation and curettage (EDC, ED & C, or ED+C) is a medical procedure commonly performed by dermatologists, surgeons and general practitioners for the treatment of basal cell cancers and squamous cell cancers of the skin. It provides de ...

, or

cryosurgery Cryosurgery (with ''cryo'' from the Ancient Greek ) is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. Cryosurgery has been historically used to treat a number o ...

. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring.

Epidemiology

Seborrheic keratosis is the most common benign skin tumor. Incidence increases with age. There is less prevalence in people with darker skin. In large-cohort studies, all patients aged 50 and older had at least one seborrheic keratosis. Onset is usually in middle age, although they are common in younger patients too, as they are found in 12% of 15-year-olds to 25-year-olds, which makes the term "senile keratosis" a misnomer.

Notes

References

External links

{{DEFAULTSORT:Seborrheic Keratosis Epidermal nevi, neoplasms, and cysts Dermal and subcutaneous growths