Seborrheic Keratosis

Aka: Seborrheic Keratosis, Seborrheic Keratoses, Stucco Keratoses, Leser-Trelat Sign, Dermatosis Papulosa Nigra

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II. Epidemiology

  1. Most common benign epithelial tumor
  2. More common in patients over age 30 years old
  3. Number of lesions increase with age
  4. Men and women affected equally
  5. Autosomal Dominant inheritance

III. Pathophysiology

  1. Common benign, hereditary tumor composed of Keratinocytes
  2. Hyperkeratotic epidermal lesion

IV. Symptoms

  1. Typically asymptomatic
  2. Pruritus may occur

V. Signs

  1. Characteristics
    1. Early (Flat lesions)
      1. Small (<3mm)
      2. Slightly elevated
      3. Variable hyperpigmented coloration
    2. Late (Raised pigmented lesions)
      1. Large Plaque (1 to 6 cm)
      2. May feel greasy, velvety or warty
      3. Keratotic (warty) appearance
        1. Appears "stuck-on" like clay
        2. Rough surface
      4. Yellow, tan, brown or black pigmentation
      5. Sharp well-circumscribed border
  2. Distribution (typically multiple are present)
    1. Trunk (esp. back, most common location)
    2. Face
    3. Scalp
    4. Upper extremities
  3. Associated lesions
    1. See variants below
    2. Horn cysts
    3. Milia-like cysts
  4. Additional exam measures
    1. Dermoscopy may be useful in differentiating Seborrheic Keratoses from Melanoma

VI. Findings: Variants

  1. Stucco Keratoses
    1. Numerous small white, dry scaly lesions on extremity
  2. Dermatosis Papulosa Nigra
    1. Small, dark Papules seen in darker skin
    2. Photodistribution of lesions (face, head, neck)
  3. Leser-Trelat Sign (paraneoplastic sign)
    1. Sudden onset and increase in number of Seborrheic Keratoses
    2. Requires thorough evaluation for malignancy
    3. Seborrheic Keratoses often resolve with malignancy treatment and reappear with cancer recurrence
    4. Associated with underlying adenocarcinoma
      1. Stomach Cancer
      2. Colon Cancer
      3. Breast Cancer

VII. Differential Diagnosis

  1. Early Seborrheic Keratosis (Flat)
    1. Solar Lentigo
    2. Spreading pigmented Actinic Keratosis
    3. Malignant Melanoma
  2. Late Seborrheic Keratosis (Raised pigmented)
    1. Pigmented Basal Cell Carcinoma
    2. Malignant Melanoma

VIII. Management

  1. Indications for excision
    1. Cosmesis
    2. Local irritation due to recurrent Trauma
    3. Malignancy suspected (Excisional Biopsy needed)
  2. Techniques
    1. Curettage with light Electrocautery
      1. Inject Local Anesthesia first
      2. Lesion easily rubs off
      3. Lightly cauterize base to prevent recurrence
    2. Cryotherapy with Liquid Nitrogen
      1. May not be effective in very thick lesions
      2. Risk of Hypopigmentation (esp. in darker skin)
    3. Excision
      1. Shave Excision
      2. Excisional Biopsy (if possible Melanoma)
    4. Topical Corticosteroids
      1. Indicated for irritated Seborrheic Keratoses

IX. References

  1. Fitzpatrick (1999) Color Atlas Dermatology
  2. Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
  3. Wagner (2024) Am Fam Physician 110(4): 353-61 [PubMed]

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Related Studies

Ontology: Dermatosis Papulosa Nigra (C0011645)

Definition (NCI) A benign skin condition commonly seen in dark-skinned individuals that is characterized by multiple small hyperpigmented papular lesions resembling seborrheic keratosis on the face and upper body.
Concepts Neoplastic Process (T191)
MSH C562379
ICD10 L82
SnomedCT 103672009, 254669003, 25499005
Dutch dermatosis papulosa nigra, dermatose; papulosa nigra, papulosa nigra; dermatose
French Dermatose papuleuse noire
German Dermatosis papulosa nigra
Italian Dermatosi papulosa nigra
Portuguese Dermatose papulosa negra
Spanish Dermatosis papulosa negra, dermatosis papulosa negra (anomalía morfológica), dermatosis papulosa negra, dermatosis papulosa nigra (trastorno), dermatosis papulosa nigra
Japanese 黒色丘疹性皮膚症, ｺｸｼｮｸｷｭｳｼﾝｾｲﾋﾌｼｮｳ
English DERMATOSIS PAPULOSA NIGRA, dermatosis papulosa nigra (diagnosis), Dermatosis Papulosa Nigra, Dermatosis papulosa nigra, Dermatosis papulosa nigra (disorder), Dermatosis papulosa nigra (morphologic abnormality), dermatosis papulosa nigra, dermatosis; papulosa nigra, papulosa nigra; dermatosis
Czech Dermatosis papulosa nigra
Hungarian Dermatosis papulosa nigra
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Seborrheic keratosis (C0022603)

Definition (NCI) A common benign skin neoplasm usually affecting older individuals. The lesions usually are multiple and arise in the face, chest, and shoulders. They appear as black or brown, slightly elevated skin lesions.
Definition (MSH) Benign eccrine poromas that present as multiple oval, brown-to-black plaques, located mostly on the chest and back. The age of onset is usually in the fourth or fifth decade.
Concepts Disease or Syndrome (T047)
MSH D017492
ICD9 702.1
ICD10 L82 , L82.1
SnomedCT 394726009, 201107006, 201096007, 267860005, 156400006, 398838000, 25499005, 394727000, 50563003
English Keratosis, Seborrheic, Seborrheic Keratosis, Keratoses, Seborrheic, Seborrheic Keratoses, Seborrheic keratosis, seborrheic keratosis, seborrheic keratosis (diagnosis), Senile warts, KERATOSIS, SEBORRHEIC, Seborrheic keratosis NOS, Keratosis, Seborrheic [Disease/Finding], Keratosis Seborrheica, seborrheic keratoses, keratosis seborrheic, seborrhoeic warts, senile keratosis, basal cell papilloma, seborrhoeic wart, inverted follicular keratosis, keratoses seborrheic, senile warts, Wart(s);senile, seborrheic wart, seborrheic warts, keratosis senilis, keratosis seborrheica, Seborrhoeic keratosis (disorder), Senile hyperkeratosis, Basal cell papilloma, Basosquamous papilloma, Seborrheic verruca, Senile keratosis, BCP - Basal cell papilloma, Keratosis senilis, Pigmented basal cell papilloma, Seborrheic wart, Seborrhoeic keratosis, Seborrhoeic wart, Senile wart, Keratosis seborrheica, Verruca seborrheica, Keratosis seborrhoeica, Seborrheic keratosis (morphologic abnormality), Seborrhoeic verruca, Senile hyperkeratosis (disorder), Verruca seborrhoeica, keratosis; seborrheic, old age; wart, seborrhea; keratosis, seborrheic; keratosis, seborrheic; wart, seborrheica; verruca, senile; verruca, senile; wart, senility; wart, verruca; seborrheica, verruca; senile, wart; seborrheic, wart; senile, wart; senility, Basal Cell Papilloma, seborrhoeic keratosis, senile wart
German seborrhoische Keratose, Keratoma senile, seborrhoische Warze, Basalzellenpapillom, Keratose, seborrhoische, Seborrhoische Keratose
Dutch basaalcelpapilloom, verruca senilis, seborroïsche wrat, verruca seborrhoica, seborrhoïsche keratosis, seborrhoïsche keratose, keratose; seborroïsch, ouderdom; wrat, seborrhoica; verruca, seborroe; keratose, seborroïsch; keratose, seborroïsch; wrat, seniel; wrat, senilis; verruca, seniliteit; wrat, verruca; seborrhoica, verruca; senilis, wrat; seborroïsch, wrat; seniel, wrat; seniliteit, Keratose, seborroïsche, Seborroïsche keratose
French Papillome basocellulaire, Verrues séniles, Verrue séborrhéique, Kératose séborrhéique
Italian Papilloma basocellulare, Verruca seborroica, Verruche senili, Cheratosi seborroica
Portuguese Queratose seborreica, Papiloma basalóide, Verrugas senis, Verruga seborreica, Ceratose Seborreica, Ceratose seborreica
Spanish Papiloma basocelular, Verrugas seniles, Verruga seborréica, Verruga seborreica, papiloma de células basales pigmentado, hiperqueratosis senil, hiperqueratosis senil (trastorno), queratosis seborreica (trastorno), papiloma basocelular, papiloma de células basales, queratosis seborreica (anomalía morfológica), queratosis seborreica, verruga seborreica, Queratosis seborreica, Queratosis Seborreica
Japanese 老人性疣贅, 基底細胞乳頭腫, ｼﾛｳｾｲｶｸｶｼｮｳ, ｼﾛｳｾｲﾕｳｾﾞｲ, ｼﾛｳｾｲｶｯｶｼｮｳ, ｷﾃｲｻｲﾎﾞｳﾆｭｳﾄｳｼｭ, ﾛｳｼﾞﾝｾｲﾕｳｾﾞｲ, 角化症-脂漏性, 脂漏性疣贅, 脂漏性角化症, 脂漏性角化腫
Swedish Keratos, seborroisk
Czech keratóza seboroická, Bazocelulární papilom, Seboroická veruka, Stařecké bradavice, Seboroická keratóza, Senilní veruka
Finnish Rasvasyylä
Russian KERATOZ SEBORREINYI, SEBORREINYI KERATOZ, КЕРАТОЗ СЕБОРРЕЙНЫЙ, СЕБОРРЕЙНЫЙ КЕРАТОЗ
Korean 지루 각화증
Polish Brodawka łojotokowa, Rogowacenie łojotokowe
Hungarian Senilis szemölcsök, Seborrhoeás keratosis, Basalsejtes papilloma, Seborrhoeás szemölcs
Norwegian Seboréisk keratose, Seboreisk keratose, Senil keratose
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Stucco keratosis (C0302894)

Concepts Disease or Syndrome (T047)
SnomedCT 103671002, 403869001, 25499005
English keratosis stucco, stucco keratosis, Stucco keratosis, Stucco keratosis (disorder), Stucco keratosis (morphologic abnormality)
Spanish queratosis con aspecto de estuco (anomalía morfológica), queratosis con aspecto de estuco, queratosis en estuco (trastorno), queratosis en estuco
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Leser-Trélat sign (C0686770)

Concepts Sign or Symptom (T184)
SnomedCT 102606000
Dutch teken van Leser-Trélat
French Signe de Leser-Trelat
German Leser-Trelat-Syndrom
Italian Segno di Leser-Trelat
Portuguese Sinal de Leser-Trelat
Spanish Signo de Leser-Trelat, signo de Leser - Trélat (hallazgo), signo de Leser - Trélat (trastorno), signo de Leser - Trélat
Japanese レーザー・トレラ徴候, ﾚｰｻﾞｰﾄﾚﾗﾁｮｳｺｳ
Czech Leser-Trelatův znak
English Leser-Trelat sign, Sign of Leser-Trélat, Sign of Leser-Trelat, Leser-Trélat sign (disorder), Leser-Trélat sign, Leser-Trélat sign (finding)
Hungarian Leser-Trelat tünet
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Hyperplastic Skin Disorders

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