II. Epidemiology

  1. Most common benign epithelial tumor
  2. Occurs 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
  2. Hyperkeratotic epidermal lesion

IV. 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 (most common location)
    2. Face
    3. Scalp
    4. Upper extremities
  3. Associated lesions
    1. Horn cysts
    2. Milia-like cysts

V. Variants

  1. Stucco keratoses
    1. Numerous small white, dry scaly lesions on extremity
  2. Dermatosis papulosa
    1. Small, dark Papules on face seen in darker skin
  3. Leser-Trelat Sign (paraneoplastic sign)
    1. Sudden onset and increase in number of 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

VI. 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

VII. 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
    3. Excision
      1. Shave Excision
      2. Excisional Biopsy (if possible Melanoma)
    4. Topical Corticosteroids
      1. Indicated for irritated Seborrheic Keratoses

VIII. References

  1. Fitzpatrick (1999) Color Atlas Dermatology
  2. Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]

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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, シロウセイユウゼイ, シロウセイカッカショウ, キテイサイボウニュウトウシュ, ロウジンセイユウゼイ, 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
Korean 지루 각화증
Polish Brodawka łojotokowa, Rogowacenie łojotokowe
Hungarian Senilis szemölcsök, Seborrhoeás keratosis, Basalsejtes papilloma, Seborrhoeás szemölcs
Norwegian Seboréisk keratose, Seboreisk keratose, Senil keratose