Seborrheic Keratoses are raised, thick, bumpy, pigmented, wart like patches that are usually seen in the elderly. They are typically tan to dark brown, round to oval, slightly elevated flat patches that occur commonly on areas of skin that have suffered prolonged sun exposure, although they may occur in non exposed areas as well. Seborrheic Keratoses need to be differentiated from warts and skin cancers like melanoma, which have a similar clinical picture. Unlike these two, seborrheic keratoses are not malignant or infectious. They may be caused by direct sun exposure for a long period. Stress and cancers of the GI tract are also known to precipitate Seborrheic keratoses, and a strong genetic predisposition has been identified in people with a family tendency for the same.
Symptoms of Seborrheic Keratoses
Clinically, patients may present with one or many waxy, scab like, darkly pigmented lesions that look like warts or moles. They may grow to more than an inch across, resembling hypertrophic scars or nodular melanoma. Seborrheic Keratoses are usually painless, sometimes itchy, and superficial, giving rise to the ‘stuck on’ or ‘glued on’ appearance. Because of the overlapping clinical features, an excision or edge biopsy becomes necessary, in order to distinguish the Seborrheic keratoses from more serious conditions like malignancies or condylomata, as histology will be required for this. The various types of Seborrheic Keratoses include Common and Reticulated Seborrheic Keratoses (also known as basal cell papillomas), Irritated Seborrheic Keratoses, Seborrheic Keratoses with Squamous Atypia, Stucco Keratoses, Clonal Keratoses, Melanoacanthomas, and Inverted Follicular Keratoses, which are white to pink pale lesions.
Treatment of Seborrheic Keratoses
Treatment of Seborrheic Keratoses is optional, as they are harmless and painless. The most common reason that people seek treatment for is their unsightly appearance. Even so, Seborrheic keratoses are easily removed, with the most common treatment option being Cryosurgery.In cryosurgery, liquid nitrogen spray or swab is used to freeze the keratoses, which causes them to crust and fall off, overall a painless and quick procedure.
Instead of cryosurgery, electrosurgery can be done after applying local anesthesia, or the keratoses can be scraped off with a sharp curette. The residual scar heals quickly and there is minimal bleeding and scarring. However, recurrence is a distinct possibility. Also, sudden appearance of many keratoses may be an alarming sign, as is itching, oozing or bleeding in a pre existing lesion. All these require clinical evaluation.