VIRGINIA BEACH DERMATOLOGY ASSOCIATES, PLLC.

SEBORRHEIC KERATOSES

Seborrheic keratoses are an extremely common skin growth. So common that they are probably the most common type of growth, benign or malignant, external (the skin) or internal (everything else).
They usually begin in adulthood. As we age, these growths may proliferate. Since they usually don’t fall off, they accumulate on our skin. The elderly may have hundreds of these unattractive encrustation.

Some people call them the barnacles of life. For as we sail through the sea of life, they attach themselves to us much like barnacles attach themselves to an ancient schooner.

These skin pests tend to run in families.

What do they look like?

Seborrheic keratoses are like a good actress. They can assume many expressions. Sometimes they may be a jet black while other times they can have a sallow yellow color. Their preferred shade is a shade of brown.

They can be a loner; a solitary being set adrift on our skin, lost in existential thought. Or they can be clustered with their friends, like sailboats bobbing on the Charles during a brisk summer day.

Their size can vary considerably. Some are mighty epidermal extensions—proud of their bulk and mass, threatening to their tiny neighbors. These tiny neighbors may be so small that it takes a good pair of eyes to see them.

They often have a waxy stuck on appearance. This stuck-on look is key in making the diagnosis. They nearly always have a well-circumscribed border.

What is their natural course?

Seborhheic keratoses often begin as a lentigo – a liver spot. They look like someone came along with a dripping candle, and carelessly let the wax fall onto the skin.

Gradually these light brown areas become a small rough bump. In their fully developed form they will have a warty, rough surface.

Where do they occur?

The back seems to be the preferred locale of these nearly ubiquitous skin creatures. They are often found on the chest, arms and legs. The more ornery ones like to plop themselves on the face where they can create all kinds of unwelcome textural patterns.

What Causes Them?

For such a common lesion, the seborrheic keratoses may be the Rodney Dangerfield of the skin – it just doesn’t get any respect.

There has been very little research in this field.

The best one can surmise is that they seem to not be sun-related and not worsened by smoking, drinking, gambling or other bad habit.

They most likely are a skin’s response to irritation. For instance the area beneath the breast, the sub-mammary region, is often peppered by these growths.

There is also a theory that these lesions may be caused by a virus.

Confusion

Another example of the lack of respect these growths get is the lack of a good layman term for them. Moles, wens, liver spots, etc. are fully understood layman terms for dermatologic entities. For something so mundane, one would think there would be a nice fitting nickname. Not so.

They are sort of like the ayelet – everybody knows what they are, but nobody knows their name.
Instead the seborhheic keratoses are called all sorts of things which they are not. Such as:

Warts. These are definitely caused by a virus while seborrheic keratoses probably are not. Seborrheic keratoses frequently occur on the back, where warts are rare.
Moles. The term mole is generally conceived to be pigmented lesion composed of melanocytes. Seborrheic keratoses are composed of basal cells.
Melanoma. Occasionally a seborrheic keratoses can have an appearance of a melanoma. This is akin to the king snake and the coral snake. One of these things (the seborrheic keratosis and king snake) is harmless and the other can be fatal (the melanoma and the coral snake).
Actinic keratoses. These can often look similar and presents confusion to patients and occasionally to the dermatologist. These are pre-cancers. The cells composing them have some atypia but there is no invasion into the second layer of the skin, the dermis. An irritated seborrheic keratoses can especially masquerade as an actinic keratoses.

Can they Become Malignant?

By and large the answer is no. There are reports of some skin cancers lying underneath the seborrheic keratosis. As mentioned above, occasionally a seborrheic keratosis appearing lesion can actually be a melanoma. However it would be exceedingly rare for a seborrheic keratosis to transform into a melanoma.

A sudden onset of numerous seborrheic keratosis may be a clarion call to check for an internal malignancy. This is called the Sign of Leser-Trelat . Usually this will be associated with other skin findings such as thinning hair, warty growths around the mouth, and thickening of the palms and soles.

Treatment

Seborrheic Keratoses are harmless growths. They need be treated only if they get caught on clothing, itch or in some ways bothers you. They are pretty darn ugly so few people would call you vain if you decided to have yours removed.

{It is a funny thing. A 25 year old woman will spend $5000 and undergo rather painful surgery if she doesn’t care for the cant of her nose. But a 67 year old man with four or five of these growths doesn’t seem bothered by them—even if the surgery costs $60 and is relatively painless. (Can something be relatively painless? It seems to me that it can only be painless or painful).}

How are they treated?

The most common form of treatment is cryotherapy. A very cold liquid, liquid nitrogen, is applied to the “seb” with either a cotton swab or a spray gun. After the lesin is frozen, crusting or a blister forms. This can be peeled off or will fall off a few weeks after the freezing. Most of the time there is no scar.

Many of us like to curette these “barnacles” off with a sharp instrument appropriately termed a curette. The seb is frozen with either light liquid nitrogen or a freeze spray. Alternatively, the seborrheic keratosis may be numbed up. The seb is scraped away. There is little bleeding and stiches are not needed.

Some people like electrosurgery. The lesion is numbed, light electrocautery is applied and the ugly or itchy seborrheic keratosis is whisked away.