Diagnosing Seborrheic Keratosis

Seborrheic Keratosis, also known as seborrheic veruca or Senile Wart, is a skin condition which is noncancerous and involves skin growths that originate in keratinocytes. They are seen more often as people age. They appear in different colors from black to light tan and are oval or round. They feel flat or slightly elevated and can range from very small to even larger than 2.5 centimeters. The growths can resemble warts though they have no viral origin. Because only the top layer of the epidermis is affected, the growths are often described as having a pasted on appearance. The lesions normally occur at the trunk or head, face, chest, shoulders, the back and the neck region of elderly and middle aged adults. The growths are normally painless and may require no treatment but you may prefer having them removed if they are irritated by the clothing or for cosmetic reasons like your own body beauty.

Histopathology for seborrheic keratosis: there is an increased number of epidermal basal cells presumably because of maturation defect. Acanthotic patterns are most frequent where a thick layer of basal cells is interspersed with pseudohorny cysts, some cells may contain melanin. Other microscopic patterns may include adenoid, desmoplastic, hyperkeratotic, and acantholytic.

The clinical features of Seborrheic Keratosis include: pigmented and predominantly basal keratinocytic proliferations, they are mainly on the trunks and the neck regions of adults and especially in the later years, the lesions may be contiguous or adjacent malignant skin neoplasm that are of various types, the growths have a greasy appearance and they look like they have been glued to the skin, as opposed to growing from it and they rarely itch. The growths have a tan or brown color at the start and they may turn dark over time.

The diagnosis of seborrheic keratosis can be a difficult task because they may be confused with other skin conditions like: Basal Cell Carcinoma, Malignant Melanoma, Squamous Cell Carcinoma, nodular melanomas and many more. However visual diagnosis is made by the stuck on appearance, the horny and crusty cysts or pearls embedded on the structure. If the doctor doubts which disease you might be suffering from he/she might and should perform a skin biopsy. This is because clinically, seborrheic keratosis is similar to epidermal nevi in appearance, condylomas and warts also can clinically resemble seborrheic keratosis and hence dermatoscopy may be helpful to distinguish and come up with the right diagnosis.

Typically seborrheic keratosis doesn’t become cancerous but it can resemble skin cancer so if the doctor suspects skin cancer he or she should take a sample of your skin for analysis in a lab (biopsy) which can simply be done even in the doctor’s office.

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