A patient with raised, hyperpigmented, skin lesions of 12 cm gets a diagnosis of seborrhoeic keratoses
A 90-year-old, otherwise healthy man presented with asymptomatic lesions in his axillae for the past twenty years. Clinical examination revealed four hyperpigmented lesions with limited cerebriform measuring 12 cm along the long axis. The patient reported that the lesions were initially small and these gradually increased in size. Dermoscopic examination showed cerebriform convolutions appearance suggesting seborrhoeic keratoses. The histopathological evaluation confirmed the diagnosis. However, neither there were signs of viral infection nor any malignant transformation.
The doctors, with patient’s consent decided to perform surgical resection. However, the excision left a permanent scar.
Seborrhoeic keratosis has other names including Verruca senilis, senile wart, verruca seborrhoica, seborrheic wart, basal cell acanthoma, benign acanthokeratoma, and basal cell papilloma. It is a benign skin tumour affecting people aged over 50 years. The name is misleading as the lesions are not limited to the seborrhoeic distribution, nor arise from seborrheic glands or have sebum. The lesions, which vary in size between a few mm to 1 cm, have a typical stuck on appearance, usually seen on the face and the trunk. However, they can involve any part of the body except palms or soles. The lesions are elevated, sharply demarcated, round or oval-shaped, and hyperpigmented. However, flat seborrheic keratoses lesions are barely above the surface and have a smooth, velvety surface. Keratotic plugs and horn cysts penetrate the lesions. These, on dermatoscopy, appear as “pseudofollicular openings” and “horn pseudocysts” with light, sharply bordered, round plugs.
The exact etiology is unknown, however there is some evidence suggesting familial predisposition.
The treatment of Seborrhoeic keratoses include cryotherapy, electrocoagulation-curettage, ablative laser surgery, focal chemical peel, shave biopsy and in some cases surgery.