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Hyperkeratotic SK. (A) Dermoscopy showing multiple fat fingers, a variation on the theme of cerebriform surface. (B) Corresponding RCM mosaic (5×3 mm) showing the lesion surface with multiple sulci and gyri.
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Elvira Moscarella,1 Gabriella Brancaccio,1 Giulia Briatico,1 Andrea Ronchi,2 Simonetta Piana,3 Giuseppe Argenziano1 1Dermatology Unit, University of Campania, Naples, Italy; 2Pathology Unit, University of Campania, Naples, Italy; 3Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalyCorrespondence: Elvira MoscarellaDermatology Un...
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Simple Summary
Basal cell carcinoma is the most frequently occurring type of skin cancer. Its treatment can be either local or surgical depending on its subtype and extension, with early recognized and superficial cases being easier to treat. Some of them, however, display unspecific features, making diagnosis difficult. Non-invasive devices such a...
Citations
... Dermoscopically, seborrheic keratosis is identified by milia-like cysts, presenting as roundish white-yellow clods of variable size, corresponding to intraepidermal horn cysts [31,32]. Additionally, well-circumscribed oval or rounded black-to-brown clods, known as comedo-like openings, align with keratin aggregates in dilated follicular openings [33,34]. ...
... The distinct cerebriform appearance of SK is characterized by fissures and ridges-thick, curved lines with colors ranging from hypopigmented to brown, black, and blue. Exophytic papillary structures (gyri) are dome-shaped and closely juxtaposed, separated by blackish comedolike openings [31]. Fat fingers, a variation of the cerebriform theme, manifest as thick, digitate linear, curvilinear, branched, or oval/circular dermoscopic structures [35]. ...
High-Intensity Focused Ultrasound (HIFU) has emerged as a precise and non-invasive modality for tissue ablation and healing. This study presents a detailed dermoscopic analysis of skin healing post-High-Intensity Focused Ultrasound (HIFU) treatment, focusing on common benign skin lesions, such as seborrheic keratosis, sebaceous hyperplasia, vascular lesions, and sebaceous nevi. Methods: Prior to HIFU treatment, a comprehensive assessment was conducted, integrating ultrasound scanning and clinical evaluations. The TOOsonix System ONE-M was employed for HIFU treatments, with parameters tailored to each lesion type. Results: A common pattern observed across all lesions includes initial whitening post treatment, followed by scab formation and the development of a pink area with reparative vessels. This study, however, highlights distinct differences in fibrosis patterns and healing timelines across different lesion types. Each lesion type exhibited unique fibrosis patterns post treatment. Flatter variants of seborrheic keratosis healed within a month, displaying hypopigmentation and reparative vessels, alongside a distinct lattice fibrosis pattern in more verrucous forms, which took about two months to heal. Sebaceous hyperplasia, characterized by rapid healing within three weeks, demonstrated fibrosis with pink areas and perpendicular white lines, concluding with a slight depression. Vascular lesions varied in healing time based on depth, with superficial ones showing whitening and crust formation, while deeper lesions had vessel occlusion and size reduction accompanied by concentric fibrotic bands. Sebaceous nevi presented the longest healing duration of three months, characterized by amorphous white-gray structures, scab formation, and the emergence of pink areas with branching vessels, leading to clear skin with reduced white lines. Conclusions: in conclusion, this meticulous clinical evaluation highlights the unique healing characteristics and timelines for each skin lesion type treated with HIFU. These insights are invaluable for optimizing follow-up assessments, identifying potential complications, and refining treatment protocols. By providing detailed insights into the healing timelines and patterns for different types of lesions, patients can be better informed about their post-treatment journey.
... Other commonly used procedures for SK include excision, electrosurgery, curettage, or combinations of these. [20][21][22] Medical treatment of acrochordons includes several medical procedures, such as snip excision, cauterization/electrosurgery, cryosurgery, and CO2 laser. 4 Electrosurgery was more common compared to cryosurgery in our institution due to the side effect of hypopigmentation in skin of color for the treatment of cryosurgery. ...
Background: Seborrheic keratosis (SK) and acrochordon are common benign neoplasms of the skin thatan be diagnosed clinically. Management of SK and acrochordon has a wide range of purposes, including aesthetic appearance and health concerns. Epidemiologic data for these entities is rare in Indonesia. Purpose: To determine the epidemiology of SK and acrochordon patients at the Dermatology & Venereology (DV) Clinic, dr. Cipto Mangunkusumo National Central General Hospital (RSCM). Method: Patient registry data at the DV Clinic, RSCM from 2014 to 2017 was collected retrospectively. Data was obtained by using the total sampling method and retrieving characteristics such as age, sex, and outpatient-based procedures. Result: In the four-year period, there were 1.202 SK patient visits with 447 new cases and 374 acrochordon patient visits with 169 new cases. The proportion of SK patients in this study was 2.2%; acrochordon was 1.8% of all patients at the DV Clinic of RSCM. The highest prevalence of SK was found in patients older than the 6th decade, while for acrochordon, it was within the 4th decade. Both SK and acrochordon were seen higher in women, with a male-to-female ratio of 1:2. Electrosurgery was the most common office procedure performed. Conclusion: Seborrheic keratosis and acrochordon proportion, respectively, are 2.2% and 1.8% at the DV Clinic, RSCM. Seborrheic keratosis and acrochordon are more frequent in women, with the peak occurring in 6th decade and 4th decade, respectively
... Seborrheic keratoses (SK), are common benign skin lesions, which increase in number and size with age [1,2]. The diagnosis of SK is usually readily made on clinical and dermoscopic examination, however at times these lesions may mimic malignant skin tumors and are excised to exclude a malignancy [3]. A better knowledge of clinical and dermoscopic characteristics of SK may help avoid unnecessary excisions. ...
Introduction
Seborrheic keratoses (SK), are very common benign skin lesions, which may increase in number and size with age.
Objectives
The aim of the study was to assess any differences seen in seborrheic keratoses in relation to different skin types (ST) and lesion location.
Methods
This was a retrospective observational study of 10-months period, based on dermoscopic images of seborrheic keratoses and patient history recorded in database. Patients were categorized according to their age, sex, skin type, and location of SK.
Results
The frequency of SK remained high on the back for skin type 1, 2, 3 and 4. This same trend was also seen on the face and chest. In skin type 3 we saw a reversal of distribution of SK, the highest frequency remained on the back, and this was followed by the chest rather than the face. In skin type 5 and 6, the nature of the distribution of SK was more facial,
Conclusions
In summary our study shows that SK are more commonly seen in males than in females, they tend to dominate in sun exposed sites especially the back and the face. Both the smaller and larger sized SK dominated in ST 1 and 2. The lighter to darker shades of color seen in seborrheic keratoses varied in accordance with the skin type, with lighter colored SK being seen more in lighter skin types as compared to darker skin types, whereas bluish colored SK were seen in all skin types except ST 1.
... Mohammed Abu et al. [14] reported seborrheic keratosis in 8 % of cases. Moscarella E [17] reported seborrheic keratosis in 43 % and cherry angioma in 63 % of cases. The incidence of seborrheic keratosis, dermatosis papulosa nigra and cherry angioma was less when compared to other studies mentioned above. ...
Skin diseases are a common and inevitable consequence of ageing. Moreover, the clinical presentation is not as classical as they do in the younger population. A lifetime of solar exposure, along with intrinsic changes in the dermal structures, predisposes to a variety of skin diseases. The aim: to study the spectrum of various geriatric dermatoses among our patient population at the Department of Dermatology, Venereology, and Leprosy at Kamineni Academy of Medical Sciences and Research Centre. Materials and methods: in this study, a total of 200 patients aged 60 years and above attending the DVL OPD of Kamineni Academy of Medical Sciences and Research Centre were included. Results: maximum number of patients in this study belonged to 60-65 years (60 %), Male to female ratio was 1.86:1. Most of the males had agriculture work, and most of the females were housewives. Diabetes mellitus was the commonest associated systemic disease seen in 68 cases (34 %), and generalised pruritus was the commonest symptom seen in 64 (32 %) cases, of which 42 cases (65.6 %) were associated with xerosis. Pathological skin disorders and eczematous conditions were seen in 56 out of 200 cases. Of this, asteatotic eczema was the common finding among the eczematous conditions seen in 14 cases (7 %). Psoriasis was seen in 32 (16 %) and lichen planus in 10 cases (5 %). Infectious diseases were seen in 78 cases (39 %). Of these, fungal infections were common, seen in 28 cases (14 %). The benign tumour was seborrheic keratosis in this study, seen in 61 cases (30.5 %); among the malignant tumours, 4 cases (2 %) of basal cell carcinoma and 2 cases (1 %) of squamous cell carcinoma were seen. Among 16 cases of bullous disorders, bullous pemphigoid was seen in 12 (6 %) cases. Among 22 cases of psychocutaneous disorders, delusional parasitosis was seen in 10 cases (5 %), and perforating folliculitis in 15 cases (7.5 %). Loss of luster was the commonest nail change seen in 182 cases (91 %), followed by nail plate thickening in 54 cases (27 %). Greying of the hair was seen in all cases. Out of 70 females, diffuse hair loss was seen in 58 cases (82.9 %), and out of 130 males, androgenetic alopecia was seen in 72 cases (55.4 %). Conclusion: skin diseases cause considerable morbidity in the elderly, particularly if associated with other comorbid conditions. Health education on proper skin care, avoidance of irritants and self-medication etc., would help to reduce the incidence of common dermatoses.
... They are referred to as a sign of ageing skin which is due to long-standing ultraviolet (UV) exposure [3]. Though SK is thought to be genetically stable, somatic alterations like FGFR3, PIK3CA, HRAS, KRAS and EGFR mutations prevail in SK that are responsible for malignant transformations [4,5]. A hypothesis postulating human papillomavirus aetiology in SK involving the genital region has also been reported in the literature. ...
Seborrheic keratosis is the most common benign tumour of epithelial origin, whose incidence increases with the advance of age. The aetiology of SK is not completely known but exposure to UV radiation may be an associated factor. Most of the cases have a rough, verrucous appearance, slightly elevated, and black or brown in colour. They are usually painless but at times present with pus discharge or ulceration.
... A definite indication of melanoma is the presence of mitosis in the deep dermis along with cellular atypia and pleomorphism. 19,20 Initial suspicion a malignant lesion prior to histopathological examination is a consideration in excision technique. Based on previous studies, excision techniques for suspected melanoma can be performed within 1-5 mm of the lesion boundary, while for benign lesions 1-2 mm from the tumor boundary. ...
Seborrheic keratosis is a benign tumor originating from keratinocytes. In this case, a 51-year-old woman with a lump on the left upper eyelid that was growing rapidly, accompanied by itchiness since 1 month. The lumps appeared to be blackish brown, with uneven edges that clinically similar to nevus and malignant melanoma lesions. To rule out the possibility of a nevus, malignant melanoma and other malignancies, excisional biopsy was performed as a diagnostic and treatment management. The similar clinical appearance between benign and malignant lesions is a consideration in performing an excisional biopsy. Histopathological examination in this case, confirmed the diagnosis of seborrheic keratosis as a gold standard that will determine further management. Keywords: Seborrheic keratosis, nevus, malignant melanoma, misdiagnosis
... Lesions often develop in early-to-middle adulthood. Some individuals have few seborrheic keratosis whereas other people have hundreds [5]. ...
... There is also acanthosis (thickening of the epidermis). In addition, keratinfilled pseudocysts (horn pseudocyst) and hyperpigmentation of the basal layer and/or the epithelium may also be present [5]. ...
... They are observed in individuals who are greater than 65 years old. The most affected site is the posterior thorax [5]. ...
A collision tumor is a neoplastic lesion comprised of two or more tumors consisting of distinct cell populations in the concurrent location. Multiple skin neoplasms at one site (MUSK IN A NEST) is a term recently coined to describe two or more cutaneous benign or malignant tumors occurring at the same anatomic site. In retrospective studies, seborrheic keratosis and cutaneous amyloidosis have both individually been documented as a component of a MUSK IN A NEST. This report describes a 42-year-old woman who presented with a pruritic skin condition on her arms and legs of 13 years' duration. Skin biopsy results showed epidermal hyperplasia with hyperkeratosis, hyperpigmentation of the basal layer with mild acanthosis, and evidence of amyloid deposition in the papillary dermis. Based on the clinical presentation and pathology findings, a concurrent diagnosis of macular seborrheic keratosis and lichen amyloidosis was established. A MUSK IN A NEST consisting of a macular seborrheic keratosis and lichen amyloidosis is likely a more common occurrence than implied by the paucity of published cases of this phenomenon.
... Seborrheic keratoses, also known as senile warts, are very common in aging skin, typically developing on the torso, head, and neck and in skin folds. 1 Seborrheic keratosis is very common in the older population and appears to increase with age. An epidemiological study in Brazil stated that 89% of lesions occurred in patients aged 80 years and over. 2 While age is a known risk factor, the precise role of UV exposure is considered to be the most important etiology. ...
... Other possible causes being investigated include genetic and metabolic factors. 1 The mechanisms underlying these benign tumor disorders are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that there is a theory regarding the inhibition of Akt and APP. 3 ...
Background: Seborrheic keratoses are benign intraepidermal neoplasms arising from epidermal keratinocytes. Age and UV exposure have a role in the course of the disease. Seborrheic keratosis consists of several types of cells, and transformation into various epithelial tumors originating from the same cell type can occur. Therefore, basal cell carcinoma may arise from the basaloid cells, which is the most commonly reported malignant neoplasm in seborrheic keratosis. Various treatment modalities are available to treat seborrheic keratoses. We report a case report of seborrheic keratosis resembling basal cell carcinoma and treated using surgical excision with the advancement flap technique. Case presentation: A 76-year-old man came with complaints of itchy, blackish-brown lumps on his left ear 3 months ago. On examination of the dermatological status on the helix auricula sinistra, there was a solitary nodule of blackish brown color with a diameter of 1cm x 1cm x 1cm and an ulcer with an uneven surface, well-defined, telangiectatic (+). An examination of the biopsy showed the results of seborrheic keratosis, keratotic type. The management of this case is excision with an advancement flap. Conclusion: Seborrheic keratosis is one of the most common benign skin tumors that occur in old age. Excision with an advancement flap showed good clinical improvement.
... Additionally, benign clonal cell proliferations can be present in SK, resembling BD. Aside from histological similarities, small biopsies with limited amounts of tissue being available for analysis can further impede the reliable histological differentiation of SK and BD [6][7][8]. Correctly distinguishing these lesions is, however, essential, as therapeutical approaches differ. Complete treatment of malignant tumors such as BD is mandatory as those will continue to grow and may evolve into invasive neoplasms with significant morbidity, potentially even mortality. ...
Background:
Some of the most common cutaneous neoplasms are Bowen's disease and seborrheic keratosis, a malignant and a benign proliferation, respectively. These entities represent a significant fraction of a dermatopathologists' workload, and in some cases, histological differentiation may be challenging. The potential of deep learning networks to distinguish these diseases is assessed.
Methods:
In total, 1935 whole-slide images from three institutions were scanned on two different slide scanners. A U-Net-based segmentation deep learning algorithm was trained on data from one of the centers to differentiate Bowen's disease, seborrheic keratosis, and normal tissue, learning from annotations performed by dermatopathologists. Optimal thresholds for the class distinction of diagnoses were extracted and assessed on a test set with data from all three institutions.
Results:
We aimed to diagnose Bowen's diseases with the highest sensitivity. A good performance was observed across all three centers, underlining the model's robustness. In one of the centers, the distinction between Bowen's disease and all other diagnoses was achieved with an AUC of 0.9858 and a sensitivity of 0.9511. Seborrheic keratosis was detected with an AUC of 0.9764 and a sensitivity of 0.9394. Nevertheless, distinguishing irritated seborrheic keratosis from Bowen's disease remained challenging.
Conclusions:
Bowen's disease and seborrheic keratosis could be correctly identified by the evaluated deep learning model on test sets from three different centers, two of which were not involved in training, and AUC scores > 0.97 were obtained. The method proved robust to changes in the staining solution and scanner model. We believe this demonstrates that deep learning algorithms can aid in clinical routine; however, the results should be confirmed by qualified histopathologists.
... Seborrhoeic keratoses (SK) are also extremely frequent. These have a brownish, dark-coloured, verrucous surface that protrudes from the skin [1,2]. Although these cannot develop into malignancy, many patients seek treatment due to potentially extreme itching or for aesthetic reasons [3]. ...
The incidence of all types of malignant skin tumours, including both melanoma and non-melanoma types, has increased in recent decades, while basal cell carcinoma is the most common human malignancy in the Caucasian race. The aging of the skin is associated with an increase in both benign and malignant tumours. As the population ages and life expectancy extends, mostly in developed countries, dermatologists are likely to face growing numbers of patients seeking therapy for such abnormalities. It is primarily UV irradiation that is responsible for the development of skin cancers, although there are other risk factors, including air pollution and X-ray irradiation. Seborrhoeic keratosis, solar lentigo and other benign lesions, despite their harmless nature, may cause distress to patients, such as itching or aesthetic issues. This review article summarises the features of the most common benign and malignant lesions of aging skin.
