Seborrhoeic Keratosis (Wart)

Also known as basal cell papilloma

Background

  • Most common benign tumour in older people.  Prevalence increases with age.  Onset usually in middle age.  More common in caucasion
  • Arise from proliferation of basal cell in the epidermis (NOT at all related to the sebaceous glands)
  • More common on sun-exposed regions but can appear on covered areas (no direct link to sunlight proven)
  • Considered to possibly be a part of the skin aging process.

Appearance

  • Classical flat-topped/warty lesion (stuck on appearance) with a well-circumscribed border
  • Usually pigmented
  • Surface is usually irregular, rough, granular
  • They initially appear as a hyperpigmented macular/plaque and initially have a soft/velvety surface before developing a raised, warty surface.

Management

  • Usually simple reassurance with no active management
  • Warts can be removed if they are causing distress (cosmetically or physically due to their location)
    • Cryotherapy (usually for thinner lesions)
    • Curettage and cautery
    • Shave biopsy

Other types of seborrhoeic keratosis

  • Solar lentigines: flat brown marks in sun-exposed areas
  • Stucco keratoses: numerous small dry grey/white stuck on lesions usually found on the lower legs and feet or other extremities
  • Dermatosis papulosa nigra: numerous, brown/purple, warty papules on the face, neck and chest of dark-skinned individuals
  • Irritated seborrhoeic keratosis: inflamed lesion, often red and crusted; may resemble BCC
  • Lichenoid keratosis: resolving keratosis or lentigo, often pink/grey coloured
  • Melanoacanthoma: very deeply pigmented seborrhoeic keratosis (tumour involves melanocytes also)
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