Is Seborrheic Keratosis a benign lesion??

Overview 

 

Commonly affecting middle-aged and older people, seborrheic keratosis (SK) is a benign skin tumour. In the outpatient context, primary care physicians and dermatologists frequently encounter these noncancerous growths as one of the most common forms of skin tumours. 

They are distinguished by flat, round, or oval-shaped, well-demarcated macules that can range in colour from light to dark brown, yellow, or grey and usually grow slowly. SKs come in a variety of sizes, from minuscule to over an inch in diameter, and are frequently characterised as appearing "stuck on". Even though they are usually not harmful or infectious, some people may decide to have them removed if clothing irritates them or for cosmetic reasons.

 

Pathophysiology

 

Mutant epidermal keratinocytes are assumed to undergo clonal expansion as the cause of seborrheic keratoses. Certain cases of SKs are inherited through an autosomal dominant mode of inheritance, and there is evidence that suggests sunlight may have a role in their development. 

There is thought to be a genetic component to the development of a high frequency of SK lesions, though the precise familial inheritance is unknown. Although black people can develop a form of SK called dermatosis papulosa nigra, SKs are less common in populations with dark skin than in those with white skin. Small, pedunculated, highly pigmented lesions with a low keratotic element characterise this variant, which primarily affects the upper cheeks and lateral orbital areas of the face.

Morphology

 

Multiple horn pearl formation is a significant clinical sign of SKs, which are most frequently found on the forehead and trunk. Features that are typical in dermoscopy include fissures and ridges, milia-like cysts, and comedo-like openings. A Buschke-Löwenstein tumour is one of the possible differential diagnoses for SKs, although most SKs have a maximum diameter of less than 4 cm. Giant lesions can occasionally develop. 

As people age and are exposed to more UV light, the incidence of SKs rises. Their clinical variability can occasionally be mistaken for other skin lesions that could be malignant. 

Risk factors

The risk factors for developing seborrheic keratosis include:

1. Age: Seborrheic keratoses tend to develop more frequently after age 50. Middle-aged and older people are more likely to have seborrheic keratoses, which tend to accumulate with age.  
2. Family history:Individuals who have a family history of seborrheic keratoses are at an increased risk of developing these benign growths. Those who have already experienced one seborrheic keratosis run the risk of getting more since some people appear to inherit a propensity to get multiple of these growths.
3. Sun exposure:Certain forms of seborrheic keratoses may be influenced by sunlight. Research indicates that skin with prolonged sun exposure is susceptible to developing these growths. More investigation is necessary to completely comprehend the role that sun exposure plays in the development of seborrheic keratoses, though, as they can also appear on skin that is constantly covered.
4. Race: Dark-skinned populations have a lower incidence of seborrheic keratoses than do white populations.

Why it is not cancerous lesion?

 

 Melanoma is the most serious kind of skin cancer, whereas seborrheic keratosis is a benign, noncancerous skin growth that can develop as you age.

 Although the two conditions can frequently have striking similarities, melanoma is a form of skin cancer that can spread to other parts of the body, whereas seborrheic keratoses are benign and noncancerous. 

 

A mole or a change in an existing mole is often the initial stage of seborrheic keratoses, which are typically tan or brown in colour and can appear anywhere on the skin, with the exception of the palms and soles. Melanoma is usually asymmetrical, larger than 6 millimetres, and comes in multiple colours. On a physical examination, a dermatologist might be able to distinguish between the two, and in certain situations, a biopsy of the growth might be required to look for cancer under a microscope. 

If you're worried about any skin growths, it's crucial to consult a dermatologist, particularly if any new ones appear.

Diagnosis and Treatment

The diagnosis of seborrheic keratosis is typically based on the distintive appearance of the lesion. In some cases, a skin biopsy may be taken to confirm the diagnosis. While SKs do not require treatment, some individuals want to remove these lesions for cosmetic reasons or if they become stuck by clothing. Removal methods include freezing the growth with liquid nitrogen (cryotherapy), scraping or shaving the skin's surface, or other treatments such as cauterization or laser treatment. Topical treatments with 40% hydrogen peroxide and the nitric-zinc complex, as well as ablative laser therapy, have also been considered as treatment . 

 

The treatment options for seborrheic keratosis include the following:

1. Cryotherapy:A seborrheic keratosis may be effectively removed by freezing the growth with liquid nitrogen. This procedure runs the risk of causing pigment loss that is permanent, particularly on dark or brown skin.
   
   
2. Excision:The growth can be removed by curettage, electrosurgery, or shaving or scraping the skin's surface. During electrosurgery, the growth is first anesthetic-numbed and then destroyed with an electric current. A curette, a surgical tool in the shape of a scoop, is used to scrape off the treated growth.
   
   
3. Topical treatments:Topical medications available over-the-counter that show promise in reducing seborrheic keratoses include potassium dobesilate, 5-FU 2.5%/salicylic acid 17%, and diclofenac gel. But there is little research on these remedies, and it takes perseverance and time for them to be effective.
4. Laser therapy:As an alternative to surgery, lasers can simultaneously seal the tissue, sterilise the wound, and burn the growth. The treatment of seborrheic keratosis by laser therapy is a possibility.
   

Lesions typically become bigger and thicker over time and do not go away on their own.

Notably, seborrheic keratoses do not progress to cancer, so their existence shouldn't have an impact on a person's general health or prognosis.