Current Understanding of Seborrheic Keratosis: Prevalence, Etiology, Clinical Presentation, Diagnosis, and Management

October 2015 | Volume 14 | Issue 10 | Original Article | 1119 | Copyright © 2015

J. Mark Jackson MD FAAD,a Andrew Alexis FAAD MPH FAAD,b Brian Berman MD PhD FAAD,c Diane S. Berson MD FAAD,d Susan Taylor MD FAAD,e Jonathan S. Weiss MD FAADf

aUniversity of Louisville, and Forefront Dermatology, Louisville, KY
bDepartment of Dermatology, Mount Sinai St. Luke’s and Mount Sinai Roosevelt; Icahn School of Medicine at Mount Sinai, The Skin of Color Center, New York, NY
cUniversity of Miami Miller School of Medicine, Miami, FL, Skin and Cancer Associates, Center for Cosmetic Enhancement and Clinical Research, Aventura, FL
dDepartment of Dermatology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
eUniversity of Pennsylvania, School of Medicine, Philadelphia, PA; College of Physicians and Surgeons, Columbia University, New York, NY; Society Hill Dermatology, Philadelphia, PA
fGwinnett Dermatology, PC, Snellville, GA

Abstract

Seborrheic keratosis (SK) is among the most common cutaneous lesions, affecting some 83 million Americans. Biologically benign, SK lesions do not require removal for medical reasons unless histologic confirmation of the clinical diagnosis is required or the lesions are traumatized and/or become symptomatic. These macular or popular pigmented lesions are often of cosmetic concern to patients. In addition, their natural history of gradually increasing in size, thickness, and/or pigmentation often serves as the impetus compelling patients to present to a dermatologist for evaluation and skin cancer screening; SK is diagnosed and managed primarily by dermatologists. Data regarding SK prevalence and management from a survey of 594 practicing, board-certified dermatologists are summarized herein: Dermatologists report they diagnose an average of 155 patients per month with SK. Among SK patients presenting to dermatologists, 33% have more than 15 SK lesions and 67% have 15 or fewer SK lesions. On average, dermatologists treat 43% of their SK patients to remove lesions. Cryosurgery is the most common removal method. Other commonly employed removal methods include shave excision, electrodessication, curettage or a combination of these. While these procedures can be used to remove SK lesions effectively, each has potential drawbacks and careful patient selection is required to optimize cosmetic results particularly in skin of color patients and patients with thick or numerous lesions. While there is great interest from both patients and providers in a topical non-invasive treatment for SK, no effective topical therapeutic agent has been developed, and this remains an area of unmet need.

J Drugs Dermatol. 2015;14(10):1119-1125.

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INTRODUCTION

Seborrheic keratosis (SK) is one of the most common dermatologic lesions, affecting 83 million Americans,1 and is one of the most common skin tumors seen by dermatologists in everyday practice.2 Despite the ubiquity of SK, current literature on this condition is surprisingly limited and there is a paucity of effective and cosmetically acceptable treatments, particularly for special populations such as individuals with large numbers of SKs or those at risk for pigmentary alterations related to treatment. Renewed interest is occurring, however, with advances in the understanding in the pathogenesis of SK and increasing patient interest in treatment. As baby boomers reach ages where SKs are more common, dermatologists are hearing from patients more frequently that they desire removal of these lesions in order to maintain a more youthful appearance and improve their quality of life. Additionally, dermatologists recognize these benign lesions as the reason for a large number of patient visits, offering opportunities to diagnose and treat critical skin disorders present but unknown to the patient. The following discussion of the most recent data regarding “best-practices” in the diagnosis and management of SK, as well as unmet needs, is the first published comprehensive account in more than two decades.

Clinical Presentation and Diagnosis

Dermatologists manage 85% of seborrheic keratosis patients seeking care from physicians.3 While SKs are benign, their presentation may be potentially life-saving because more serious skin disorders and skin cancers may be detected by the dermatologist during the office visit. Patients presenting with SK often have concerns that the lesions might be melanoma or they may

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