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Presentation
Case Findings: A middle-aged couple comes into your office. The wife is concerned about a strange looking growth on her husband鈥檚 upper back that she feels has been stable for the past two years. She tells you that her husband is a dermatologist, but rarely uses sunscreen despite all the advice he gives his patients. The husband tells you that he would like to be a back model again someday if you could just get rid of this growth.
What is your diagnosis?
92% Bowen鈥檚 disease
1363% Seborrheic keratosis
418% Dermatofibroma
252% Basal cell carcinoma
451% Atypical nevus
293% Squamous cell carcinoma
447% Melanoma
Seborrheic keratoses (SKs) are exceedingly common benign thickenings of the epidermis that typically appear on the chest and back. There can be few or hundreds of these raised, 鈥渟tuck-on鈥�-appearing papules and plaques with well-defined borders. The etiology is unknown, although there is a familial trait for development of multiple SKs with an autosomal dominant mode of inheritance. Multiple eruptive SKs should prompt a search for underlying internal malignancy, especially if patient history or review of systems is suspicious for cancer. Although melanoma is always in the differential of pigmented solitary lesions, wide surgical excision is not an acceptable form of therapy for an obvious SK. SKs are commonly managed with cryosurgery, curettage and cautery, or shave excision.
What To Look For:
Pink, skin-colored, yellow-brown to brownish-black, waxy, 鈥渟tuck-on鈥�-appearing papules. Pigmentation may be variable within a single lesion. The surface may appear verrucous. They may occur on any body site, except for the palms, soles, and mucous membranes.
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