Diagnosis: Multiple seborrheic keratoses
A 72-year-old retired male presents with numerous asymptomatic brown plaques on his back that have gradually increased in number over the past several years. Examination reveals multiple well-demarcated, stuck-on appearing lesions, characteristic of a common benign skin condition prevalent in older adults.
A 72-year-old male retiree reports a 5-year history of multiple brown plaques on his back, which he describes as 'stuck-on'. He has no associated symptoms such as itching or pain. On examination, there are numerous well-defined, hyperpigmented lesions ranging from 0.5 to 3 cm, with a waxy surface texture. The lesions are primarily located on the back and shoulders.Number of lesions: Multiple, with varying sizes.Color: Brown to black, with some lesions appearing lighter.Surface texture: Waxy and stuck-on.Distribution: Predominantly on the back and shoulders.Asymptomatic: No associated pruritus or tenderness.
The patient reports that the lesions began to appear in his late sixties and have progressively increased in number. There are no known triggers for the lesions, and he has not sought treatment previously. His past medical history is notable for hypertension and hyperlipidemia, both well-controlled with medication. He has no family history of skin cancer or similar lesions. He is a non-smoker and spends limited time outdoors, using sunscreen sporadically.Onset: Lesions started appearing in his late sixties.Progression: Gradually increased in number over the years.Prior treatments: None sought for the lesions.Past medical history: Hypertension and hyperlipidemia.Family history: No known skin cancer or similar lesions.Social history: Non-smoker, limited sun exposure.
Acute / First-Line ManagementCryotherapy: Liquid nitrogen can be applied to individual lesions, causing them to freeze and eventually fall off. Typically, a single treatment is sufficient for most lesions.Curettage: Manual removal of lesions using a curette is effective for larger lesions or those in cosmetically sensitive areas.Electrosurgery: This technique can be used for removal and is effective in minimizing bleeding.Workup and Diagnostic ConfirmationClinical diagnosis: Typically made based on characteristic appearance and distribution of lesions.Biopsy: Reserved for atypical cases or when malignancy is suspected; shows a well-circumscribed proliferation of keratinocytes.Long-Term ManagementObservation: Most cases require no treatment unless lesions become symptomatic or for cosmetic reasons.Patient education: Inform patients about the benign nature of the condition and the importance of monitoring for new or changing lesions.
Actinic keratosis: Typically presents as rough, scaly patches on sun-exposed areas; often associated with a history of sun damage.Basal cell carcinoma: Usually appears as a pearly papule with telangiectasia; may ulcerate; requires biopsy for confirmation.Melanoma: Asymmetrical, irregular borders, and varied colors; important to biopsy any atypical lesions.Dermatofibroma: Firm, raised lesions often associated with a central dimple; usually solitary.Keratoacanthoma: Rapidly growing, dome-shaped nodules that may resemble squamous cell carcinoma; often self-limiting.Psoriasis: Characterized by well-defined, erythematous plaques with silvery scales; typically associated with pruritus.Nevi: Benign moles that can vary in size and color; regular monitoring is essential.Verruca vulgaris: Cauliflower-like lesions caused by HPV, often located on hands and feet; can be painful.
High-Yield PearlsBenign nature: Seborrheic keratoses are benign tumors that do not require treatment unless symptomatic or for cosmetic reasons.Commonality: These lesions are very common in older adults, particularly those over age 50.Diagnosis: Diagnosis is primarily clinical; biopsy is rarely needed unless the lesions are atypical.Treatment options: Various treatment modalities exist, including cryotherapy, curettage, and electrosurgery, depending on the patient’s preferences and lesion characteristics.Monitoring: Regular skin examinations are recommended to monitor for new lesions or changes in existing ones.Remember, seborrheic keratoses are often described as 'stuck-on' lesions and are a hallmark of aging skin.
Tags: seborrheic keratosis, elderly