Seborrheic Keratosis / Actinic Keratosis

Question 1

Presentation of what issue /tx?
(1) Usually multiple lesions, which can arise anywhere except the lips, palms and soles.
(2) these begin as circumscribed tan brown patches or thin plaques.
(3) Over time, they may become more papular or verrucous with a greasy scale and a stuck- on appearance.
(4) Unless disturbed, these tend to persist and grow slowly.
(5) Some lesions may be removed by trauma. Develop over hair bearing areas.
(6) Surface tends to crumble when picked.

Answer 1

Seborrheic Keratosis
Benign, doesn’t need removal unless symptomatic or symptomatic concerns
(1) Cryotherapy
-(a) Most commonly used, particularly for flat or thin lesions
-(b) Cryotherapy should only be used if the clinical diagnosis is not in doubt
(2) Curettage/shave excision
-(a) Curettage or shave excision, with submission of specimen for pathology, can be performed with a no. 15 scalpel blade after anesthesia with 1% lidocaine.
(3) Electrodessication
-(a) Electrodessication alone or followed by curettage usually requires anesthesia with 1% lidocaine.

Question 2

Seborrheic Keratosis Overview
(1) Most common acquired benign epithelial tumor of the skin. Often mistaken for _______.
(2) Typically develop after the age of ____, but they can also appear in young adulthood.
(3) There is a genetic predisposition to develop a high number of seborrheic keratoses, although the precise inheritance pattern is unknown.
(4) The pathogenesis is incompletely understood (we don’t completely know why people get them).
(5) They are generally (ASYMPTOMATIC/SYMPTOMATIC), but chronic irritation due to friction trauma may occasionally cause pruritus, pain, or bleeding.

Answer 2

1) Melanoma
2) 50
5) Asymptomatic

Question 3

SK Differential Diagnosis

Answer 3

(1) Pigmented Actinic Keratosis
(2) Superficial Spreading Melanoma

Question 4

SK lab considerations

Answer 4

Biopsy if doubt in dx

Question 5

Disposition SK /

Answer 5

(1) Full duty
(2) Derm consult if you’re unsure or concerned

Question 6

What issue / tx
Pt Hx
(a) Extensive sun exposure, hx of sunburns, sunscreen usage.
(b) Fair skin (FS I-II), male, >40 years old, geography (hot places).
Presentation
1) From the proliferation of atypical epidermal keratinocytes
2) Frequently occur in sun-exposed areas.
3) Predominate on the face, head, neck & dorsal aspect of the hands.
4) Commonly described as having a “rough, sandpaper-like” feeling.
5) Easier to detect by palpation rather than by observation initially.
6) As lesion progresses, scale becomes thicker and more yellow in color.

Answer 6

Actinic keratosis (AKA solar keratosis)
-Patient education
-Refer to Dermatology
(a) Topical 5-fluorouracil 5% cream (Efudex)
(b) Imiquimod 5% cream
(c) Electrodessication & curettage
(d) Application of liquid nitrogen (cryotherapy)

Question 7

AK ddx

Answer 7

(1) Squamous Cell Carcinoma
(2) Actinic Cheilitis (if lesion is on or near the orolabial area of the face)

Question 8

Lab considerations

Answer 8

Refer for Biopsy/eval

Question 9

SK Complications

Answer 9

Squamous Cell Carcinoma (SCC)