Seborrheic Keratosis: What It Is, How to Identify It, and When to Treat

What Is a Seborrheic Keratosis?

A seborrheic keratosis is a common, harmless skin growth that typically appears in middle-aged and older adults. These growths have a characteristic waxy, stuck-on appearance and range in color from light tan to dark brown or even black. Despite their sometimes alarming appearance, seborrheic keratoses are completely benign.

They develop from keratinocytes, the cells that make up the outermost layer of skin. The exact cause is not fully understood, but genetics, sun exposure, and aging all play a role. Most people develop at least one seborrheic keratosis by the time they reach their 50s, and it is common to have multiple growths.

“Every skin lesion deserves a proper diagnosis before treatment. Many seborrheic keratoses look similar to other conditions, and dermoscopic examination is the key to telling them apart safely.”

How to Identify a Seborrheic Keratosis

Seborrheic keratoses have several distinctive features that help distinguish them from other skin conditions:

Appearance. They look waxy, scaly, or slightly raised, as if they were pasted onto the skin surface. Some have a rough, crumbly texture, while others appear smoother. They can range from a few millimeters to several centimeters in size.

Color. Most are tan, brown, or dark brown, though they can also be yellowish, gray, or nearly black. A single lesion may contain multiple colors.

Location. They appear most commonly on the face, chest, shoulders, and back, but can develop almost anywhere on the body except the palms of the hands and soles of the feet.

Sensation. Seborrheic keratoses are typically painless. However, they can become itchy or irritated, especially in areas where clothing rubs against them.

When Is Professional Evaluation Needed?

While seborrheic keratoses are harmless, not every brown or raised skin lesion is a keratosis. Some skin cancers, including melanoma, can resemble a seborrheic keratosis in their early stages. This is why professional evaluation is always recommended when you notice a new or changing skin growth.

You should seek evaluation promptly if a lesion:

At our clinic, every lesion undergoes a thorough clinical and dermoscopic examination before any treatment is considered. Dermoscopy allows visualization of structures beneath the skin surface that are invisible to the naked eye, providing a high degree of diagnostic accuracy.

Treatment Options

Seborrheic keratoses do not require treatment from a medical standpoint. However, many patients choose to have them removed for cosmetic reasons, because they are bothersome in a certain location, or because the lesion becomes repeatedly irritated.

Laser Treatment

Laser removal is one of the most effective and precise methods for treating seborrheic keratoses. The laser targets the keratosis with controlled energy, vaporizing the abnormal tissue while sparing the surrounding healthy skin. Advantages include:

You can see examples of seborrheic keratosis treatment results in our treatment gallery.

Cryotherapy

Freezing with liquid nitrogen is another common approach. It works well for smaller, thinner lesions but may require multiple sessions for larger growths.

Curettage

A small instrument is used to scrape off the growth after numbing the area. This method works well but may leave a slightly larger mark than laser treatment.

The Importance of Proper Diagnosis

One important point deserves emphasis: the appearance of seborrheic keratoses can overlap significantly with other conditions. A dark seborrheic keratosis can look like melanoma. An irritated keratosis can resemble squamous cell carcinoma. Only a trained dermatologist using dermoscopy can reliably distinguish between these conditions.

This is why at our clinic, we follow a diagnosis-first approach. Before any removal procedure, Dr. Kaplan performs a comprehensive examination of the lesion. If there is any suspicion of malignancy, a biopsy is performed and the tissue is sent for pathological analysis.

For lesions confirmed to be malignant, treatment follows a completely different pathway, potentially including surgical excision or Mohs surgery to ensure complete removal.

Living with Seborrheic Keratoses

If you choose not to have your seborrheic keratoses treated, there is no medical harm in leaving them alone. Keep these practical points in mind:

When to See a Doctor

Regular skin checks are valuable for everyone, particularly if you have multiple skin lesions. A dermatologist can evaluate all your growths efficiently and identify anything that warrants closer attention.

If you have seborrheic keratoses that you would like evaluated or treated, schedule a consultation with Dr. Kaplan for a thorough assessment and personalized treatment plan.