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Seborrheic Keratosis (Seborrheic Eczema) and Actinic Keratosis (Solar Keratosis)

by Carlo Raj, MD
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    00:02 Our topic now, we'll go through a bunch of names that sound quite a like, so I really need you to focus on the manner in which I’m describing and pronouncing these names, okay? The last time we’ve seen the term seborrheic is something that you want to make sure that you are firmly, firmly familiar with.

    00:22 When we talked about -- Well do you remember that waxy, greasy, yellow type of appearance in an infant known as a cradle cap? What was that called? Seborrheic dermatitis.

    00:37 Clear? So if you’re not familiar with seborrheic dermatitis, go back and review that in our discussion.

    00:45 Our topic here is seborrheic keratosis.

    00:49 Where you’ve learned about this and where you’ve seen this in medical school in your education has been with Leser-Trélat sign, but I’m really going to go into further detail.

    00:58 Because it’s not always that.

    01:01 Very common in the elderly.

    01:02 Has nothing to do with GI cancer.

    01:05 Nothing to do with gastrointestinal neoplasia.

    01:07 Is that clear at this point? Very common in the elderly.

    01:12 Greater than 65% of persons older than 80 may have quite a number of these seborrheic keratosis or keratoses.

    01:23 Thought to be inherited in an autosomal dominant fashion with a cherry angioma.

    01:28 You know, with cherry angioma.

    01:30 A cherry angioma versus a strawberry hemangioma.

    01:35 A strawberry hemangioma was seen in a child and here, the size of that particular rash literally looks like a peel of strawberry.

    01:45 You would recommend that it would get bigger then it would subside over maybe weeks, months, years with strawberry.

    01:52 A cherry hemangioma or cherry angioma will be permanent and once again will be a benign accumulation of blood in your blood vessel.

    02:02 And say that you have these cherry hemangiomas that are then going to give what’s known as a dark brown, almost like a chocolate-like appearance.

    02:12 In pathology, we describe this as being a stuck on appearance.

    02:16 What do we mean by that? It means that you’re -- work with me here -- chewing on a piece of chocolate maybe like toffee , took it out of your mouth and literally placed it on the back of your patient.

    02:29 That’s what seborrheic keratosis looks like.

    02:32 It could be inherited in terms and with cherry angioma also being associated.

    02:39 Possesses absolutely no malignant potential.

    02:44 Seborrheic keratosis in this case, here is something that I’m giving you, without the association of GI cancer.

    02:52 Morphology would be sharply circumscribed.

    02:54 Literally like taking a piece of chocolate and putting it on a person’s back.

    02:59 We call this stuck on.

    03:03 White-yellow, maybe brown in appearance.

    03:09 Management: Well, requires really no treatment.

    03:13 Seborrheic keratosis, SK, doesn’t require a treatment.

    03:16 If inflamed, traumatized or symptomatic, they may be destroyed.

    03:22 What I wish to bring to attention is something that we talked about.

    03:25 Is that if you do have a patient that has GI cancer, maybe a primary gastric adenocarcinoma or maybe colorectal cancer, there is every possibility that you might have a sudden outcropping of the seborrheic keratosis.

    03:41 It has nothing to do autosomal dominant, not inherited, and has nothing to do with elderly.

    03:45 It’s an association that you might find with your GI cancer.

    03:50 So this type of GI cancer and this type of seborrheic keratosis appearing, you would then call this what? Leser-Trélat sign, that we’ve talked about in GI.

    04:01 At this point, our strict discussion is in terms of dermatology.

    04:06 Seborrheic keratosis not to be confused with seborrheic dermatitis and definitely not to be confused with, later on, we’ll talk about actinic keratosis.

    04:17 You see as to how terminologies -- everything in derm.

    04:22 Your pathology, acanthotic.

    04:24 What does that mean to you? Thickened epidermis with overlying hyperkeratosis, sharply demarcated base.

    04:31 It looks like, as I told you earlier, a piece of chocolate that has been placed on the back and therefore if you take a look at the histology here, It will be sharply demarcated because of increased thickness of your keratinocytes.

    04:43 Hyperkeratosis, as you can see in the histologic picture here.

    04:47 Management: As a general rule, 50% have regressed by age 5.

    04:52 Seventy percent by age 7.

    04:54 Ninety percent by age 9.

    04:56 High dose oral steroids can be used for lesions threatening vital structures if it gets to be that massive.

    05:03 Surgery is reserved only for those that are threatening vital structures and that then failed to respond to high dose steroids.

    05:10 But as a general rule, you pay attention to 50-5, 70-7, 90-9.

    05:16 Clear? Most of these will be self-limited, they will regress and exactly these percentages that I’ve given you as a rule of thumb.

    05:27 Here, we move on to actinic keratoses or actinic keratosis.

    05:31 Pause here for a second and make sure that you know that our topic is actinic keratosis versus seborrheic keratosis.

    05:42 So what does actinic keratosis mean to you? This is premalignant.

    05:46 Is that clear? Seborrheic keratosis, really no chance of going on to malignancy.

    05:53 So if you’re thinking about malignancy, then you’re thinking about on your skin exposure to UV rays.

    05:58 So therefore, actinic keratosis is premalignant caused by UV exposure.

    06:04 Have a potential to move on -- Now of the type of skin cancers that we will discuss in this section, which will then include squamous cell cancer, which is our topic, squamous cell cancer of the skin or cutaneous squamous cell is what you must think of actinic keratosis as being premalignant to.

    06:22 Is that clear? Clinically feels gritty, like sand paper.

    06:28 Remember, as far as the skin is concerned, what kind of cells are these? Squamous cells.

    06:33 So therefore, upon exposure to UV rays, maybe premalignant condition such as actinic as you see in the picture here and worst case scenario, unfortunately, may go on to squamous cell cancer of the skin.

    06:46 Our first true premalignant condition, actinic keratosis.


    About the Lecture

    The lecture Seborrheic Keratosis (Seborrheic Eczema) and Actinic Keratosis (Solar Keratosis) by Carlo Raj, MD is from the course Neoplastic Skin Diseases. It contains the following chapters:

    • Seborrheic Keratosis
    • Actinic Keratoses

    Included Quiz Questions

    1. This lesion has no malignant potential
    2. Has malignant potential and needs intervention
    3. Needs further evaluation and treatment
    4. High dose of steroids is strongly recommended
    5. Needs surgical treatment
    1. Actinic keratosis
    2. Seborrheic dermatitis
    3. Seborrheic keratosis
    4. Benign nevus
    5. Pyogenic granuloma
    1. Seborrheic keratosis
    2. Seborrheic dermatitis
    3. Actinic keratosis
    4. Strawberry hemangioma
    5. Psoriasis
    1. By UV radiation
    2. Exposure to chemicals
    3. Exposure to extreme heat
    4. Itching
    5. By the bite of an insect

    Author of lecture Seborrheic Keratosis (Seborrheic Eczema) and Actinic Keratosis (Solar Keratosis)

     Carlo Raj, MD

    Carlo Raj, MD


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