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Patient Case: Basal Cell Papilloma (Seborrheic Keratosis)

Patient Case: Basal Cell Papilloma (Seborrheic Keratosis)

Discussion

A 67-year-old woman presents to the dermatology clinic with a dark brown, slightly raised lesion on her left shoulder that she first noticed several years ago. She reports that the lesion has gradually increased in size but has remained painless and non-itchy. Recently, she became concerned after noticing a rough texture and some mild scaling on its surface.

On examination, the lesion is well-defined, oval, and has a "stuck-on" appearance with a waxy, verrucous texture. It is asymmetrical but non-ulcerated and measures 1.5 cm in diameter. There is no surrounding redness or signs of inflammation.

A clinical diagnosis of seborrheic keratosis (basal cell papilloma) is made. The patient is reassured that the lesion is benign, and she is offered cryotherapy or curettage if she wishes for cosmetic removal.

Questions
  1. What is the most likely diagnosis for this patient’s skin lesion?
    a) Actinic keratosis
    b) Seborrheic keratosis
    c) Basal cell carcinoma
    d) Melanoma
  2. Which clinical feature is most characteristic of seborrheic keratosis?
    a) Rapid ulceration and bleeding
    b) A waxy, "stuck-on" appearance
    c) Central ulceration with rolled borders
    d) Poorly defined irregular borders
  3. What is the most appropriate management for seborrheic keratosis?
    a) Wide surgical excision
    b) Topical chemotherapy
    c) Reassurance, with removal for cosmetic reasons or irritation
    d) Immediate biopsy and systemic treatment
  4. Which of the following statements is true regarding seborrheic keratosis?
    a) It has a high risk of malignant transformation
    b) It is commonly seen in elderly individuals
    c) It is always pruritic and painful
    d) It requires aggressive surgical treatment
Reveal answers

Answers

  1. (b) Seborrheic keratosis
    • The lesion's gradual onset, waxy surface, and "stuck-on" appearance are classic for seborrheic keratosis, distinguishing it from actinic keratosis, basal cell carcinoma, and melanoma.
  2. (b) A waxy, "stuck-on" appearance
    • The hallmark of seborrheic keratosis is its waxy, verrucous texture that appears as if it is pasted onto the skin, unlike malignant lesions that tend to ulcerate or have irregular borders.
  3. (c) Reassurance, with removal for cosmetic reasons or irritation
    • Seborrheic keratosis is benign and usually requires no treatment. However, lesions may be removed using cryotherapy, curettage, or laser therapy if they cause irritation or cosmetic concern.
  4. (b) It is commonly seen in elderly individuals
    • Seborrheic keratosis is also known as senile wart because it is age-related, appearing more frequently in older adults. Unlike malignant lesions, it has no risk of cancer transformation.