Seborrheic keratosis (SK) is a common, benign skin growth that tends to appear on the scalp, face, trunk, and extremities starting in the 4th decade of life. SKs tend to be raised, white/tan/pink/brown/black in color, and can have a somewhat greasy appearance. Some people might only have a few SKs on their entire body, while others may go on to develop hundreds of them. While SKs are nearly always benign, rare cases of skin cancer arising within or adjacent to them have been reported.
Seborrheic keratoses are harmless benign skin growths, so removal is considered elective. However, they are often perceived as cosmetically bothersome due to their rough and discolored appearance. Some individuals have numerous seborrheic keratoses on the face or back, which causes the skin to appear rough in texture and uneven in color.
Although it is not known exactly what causes SKs, many people will say that one or both of their parents also had them, and autosomal dominant inheritance of SKs has also been described in dermatology literature. While seborrheic keratoses are not completely preventable, as they are largely influenced by genetics and aging, protecting your skin from excessive sun exposure by wearing sunscreen and protective clothing may reduce the likelihood of their development over time.
Seborrheic keratosis should only be removed by an experienced, board-certified dermatologist. Only dermatologists are expertly trained in the diagnosis and management of various skin growths. Before any removal takes place, a proper diagnosis must be rendered to ensure that the growth is not cancerous, as treatment options for cancerous growths are vastly different from treatment options for benign growths.
Understanding Seborrheic Keratosis
A seborrheic keratosis (seb-o-REE-ik ker-uh-TOE-sis) is a common benign skin growth, similar to a mole. Most people will have at least one in their lifetime. They tend to appear in mid-adulthood and their frequency increases with age. They are harmless and don’t require treatment, but you can have them removed if they bother you.
Skin growths like seborrheic keratoses are sometimes also called epidermal tumors. That doesn’t mean they’re cancer, though. Technically, moles and warts are also epidermal tumors. That just means they are clusters of extra cells on the epidermis, the outer layer of the skin. They aren’t considered a risk factor for skin cancer.
Appearance of Seborrheic Keratoses
Seborrheic keratoses are roundish or oval-shaped patches on the skin with a “stuck on” appearance. They are sometimes described as waxy or scaly. They are raised above the skin and even when they are flat you can feel them with your finger. They are usually brown, but can also be black or tan, and less often, pink, yellow or white. They often appear in numbers.
Seborrheic keratoses are characterized by keratin on the surface - the same fibrous protein that fingernails, hooves, and horns are made of. This causes the textural details that often distinguish the growths. Sometimes it looks like small bubbles or cysts within the growth. Sometimes it looks scabby or wart-like. Sometimes it looks like the ridges and fissures in a brain. A brown spot under the eye can be an example of seborrheic keratosis.
Who is Affected by Seborrheic Keratosis?
Anyone can get one, but most commonly:
- People who are 50 and older. They usually begin to appear in middle age, and rarely in younger people. About 30% of people have at least one by the age of 40, and about 75% by the age of 70.
- People with a family history of it. About half of all cases of multiple seborrheic keratoses occur in families, suggesting that the tendency to develop many of them may be inherited.
- Lighter-skinned people. Classic seborrheic keratosis as described here appears less frequently in darker-skinned people.
Seborrheic keratoses can develop almost anywhere on the body, except for the palms of the hands, soles of the feet, and lips. They most commonly appear on the scalp, face, neck, shoulders, and back, where they may form in clusters or as isolated growths.
Laser Treatment for Seborrheic Keratosis
Laser treatment is one option to treat thin seborrheic keratoses. This method uses an intense beam of light to selectively destroy the brown portion of the seborrheic keratosis. Laser removal is minimally invasive and minimizes scarring.
Ablative CO2 and Er:YAG devices have shown success in achieving single-session clearance in up to 90% of lesions. In contrast, pigment-selective nonablative modalities, such as 755-nm alexandrite, 1,064-nm Nd:YAG, 532-nm KTP, 585-nm pulsed-dye, and 730-nm and 755-nm picosecond lasers, typically require a mean of 1 to 3 sessions.
Recurrence rates for laser treatment have ranged from 0% to 6% at ≤12-month follow-up. Patient-reported satisfaction with laser therapy has varied from moderate to high, ranging from 64% to 95%.
The Laser Procedure
A laser procedure often won’t require numbing medicine, but if it is needed, a topical anesthetic can be applied to your skin to numb the area. The dermatologist then directs the beam of laser light at the seborrheic keratosis, which instantly destroys the cells of the growth. This type of removal is brief overall, and patients are able to return home immediately after.
At Gateway Aesthetic Institute and Laser Center, board-certified dermatologists use a state-of-the-art erbium laser to precisely ablate SKs. The spot size used during this process is less than 1 mm in diameter, allowing for extremely careful destruction of the SK while sparing damage to the surrounding skin.
Although some physicians recommend treating SKs by curetting them (scraping with a sharp metal loop), freezing them (cryotherapy), or burning them (cautery or electrodesiccation), these approaches are often imprecise and can lead to overaggressive treatment causing scarring or pigmentary issues, undertreatment where the SK is not completely removed, or pigmentary damage to the surrounding skin (either hyperpigmentation where the skin becomes darker, or hypopigmentation or even depigmentation where the pigment is temporarily or permanently destroyed).
Seborrhoeic Keratosis Removal - See The Laser Treatment
Healing and Results After Laser Treatment
Once the laser treatment is complete, the treated area may initially appear gray and will then darken over the course of the next two weeks. Aftercare can include applying Vaseline to keep the area moist and promote maximum healing. The treated area must be protected from the sun to minimize hyperpigmentation. The lesion will then eventually fall off over the course of two weeks.
When you’ve fully recovered from your laser treatment, the appearance of your seborrheic keratosis should be significantly reduced, if not eliminated completely. There may be some mild discoloration or pinkness, which fades over time. It is important to avoid sun exposure in the treated areas to prevent hyperpigmentation.
Recovery time can range from a couple of days to several weeks, depending on the number of SKs to be treated, their size, anatomic location, and density. Areas with a more robust blood supply that are rich in follicles and glands will heal more quickly than areas of the body that lack these characteristics. For example, SKs treated on the face and scalp will heal more quickly than those treated on the lower legs.
Once the treated areas have healed, it is possible to apply sunscreen and/or makeup over them to camouflage any residual redness, which will eventually fade with time. When people have hundreds of SKs on the trunk (back and/or abdomen and chest) or legs that they wish to have treated in a single session, the treated areas can stay red for weeks to months even after the skin has healed.
Current Evidence and Alternatives
Current evidence supports laser therapy as a safe, effective alternative to cryotherapy, curettage, and electrosurgery, especially when cosmesis is paramount.
While many practitioners offer to freeze, burn, or scrape off SKs, these approaches are imprecise, as well as fraught with a high risk of complications. Additionally, because many people with SKs are in their 4th/5th decade of life and beyond, with a history of sun exposure, it is important to have a board-certified dermatologist carefully examine your skin both before and during treatment, to ensure that no spots suspicious for skin cancer or precancer are hiding amongst your SKs.
Other Treatment Modalities
Other methods for seborrheic keratosis removal include:
- Hyfrecation (Electrodessication): This method utilizes gentle amounts of electric energy to remove the growth and can remove larger and thicker seborrheic keratoses than laser treatments. Multiple treatments may be necessary.
- Shave Removal: For larger seborrheic keratoses, a shave removal may be required. This procedure uses a surgical blade to debulk and pare down the majority of the lesion, sometimes in combination with hyfrecation for the best cosmetic outcome.
- Cryotherapy: Freezing the growth with liquid nitrogen can be an effective way to remove a seborrheic keratosis, but it doesn't always work on raised, thicker growths and carries the risk of permanent loss of pigment, especially on darker skin tones.
It is absolutely possible to have other treatments performed on the same day. Because SKs on the face are superficial growths that do not extend beyond the epidermis, it is in most cases possible to have any number of other treatments performed on the same day, in order to bundle your recovery time.
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