Unsightly, perhaps: but dangerous?

November 8, 2013

The location is unusual, but the appearance is characteristic. Your dx?



This raised, approximately 1.3-cm in diameter, irregular, waxy lesion at the lateral eyebrow of a 62-year-old man had been present for about 2 years. It had gradually enlarged but remained asymptomatic, although the patient considered it unsightly.

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Answer:C. Seborrheic keratosis

The lesion was removed in the office under local anesthesia by shave excision at its base followed by electrodessication of the base. Mupirocin ointment was applied twice daily with complete healing reached after 7 to 10 days, with good cosmesis. The pathologic diagnosis was seborrheic keratosis.

Seborrheic keratoses are the most common benign skin neoplasms and have no malignant potential. They occur on hair any hair-bearing surface and are more common with advancing age. They appear to be stuck to the skin and are located within the epidermis; they have a sharp border, and variable brown coloration.

The diagnosis can be made based on the typical appearance in most cases. In the unusual case where there is doubt about diagnosis, a biopsy should be performed, if not total excision for diagnostic purposes.

Seborrheic keratoses may appear singly or in numbers and this may influence choice of treatment. Removal is typically for cosmetic reasons or to eliminate irritation. An elliptical incision is unnecessary in a typical case. The lesion is usually either shave-excised at its base or removed by cryotherapy or curettage.

This dermatologic lesion is easily treated in the primary care physician’s office so requires no referral. This is an unusual location for a seborrheic keratosis but removal went smoothly nonetheless.