SEBORRHEIC KERATOSES

CLINICAL OVERVIEW & TREATMENT APPROACH

Seborrheic keratoses (SKs) are common benign skin growths that develop from the outer layer of the skin. They often have a raised, waxy, rough, or “stuck-on” appearance and may range in color from light tan to brown, dark brown, or nearly black.

Seborrheic keratoses may occur almost anywhere on the body and are frequently found on the face, scalp, neck, trunk, and extremities. Some patients develop only a few lesions, while others develop numerous growths that gradually increase in number and thickness over time.

Although seborrheic keratoses are benign, they may become irritated, inflamed, itchy, repeatedly traumatized, or cosmetically bothersome. Dark or changing lesions may also resemble other pigmented skin growths and require careful evaluation before treatment.

At International Vein & Skin Institute, seborrheic keratoses are evaluated and treated by Dr. Jozef Tryzno, MD. Treatment is selected according to the diagnosis, lesion size and thickness, number and distribution, anatomic location, symptoms, and expected healing.

CLINICAL EVALUATION

Evaluation begins with focused clinical examination and, when appropriate, dermoscopic assessment.

Important characteristics include:

Color and pigmentation
Surface texture and thickness
Degree of elevation
Number and distribution
History of growth or change
Irritation, inflammation, itching, or bleeding
Diagnostic certainty

Many seborrheic keratoses have a characteristic appearance. Others, particularly darkly pigmented, inflamed, rapidly changing, or atypical lesions, may require additional evaluation before treatment.

WHEN BIOPSY MAY BE NEEDED

Not every raised, pigmented, or “stuck-on” appearing lesion is a seborrheic keratosis.

Biopsy or removal for histopathologic examination may be recommended when:

The diagnosis is uncertain
A lesion has atypical clinical or dermoscopic features
There has been significant change in appearance
A lesion repeatedly bleeds or becomes ulcerated
Another skin lesion or malignancy needs to be excluded

When diagnostic tissue is needed, biopsy or surgical removal is selected rather than destructive treatment.

WHEN SEBORRHEIC KERATOSES ARE TREATED

Seborrheic keratoses do not require treatment simply because they are present.

Removal may be considered when lesions are:

Inflamed, irritated, itchy, or painful
Repeatedly traumatized by clothing, jewelry, shaving, or grooming
Bleeding
Increasing in size or thickness
Located where they interfere with daily activities
Cosmetically bothersome
Diagnostically uncertain

Treatment may involve one lesion, several selected lesions, or numerous lesions within a larger area, depending on the presentation.

TREATMENT OPTIONS AT IVSI

Seborrheic keratoses vary considerably in size, thickness, pigmentation, location, and number. The treatment method is selected according to the individual lesion and whether tissue needs to be preserved for histopathologic examination.

CO₂ LASER ABLATION / EVAPORATION

Ablative CO₂ laser treatment may be used for selected seborrheic keratoses, particularly when multiple raised or superficial lesions are being treated.

The laser allows controlled evaporation of the lesion with limited procedural bleeding. Treatment depth can be adjusted according to the thickness and location of the growth.

CO₂ laser treatment is particularly useful in cosmetically sensitive areas and when numerous appropriate lesions are treated during the same session.

CO₂ LASER–ASSISTED SHAVE REMOVAL

For thicker or more elevated seborrheic keratoses, CO₂ laser-assisted shave removal may be used.

The raised portion of the lesion is removed tangentially using a surgical instrument or CO₂ laser. The remaining base may then be treated with controlled CO₂ laser ablation and coagulation.

When diagnostic confirmation is needed, removed tissue can be preserved and submitted for histopathologic examination rather than destroying the entire lesion.

SURGICAL REMOVAL / BIOPSY — SELECT LESIONS

Selected lesions that are very thick, atypical, repeatedly traumatized, or diagnostically uncertain may be better treated by biopsy or surgical removal.

This approach preserves tissue for histopathologic examination and allows the diagnosis to be established before any additional treatment is considered.

MULTIPLE SEBORRHEIC KERATOSES

Some patients develop numerous seborrheic keratoses across the face, neck, trunk, or other areas rather than one isolated lesion.

Treatment of multiple lesions may be performed during the same session when appropriate. The number treated at one time depends on the size and thickness of the lesions, treatment area, skin characteristics, and expected healing.

When extensive numbers of lesions are present, treatment may be staged over more than one session rather than attempting to treat every lesion at once.

EXPECTATIONS & RECURRENCE

Removal eliminates or reduces the treated growth, but it does not prevent additional seborrheic keratoses from developing elsewhere.

Some thicker lesions may require additional treatment when residual tissue remains. New lesions may also continue to develop over time.

The cosmetic result depends on the size and depth of the lesion, treatment method, anatomic location, skin characteristics, and individual healing response.

YOUR ROLE IN PROPER HEALING

Following treatment, temporary redness, mild swelling, superficial crusting, or color difference between treated and surrounding skin may occur.

Treated areas should be kept clean and protected from picking, scrubbing, friction, and unnecessary irritation while healing. Sun protection is particularly important for treated areas exposed to sunlight.

Specific aftercare instructions are provided according to the treatment performed and location of the lesions.

IMPORTANT PROCEDURAL CONSIDERATIONS

Seborrheic keratoses are benign, but diagnostic certainty comes before destructive treatment. A lesion that is clinically atypical or cannot be confidently identified may require biopsy or histopathologic examination.

Treatment planning also considers skin type, lesion pigmentation, location, depth, and healing characteristics, particularly when lesions occur on the face or other cosmetically sensitive areas.

Symptomatic or diagnostically uncertain lesions may require medical treatment, while removal of stable benign lesions for appearance alone is generally cosmetic.

SCHEDULE A SKIN LESION EVALUATION

An evaluation can help determine whether a growth represents a seborrheic keratosis or another type of skin lesion and which removal method is appropriate.

📞 Call (847) 518-9999 to schedule a skin lesion evaluation

Medical Disclaimer
This information is provided for educational purposes only and does not replace individualized medical evaluation. Treatment recommendations depend on clinical findings, diagnostic requirements, and patient-specific factors. Outcomes may vary, and no specific medical or cosmetic result can be guaranteed.

Learn More About