SEBORRHEIC KERATOSES

CLINICAL OVERVIEW & MANAGEMENT APPROACH

Seborrheic keratoses (SKs) are common benign skin growths that develop from the outer layer of the skin. They often appear as raised, waxy, or “stuck-on” lesions and may vary in color from light tan to dark brown or black.

Seborrheic keratoses can occur anywhere on the body but are most frequently found on the face, trunk, scalp, neck, and extremities. They are not contagious and are not caused by sun exposure alone, although they may coexist with sun-damaged skin.

CLINICAL EVALUATION

Evaluation of suspected seborrheic keratoses typically includes:

• Focused clinical examination
• Dermoscopic assessment, when appropriate
• Review of lesion characteristics, including:
  • Color and surface texture
  • Thickness and degree of elevation
  • Number and distribution of lesions
  • History of growth, irritation, or bleeding

While many seborrheic keratoses have a characteristic appearance, some lesions may resemble other benign or malignant conditions, particularly when they are dark, inflamed, rapidly changing, or located on the face.

WHEN DIAGNOSTIC CONFIRMATION IS REQUIRED

In certain situations, histopathologic confirmation is required before treatment.

A biopsy may be necessary when:

• The lesion has atypical features
• The diagnosis is uncertain based on clinical or dermoscopic evaluation
• There is concern for malignancy
• The lesion has changed in appearance, bled, or become symptomatic

Biopsy allows accurate diagnosis and ensures that lesions requiring medical or oncologic management are not treated as presumed benign growths.

TREATMENT CONSIDERATIONS

Seborrheic keratoses are benign and do not require treatment unless they raise diagnostic concern or cause symptoms. Treatment decisions are individualized and based on:

• Diagnostic certainty
• Lesion size, thickness, and location
• Number of lesions
• Symptoms such as irritation, bleeding, or recurrent inflammation

WHEN TREATMENT IS MEDICALLY NECESSARY

Seborrheic keratoses may require medical treatment when they are:

• Inflamed, irritated, or painful
• Recurrently traumatized (e.g., bleeding from clothing or shaving)
• Rapidly changing in appearance
• Symptomatic (itching, tenderness, bleeding)
• Clinically atypical or indistinguishable from malignancy on exam

In these situations, diagnostic confirmation or surgical management may be required.

MEDICALLY NECESSARY SURGICAL TREATMENT OPTIONS

When medical indications are present, treatment may include:

1. Surgical Excision

• Used when complete removal is required
• Appropriate for lesions with concerning features
• Allows for histopathologic evaluation when needed

2. Shave Removal / Biopsy

• Commonly used for raised or irritated lesions
• May be performed for:
  • Symptom relief
  • Diagnostic clarification
  • Pathology confirmation

Pathology review is obtained when clinically indicated and may be required to support medical necessity and insurance authorization.

COSMETIC TREATMENT OPTIONS

(When no medical indication is present)

When seborrheic keratoses are asymptomatic, stable, and clinically benign, treatment may be considered elective and cosmetic.

Cosmetic options offered at IVSI include:

1. CO₂ Laser–Assisted Shaving and Ablation

• Controlled removal of raised lesions
• Allows precise contouring of the lesion surface
• Particularly useful on cosmetically sensitive areas

2. CO₂ Laser Destruction / Evaporation

• Ablative removal of multiple superficial benign growths
• Intended to improve appearance, not for diagnosis

Cosmetic treatments are not submitted to insurance and are discussed separately with clear expectations regarding healing and results.

DIAGNOSTIC ACCURACY BEFORE DESTRUCTIVE TREATMENT

Lesions that are:

• Pigmented
• Rapidly changing
• Ulcerated or bleeding
• Atypical in appearance

require clinical evaluation and, when indicated, biopsy before laser destruction or cosmetic removal.

Destructive procedures are not performed on lesions with uncertain diagnosis.

MEDICAL VS. COSMETIC CARE

• Medical treatment is performed to address symptoms, injury, or diagnostic concern
• Cosmetic treatment is elective and intended to improve appearance only

This distinction is discussed clearly during consultation to support safe care, proper diagnosis, and informed decision-making.

Learn more about our approach to Skin Surgery & CO₂ Laser Procedures.

SCHEDULE AN EVALUATION

If you have a growth that is inflamed, changing, injured, or cosmetically concerning:

📞 Call (847) 518-9999

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.