Ann Dermatol.  2016 Apr;28(2):152-158. 10.5021/ad.2016.28.2.152.

Clinical and Histopathological Investigation of Seborrheic Keratosis

• Roh NK
• Hahn HJ
• Lee YW
• Choe YB
• Ahn KJ

• KMID: 2171370
• DOI: http://doi.org/10.5021/ad.2016.28.2.152

Abstract

BACKGROUND
Seborrheic keratosis (SK) is one of the most common epidermal tumors of the skin. However, only a few large-scale clinicohistopathological investigations have been conducted on SK or on the possible correlation between histopathological SK subtype and location.
OBJECTIVE
The aim of this study was to analyze the clinical and histopathological features of a relatively large number of cases of diagnosed SK.
METHODS
Two hundred and seventy-one pathology slides of skin tissue from patients with clinically diagnosed SK and 206 cases of biopsy-proven SK were analyzed. The biopsy-proven cases of SK were assessed for histopathological subclassification. The demographic, clinical, and histopathological data of the patients were collected for analysis of associated factors.
RESULTS
The most frequent histopathological subtype was the acanthotic type, followed by mixed, hyperkeratotic, melanoacanthoma, clonal, irritated, and adenoid types; an unexpectedly high percentage (9.2%) of the melanoacanthoma variant was observed. The adenoid type was more common in sun-exposed sites than in sun-protected sites (p=0.028). Premalignant and malignant entities together represented almost one-quarter (24.2%) of the clinicopathological mismatch cases (i.e., mismatch between the clinical and histopathological diagnoses). Regarding the location of SK development, the frequency of mismatch for the sun-exposed areas was significantly higher than that for sun-protected areas (p=0.043).
CONCLUSION
The adenoid type was more common in sun-exposed sites. Biopsy sampling should be performed for lesions situated in sun-exposed areas to exclude other premalignant or malignant diseases.

Keyword

Classification; Pathology; Seborrheic keratosis

MeSH Terms

Adenoids
Biopsy
Classification
Humans
Keratosis, Seborrheic*
Pathology
Skin

Figure

• 

  Fig. 1 Age distribution of (A) 271 clinically diagnosed and (B) 206 biopsy-proven seborrheic keratosis patients.

• 

  Fig. 2 An acanthotic type of seborrheic keratosis, taken from the left postauricular region of an 86-year-old woman. The epidermis is greatly thickened. Horny invaginations appear as pseudohorn cysts (H&E, ×40).

• 

  Fig. 3 An adenoid-type seborrheic keratosis taken from the forehead of a 73-year-old man. Numerous thin tracts of epidermal cells extend from the epidermis and branch and interweave within the dermis. Many of the tracts are composed of only a double row of basaloid cells (H&E, ×40).

• 

  Fig. 4 Distribution of histopathological subtypes in the 206 biopsy-proven cases of seborrheic keratosis.

• 

  Fig. 5 Distribution of histopathological subtypes in the (A) sun-exposed and (B) nonexposed sites.

Reference

1. Lee GS, Ahn KJ, Kim JM, Lee ES. A histopathologic study of the seborrheic keratosis. Korean J Dermatol. 1992; 30:76–80.

2. Elder DE, Elenitsas R, Johnson BL Jr, Murphy GF, Xu X. Lever's histopathology of the skin. 10th ed. Philadelphia: Lippincott-Raven;2009. p. 795–798.

3. Yeatman JM, Kilkenny M, Marks R. The prevalence of seborrhoeic keratoses in an Australian population: does exposure to sunlight play a part in their frequency? Br J Dermatol. 1997; 137:411–414.

4. Kwon OS, Hwang EJ, Bae JH, Park HE, Lee JC, Youn JI, et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol Photoimmunol Photomed. 2003; 19:73–80.

5. Park JW, Kyung MS, Kim KS, Shin DH, Choi JS, Kim KH. An acantholytic variant of sevorrheic keratosis. Korean J Dermatol. 2000; 38:705–707.

6. Kim HY, Kim HS, Cho EB, Park EJ, Kim KH, Kim KJ. A clinicohistopathological study on the lesion resembling seborrheic keratoses of the face. Korean J Dermatol. 2013; 51:494–500.

7. Jeong YI, Lee WJ, Bak HN, Oh SH, Jung HJ, Chang SE, et al. Detection of human papilloma virus DNA in seborrheic keratosis of Korean skin. Ann Dermatol. 2007; 19:99–105.

8. Marks R, Jolley D, McCormack C, Dorevitch AP. Who removes pigmented skin lesions? J Am Acad Dermatol. 1997; 36:721–726.

9. Park S, Park H, Cho K. Clinical and histopathologic study of seborrheic keratosis. Korean J Dermatol. 2011; 49:12–19.

10. Gill D, Dorevitch A, Marks R. The prevalence of seborrheic keratoses in people aged 15 to 30 years: is the term senile keratosis redundant? Arch Dermatol. 2000; 136:759–762.

11. Ahn SK, Shin DH, Lee KG, Choi IJ. Seborrheic keratosis: A clinical and histopathological study. Korean J Pathol. 1986; 20:484–490.

12. Cheng AG, Deubner H, Whipple ME. Melanoacanthoma of the external auditory canal: a case report and review of the literature. Am J Otolaryngol. 2007; 28:433–435.

13. Carlos-Bregni R, Contreras E, Netto AC, Mosqueda-Taylor A, Vargas PA, Jorge J, et al. Oral melanoacanthoma and oral melanotic macule: a report of 8 cases, review of the literature, and immunohistochemical analysis. Med Oral Patol Oral Cir Bucal. 2007; 12:E374–E379.

14. Andrews BT, Trask DK. Oral melanoacanthoma: a case report, a review of the literature, and a new treatment option. Ann Otol Rhinol Laryngol. 2005; 114:677–680.

15. Kihiczak GG, Centurión SA, Schwartz RA, Lambert WC. Giant cutaneous melanoacanthoma. Int J Dermatol. 2004; 43:936–937.

16. Fornatora ML, Reich RF, Haber S, Solomon F, Freedman PD. Oral melanoacanthoma: a report of 10 cases, review of the literature, and immunohistochemical analysis for HMB-45 reactivity. Am J Dermatopathol. 2003; 25:12–15.

17. Simón P, Requena L, Sánchez Yus E. How rare is melanoacanthoma? Arch Dermatol. 1991; 127:583–584.

18. Hafner C, van Oers JM, Hartmann A, Landthaler M, Stoehr R, Blaszyk H, et al. High frequency of FGFR3 mutations in adenoid seborrheic keratoses. J Invest Dermatol. 2006; 126:2404–2407.

19. Maize JC, Snider RL. Nonmelanoma skin cancers in association with seborrheic keratoses. Clinicopathologic correlations. Dermatol Surg. 1995; 21:960–962.