Seborrheic keratoses (SKs) are the most common benign epidermal tumor of the skin and a

frequent focus of patient concern because of their variable appearance. These lesions are
common in middle-aged individuals and can arise as early as adolescence.1 Although there are
many clinical variants of the lesions, these lesions usually begin as well-circumscribed, dull, flat,
tan, or brown patches. As they grow, they become more papular, taking on a waxy, verrucous,
or stuck-on appearance (Figs. 118-1 and 118-2). Many lesions display distinctive pseudohorn
cysts that likely represent plugged follicular orifices. SKs may arise on any nonmucosal surface,
and multiple lesions may be distributed in a Christmas tree pattern along skin folds or in
Blaschko's lines.2 The color of these lesions ranges from pale white to black. At times,
distinguishing these lesions from a nevus or melanoma can be clinically challenging. Because
melanoma, basal cell carcinoma, and other cutaneous malignancies have been reported to
arise in SKs, care must be taken to critically evaluate rapidly growing, symptomatic, or unusual
lesions.3,4