Management of Seborrheic Keratosis

Diagnostic Considerations

• The American Academy of Dermatology recommends assessing for major warning signs using the revised checklist for suspected malignant melanoma, including change in size, change in shape, change in color, diameter ≥ 7 mm, inflammation, sensory change, and crusting or bleeding 1

Assessment Algorithm

• The British Medical Association suggests that photographic evaluation alone is not sufficient for definitive diagnosis, and cases of melanoma mimicking seborrheic keratosis have been documented, highlighting the risk of misdiagnosis based solely on visual assessment 1

Management Options After In-Person Evaluation

• For uncertain diagnosis, the British Journal of Cancer recommends complete excision with a narrow rim (2 mm) of normal skin, and tissue should be sent for histopathological examination 2
• The Journal of the American Academy of Dermatology suggests that reflectance confocal microscopy (RCM) may be used as an additional diagnostic tool in specialized settings, but has limitations for very thickened or ulcerated lesions 4