Update on Seborrheic Keratosis: Optimizing Patient Outcomes
Seborrheic keratosis (SK) is a common benign lesion, usually round or oval, ranging from light tan to dark brown. SK lesions affect 1 out of 5 Americans, particularly those older than 50 years. Clinicians must accurately diagnose SK lesions before removing them. SK lesions are be- nign and can be removed for cosmetic reasons if the patient desires; treatment may be indicated—and reimbursable—if the lesion is irritated. In the case of suspicious lesions, clinicians should perform a shave biopsy to ensure that they are not premalignant or malignant tumors. Choice of treatment is based on the number of lesions, location on the body, skin pigmentation, thickness of the lesion, and overall esthetic considerations. Cryosurgery is the method preferred by most physicians for removing these lesions; other methods include curettage, electrosurgery, lasers, and a combination of modalities. Emerging topical therapies may provide effective lesion removal without the adverse effects seen with cryotherapy, lasers, or other standard modalities.
Some 83 million Americans—approximately 20% to 25% of the population—are affected by SK.1,2 These benign lesions are usually seen in people older than 50 years.2 SK lesions are equally distributed among men and women, although a recent survey of patients with SK found a slightly higher rate among men.2 Furthermore, SK is thought to be more prevalent in Caucasians, but a variant form known as dermatosis papulosa nigra can affect people with Fitzpatrick skin type VI (Table 1).3,4
Participants should read the activity information, review the activity in its entirety, and complete the online post- test and evaluation. Upon completing this activity as designed and achieving a passing score on the post- test, you will be directed to a Web page that will allow you to receive your certificate of credit via e-mail or you may print it out at that time.
Inquiries about continuing medical education (CME) accreditation may be directed to the University of Louisville Office of Continuing Medical Education & Professional Development (CME & PD) at email@example.com or (502) 852-5329.
Physicians: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Louisville and Global Academy for Medical Education, LLC. The University of Louisville is accredited by the ACCME to provide continuing medical education for physicians. The University of Louisville Office of CME & PD designates this enduring material for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education: Postgraduate Institute for Medicine (PIM) is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for 0.6 contact hour is provided by the PIM. This educational activity is designated for 0.1 contact hour of pharmacotherapy credit for Advance Practice Registered Nurses.
Brian Berman, MD, PhD
Christopher B. Zachary, MBBS, FRCP
Seborrheic keratosis (SK) is a common and benign skin lesion that affects more than 80 million Americans. Medical intervention is not required unless the diagnosis is uncertain and a biopsy is indicated, or unless the SKs are symptomatic (pruritus, irritation, or bleeding). Still, many patients seek medical advice because of cosmetic issues or concerns about the possibly malignant nature of the lesions. Current treatment modalities involve tissue destruction, which poses a risk for scarring, hyper- or hypopigmentation, or other unwanted sequelae. Future treatments may offer a topical approach that reduces the risk of unacceptable outcomes. Clinicians should be able to diagnose SK accurately and efficiently, and should be aware of current and emerging treatment strategies.
By reading and studying this supplement, participants should be better able to:
- Differentiate seborrheic keratosis (SK) from other skin lesions
- Describecurrentandemergingtreatmentoptions for SK
- Matchpatientswiththemostappropriateinterventions for effective removal of SKs, including those in cosmetically sensitive areas, such as the face and neck
Individuals in a position to control the content of this educational activity are required to disclose: 1) the existence of any relevant fi- nancial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commer- cial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.
Brian Berman, MD, PhD
Consultant: Aclaris Therapeutics, Inc.
Christopher B. Zachary, MBBS, FRCP, has no relevant financial relationships to disclose.
Staff and Advisory Board Disclosures: The University of Louisville CME & PD Advisory Board and office staff have nothing to disclose.
CME/CE Reviewers: Cindy England Owen, MD, Assistant Professor, Division of Dermatology, University of Louisville School of Medicine, has no relevant financial relationships to disclose. The PIM planners and managers, Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker-Mitchek, MBA, MSN, RN; and Jan Schultz, MSN, RN, CHCP, have no relevant financial relationships to disclose.
Global Academy for Medical Education Staff: Suzanne Bujara; Sylvia H. Reitman, MBA, DipEd; Ron Schaumburg; and Shirley Jones, MBA, have no relevant financial relationships to disclose.
This CME/CE supplement was developed from interviews with the faculty. Dr Berman and Dr Zachary acknowledge the editorial assistance of Global Academy for Medical Education and Suzanne Bujara, medical writer, in the develop- ment of this supplement. Neither the editors of Dermatology News nor the Editorial Advisory Board nor the reporting staff contributed to its content. The ideas and opinions expressed in this supplement are those of the faculty and do not necessarily reflect the views of the supporter, Global Academy for Medical Educa- tion, the University of Louisville, Postgraduate Institute for Medicine, or the Publisher.
Copyright © 2017 Global Academy for Medical Education, LLC, and Frontline Medical Com- munications. All rights reserved. No part of this publication may be reproduced or trans- mitted in any form, by any means without prior written permission of the Publisher.
Global Academy for Medical Education, LLC, Frontline Medical Communications, The University of Louisville, and Postgraduate Institute for Medicine will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including claims related to the products, drugs, or services mentioned herein.
1. Jackson JM, Alexis A, Berman B, Berson DS, Taylor S, Weiss JS. Current understanding of seborrheic keratosis: prevalence, etiology, clinical presentation, diagnosis, and management. J Drugs Dermatol. 2015;14(10):1119-1125.
2. Del Rosso JQ. A closer look at seborrheic keratoses: patient perspectives, clinical relevance, medical necessity, and implications for management. J Clin Aesthet Dermatol. 2017;10(3):16-25.
3. Hafner C, Vogt T. Seborrheic keratosis. J Dtsch Dermatol Ges. 2008;6(8):664-677.
4. Roberts WE. Skin type classification systems old and new. Dermatol Clin. 2009;27(4):529-533.
5. Squillace L, Cappello M, Longo C, Moscarella E, Alfano R, Argenziano G. Unusual dermoscopic patterns of seborrheic keratosis. Dermatology. 2016;232(2):198-202.
6. Neel VA, Todorova K, Wang J, et al. Sustained Akt activity is required to maintain cell viability in seborrheic keratosis, a benign epithelial tumor. J Invest Dermatol. 2016;136(3):696-705.
7. Walter FM, Prevost AT, Vasconcelos J, et al. Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study. Br J Gen Pract. 2013;63(610):e345-e353.
8. Eads TJ, Hood AF, Chuang TY, Faust HB, Farmer ER. The diagnostic yield of histologic examination of seborrheic keratoses. Arch Dermatol. 1997;133(11):1417-1420.
9. Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669-676.
10. Carrera C, Segura S, Aguilera P, et al. Dermoscopic clues for diagnosing melanomas that resemble seborrheic keratosis. JAMA Dermatol. 2017;153(6):544-551.
11. Patel P, Khanna S, McLellan B, Krishnamurthy K. The need for improved dermoscopy training in residency: a survey of US dermatology residents and program directors. Dermatol Pract Concept. 2017;7(2):17-22.
12. Rogers T, Marino M, Dusza SW, Bajaj S, Marchetti MA, Marghoob A. Triage amalgamated dermoscopic algorithm (TADA) for skin cancer screening. Dermatol Pract Concept. 2017;7(2):39-46.
13. Sato Y, Fujimura T, Tamabuchi E, Haga T, Aiba S. Dermos- copy findings of hidroacanthoma simplex. Case Rep Dermatol. 2014;6(2):154-158.
14. Piccolo D, Di Marcantonio D, Crisman G, et al. Unconventional use of intense pulsed light. Biomed Res Int. 2014;2014:618206.
15. Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol. 2004;43(4):300-302.
16. Taylor SC. Advancing the understanding of seborrheic keratosis. J Drugs Dermatol. 2017;16(5):419-424.
17. ClinicalTrials.gov. A study of A-101 solution 40% in subjects with seborrheic keratosis. NCT02667236. https://clinicaltrials.gov/ct2/ show/NCT02667236. Updated December 1, 2016. Accessed July 21, 2017.
18. ClinicalTrials.gov. A randomized, double-blind, vehicle-controlled study in subjects with seborrheic keratosis (SK). NCT02667275. https://clinicaltrials.gov/ct2/show/NCT02667275. Updated December 1, 2016. Accessed July 21, 2017.
19. ClinicalTrials.gov. An open-label safety study of A-101 solution. NCT02667288. https://www.clinicaltrials.gov/ct2/show/ NCT02667288. Updated December 1, 2016. Accessed August 14, 2017.
20.Cuevas P, Angulo J, Salgüero I, Giménez-Gallego G. Clearance of seborrhoeic keratoses with topical dobesilate. BMJ Case Rep. 2012;2012.
21. Aktaş, H. Ergin C, Keseroğlu HÖ. Diclofenac gel may be a new treatment option for seborrheic keratosis. Indian Dermatol Online J. 2016;7(3):211-212.
22. Levy-Nissenbaum E, Thio HB, Burstein P, Thaçi D. Seborrheic keratosis removal in a multicentre phase I/II clinical trial using a novel topical formulation (BL-5010). Br J Dermatol. 2015;173:247-249.
23. Levy-Nissenbaum E, Thio HB, Burstein P, Thaçi D. Seborrheic keratosis removal in multicenter phase I/II trial using a novel topical formulation (BL-5010). Poster presented at: 23rd Congress of the European Academy of Dermatology and Venerology; October 8-12, 2014; Amsterdam, The Netherlands.
24.Brodsky J. Management of benign skin lesions commonly affecting the face: actinic keratosis, seborrheic keratosis, and rosacea. Curr Opin Otolaryngol Head Neck Surg. 2009;17(24):315-320.
25. Mitsuhashi Y, Kawaguchi M, Hozumi Y, Kondo S. Topical vitamin D3 is effective in treating senile warts possibly by inducing apoptosis. J Dermatol. 2005;32(6):420-423.