Seborrheic keratosis: The Daily PANCE Blueprint

The answer is A. Bownish, verrucous-like lesions with a “stuck on” appearance

Seborrheic keratoses are benign epidermal tumors that typically present as well-demarcated, brownish to black lesions with a characteristic “stuck on” or “pasted on” appearance. These lesions often have a verrucous, waxy texture with keratin-filled invaginations called horn cysts that may be visible on close examination. They commonly develop in middle-aged to elderly individuals and tend to increase in number with age. Seborrheic keratoses show no malignant potential and typically require no treatment unless they become irritated, inflamed, or are cosmetically concerning to the patient.

Incorrect Answer Explanations:

• B. Dome-shaped, flesh-colored nodules – This description is characteristic of basal cell carcinoma (nodular type), which presents as a pearly, flesh-colored or pink dome-shaped nodule often with telangiectasias on the surface. Unlike seborrheic keratoses, basal cell carcinomas are malignant and typically occur on sun-exposed areas.
• C. Irregular lesions with ulceration – This description suggests either an advanced basal cell carcinoma or a squamous cell carcinoma, both of which can present with irregular borders and central ulceration. Seborrheic keratoses typically do not ulcerate unless traumatized.
• D. Plaques with silvery scale – This is the classic presentation of psoriasis, an immune-mediated inflammatory condition characterized by well-demarcated, erythematous plaques covered with silvery scales, often on extensor surfaces. Psoriasis is a chronic condition requiring ongoing management.
• E. Erythematous macules on sun areas – This description is consistent with actinic keratosis, a precancerous lesion that presents as rough, scaly, erythematous patches or macules on sun-exposed skin. Unlike seborrheic keratoses, actinic keratoses have malignant potential.