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Benign Epithelial Tumors and Proliferations


The entities in this chapter can be further classified according to the algorithm in Fig. 89.1 .

Fig. 89.1
Simplified classification of benign epidermal proliferations.
Although the term solitary lichenoid keratosis is sometimes used, patients may develop multiple lesions, especially those with skin phototypes I or II and significant actinic damage. Entities in italics are not covered.

Courtesy, Luis Requena, MD.

Common

Seborrheic Keratosis

  • Begin to appear during the 4th decade of life and then gradually increase in number.

  • Macular, papular, or verrucous; colors vary from white to black but most commonly brown.

  • Typically has a “stuck-on” appearance with a smooth to verrucous surface ( Fig. 89.2 ).

    Fig. 89.2, Seborrheic keratoses.

  • Spares the palms, soles, and mucosal surfaces.

  • May resemble a melanoma clinically but has no pigment network (by dermoscopy) and has horn pseudocysts.

  • Sudden appearance of multiple lesions may be associated with internal malignancy ( sign of Leser–Trélat) or erythroderma; the former may also be associated with skin tags, irritated seborrheic keratoses, tripe palms, and acanthosis nigricans.

  • Histopathology: a spectrum of different architectures, most commonly acanthotic, papillomatous and hyperkeratotic, or irritated ( Fig. 89.3 ).

    Fig. 89.3, Seborrheic keratoses – spectrum of histologic subtypes.

  • Variants:

    • –

      Dermatosis papulosa nigra ( Fig. 89.4 ): common in dark-skinned individuals; 1- to 5-mm hyperpigmented papules on the face

      Fig. 89.4, Dermatosis papulosa nigra.

    • –

      Stucco keratosis ( Fig. 89.5 ): 1- to 4-mm gray-white papules on the lower extremities (especially dorsal feet and ankles) of older adults

      Fig. 89.5, Stucco keratoses.

    • –

      Inverted follicular keratosis : endophytic variant of seborrheic keratosis; tan to pink papule, typically on the face of adults

Cutaneous Horn

  • Clinical term for marked hyperkeratosis arising from a papule or nodule ( Fig. 89.6 ).

    Fig. 89.6, Cutaneous horn.

  • The base of the lesion most commonly represents an actinic keratosis or wart, but of the entities in this chapter, a seborrheic keratosis is most common; sometimes the base is a squamous cell carcinoma.

Solitary Lichenoid Keratosis/Lichen Planus-Like Keratosis

  • Pink to pink-brown papule or plaque ( Fig. 89.7 ); arises in chronically sun-damaged skin, most commonly on the chest, arms, and shins.

    Fig. 89.7, Lichenoid keratosis.

  • Occasionally multiple.

  • Clinically mimics basal cell carcinoma or Bowen disease.

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