The most common lesions dermatologists see are not pimples, moles (also called nevi), or freckles. They are seborrheic keratoses. What? You have never heard of them? In the confusing and archaic world of dermatology terms, seborrheic keratosis ranks high in difficult spelling and pronunciation. An easier synonym is “age spot” or “barnacle”. It is pretty tough on a younger patient to hear they have an “age spot” the first time. Many dermatologists use pleasant euphemisms, “knowledge spot”, “wisdom mark”. Older patients may use the term “liver spots.” You don’t have to be ancient to have them, but their prevalence increases dramatically with the years.
“Seb Kers” as we fondly call them, are raised velvety or warty looking spots that can be a variety of colors from white to black with yellows and many shades of brown in between. Often they appear “stuck on” or “pasted on” to the skin. They can occur almost anywhere on the body. They have absolutely nothing to do with sun exposure, and almost everything to do with genetics. You are somehow programmed that at a certain age, you will begin to get them. Some people will get a few, some literally hundreds. Unfortunately there is no cream or medication that can prevent or eradicate these growths. The good news is they are completely benign and don’t evolve into anything cancerous.
In the doctor’s office there are some procedures that can remove seborrheic keratoses. The most common methods of removal are liquid nitrogen treatment (cryotherapy) or surgical removal with a scalpel or a sharp circular blade called a curette. Cryotherapy does not require an injection of local anesthetic, so is easier to perform and more popular with doctors and patients. The risk of both of these procedures is a discoloration or lightening of the treated area, or an area of texture change or scar. This occurs more often when seborrheic keratoses on the legs or back are treated.
Seborrheic keratoses can get red, swollen and crusty. These inflamed lesions can be itchy or tender. Many insurances cover removal of inflamed lesions. Treatment of asymptomatic, noninflamed age spots is considered to be cosmetic. Most practices will perform removal of multiple seb kers for a reasonable fee. Post freezing of the lesions, application of petroleum jelly, or of the ointment Aquaphor to the treated area 2 to 3 times per day will speed up the healing process. Earlier, smaller, flatter lesions are a lot easier to remove than large, thick ones. For a better cosmetic outcome, have them treated with liquid nitrogen periodically at the dermatologists office.
One big problem with seb kers is they make self skin exam difficult. We have been instructing our patients for years to monitor their skin for changing moles, and the “A, B, C, D, E”s of melanoma. When you have many brown spots, and all appear irregular, different colors, and changing, identification of worrisome moles and melanomas becomes difficult. Moles (nevi) tend to be smoother in texture than a seb ker, but that is sometimes difficult to judge. In fact, every dermatologist has sent in biopsies over the years to the lab asking them to identify whether the growth in question was an innocent seborrheic keratosis or a dangerous mole or melanoma. For that reason, it is important for patients with many spots and changing lesions to be monitored by their dermatologist or primary care doctor.
Most of us would like to grow old. We can’t always do that without a few barnacles to show for it. No need to panic if an evenly tan or brown, velvety spot appears on the face, back of the hands, or other location on the trunk or extremities. If the presence of an age spot is getting you down and you want to eradicate it, see a dermatologist. If it is irregular and you are not sure what it is, see a dermatologist. He or she will be very impressed when you say that 8 syllable tongue twister “seborrheic keratosis“.
Madeline Krauss, M.D.