Keratoma: symptoms, treatment, prevention

In this material, we will analyze in detail the causes of seborrheic keratosis, its varieties, possible health difficulties, methods of treatment and prevention. To facilitate understanding: seborrheic keratosis and keratoma will be used as synonyms in the future.
Seborrheic keratosis/keratoma is one of the most common benign tumors of human skin. It usually develops in old age due to the proliferation of the epidermis with pronounced keratinization. [1]

The epidermis is the top layer of the skin that is constantly exfoliated and completely changes within about two weeks. Its thickness ranges from 0.07 to 1.4 mm. Thus, it becomes clear that keratoma is a very superficial formation. Despite the fact that the foci of seborrheic keratosis can be very large in area, they do not penetrate into the depth of the skin.
Most often keratomas are formed on: the trunk, neck, head. Seborrheic keratosis on the skin of the extremities is quite rare, but it is not worth saying that it does not happen there.
Who has keratomas more often?

It is noted that most often these formations appear in people older than 30 years [2]. According to this Australian study [3], 12% of patients aged 15 to 25 years had an average of 6 keratomas on the skin.
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Risk factors for seborrheic keratosis:

  1. Sunlight. At least one study shows a link between the appearance of keratomas and exposure to ultraviolet light [3], although there are works questioning this statement. [2]
  2. Genetic predisposition. There are several described cases of families with inherited large amounts of keratomas, sometimes at a very young age [4].
  3. Human papillomavirus. There are indications that the DNA of the human papillomavirus can be detected on the surface of many keratomas by PCR [4]. At the same time, it should be noted that the same fragments of HPV DNA are found on unchanged skin. The role of HPV in the development of keratomas is currently quite controversial.
  4. Violations of immunity. The occurrence and progression of foci of seborrheic keratosis is possible in patients in a state of immunosuppression [15]. Prolonged use of glucocorticosteroid hormones can lead to immunodeficiency.

What does keratoma (seborrheic keratosis) look like

The appearance of a keratoma largely depends on the age of its existence.
In the initial stage, this formation protrudes very slightly above the skin level, differs slightly from it in density and has a color very close to the body. The shape of the foci is round or oval.
Then, as the number of epidermal cells in the formation increases, the keratoma increases in thickness and in height. These formations are visible to the naked eye – mili-like cysts and comedon-like spots.
One of the most common symptoms for keratoma, visible to the naked eye, is a surface that somewhat resembles the earth, cracked after rain. Such a pattern is formed by layers consisting of keratinized cells of the epidermis.
Leser-Trel syndrome
You can talk about this syndrome when a person suddenly has a lot of keratomas, especially on the trunk. In 35% of cases, this condition is associated with black acanthosis. About 50% of patients report severe itching in the keratoma area. [4]
In addition to the clinical form – on a broad basis – there is a form of seborrheic keratosis on the leg. The human papillomavirus has a very distant relation to this form of keratoma. Only in isolated cases, during histological examination of such formations, there were indications of signs of a viral lesion.
The Leser-Trel syndrome may indicate the presence of malignant tumors of internal organs, according to some reports - late stages. Most often we are talking about adenocarcinomas of the stomach, colon, breast cancer, lymphoma or leukemia. The average life expectancy of patients with this syndrome is 11 months. [4]

This means that if multiple keratomas appeared gradually and have been present on the trunk for many years – most likely, this syndrome is not in question.

Some researchers question the existence of the syndrome. This is due to the fact that these malignant tumors are more common in older patients, as well as seborrheic keratosis itself.
Keratoma treatment

It is considered that it is not necessary to treat seborrheic keratosis, because the nature of this disease is benign. Nevertheless, the removal of foci can be indicated to exclude malignancy in cases where the clinical examination data are ambiguous. Regular traumatization, for example by clothing, can lead to inflammation, bleeding and itching and be a reason for removal.

Ways to remove keratomas:
  • laser;
  • electrocoagulation;
  • the method of razor excision.

Whatever method of removal is recommended to you, it should be carried out with a histological examination, since in some cases it is possible to catch a malignant tumor at an early stage. Here are some studies:

  1. In 1.4–4.4% of cases, squamous cell carcinoma in situ is detected against the background of seborrheic keratosis [5,6]. Squamous cell carcinoma on the background of seborrheic keratosis. [11]
  2. 43 cases of basal cell carcinoma, 6 – squamous cell carcinoma, 2 melanomas on the background of seborrheic keratosis. [9]
  3. 3 cases of melanoma on the background of keratoma. [7,8,10]

There are reports that the external use of vitamin D analogues can be effective. [12] Systemic (oral administration) of 1,25-dihydroxyvitamin D3 at a dose of 0.5 mcg / day in multiple seborrheic keratosis may have a certain effect. [13] External administration of the drug "Tazaroten" has also shown its effectiveness in almost 50% of patients. [14]
Prevention of seborrheic keratosis is to protect against excessive exposure to sunlight. Unfortunately, there are no other methods of prevention, because, alas, we cannot influence our age. The situation is similar with heredity. The role of HPV in the development of keratomas is not so convincingly proven to prescribe preventive treatment.
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If you are diagnosed with keratoma, there is nothing to worry about. You can safely remove them if they cause inconvenience, but it is better to do with an additional histological examination.

If keratomas are not removed, this will not lead to negative consequences and will not affect their further appearance.

List of literature
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List of literature
  1. I. A. Lamotkin. Clinical dermatooncology: Atlas/M.: Laboratory of Knowledge, 2011.
  2. Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol, 2003.
  3. Yeatman JM, Kilkenny M, Marks R. The prevalence of seborrhoeic keratoses in an Australian population: does exposure to sunlight play a part in their frequency? Br J Dermatol, 1997
  4. Hafner C, Vogt T. Seborrheic keratosis. J Dtsch Dermatol Ges. 2008 Aug; 6(8):664-77. doi: 10.1111/j.1610-0387.2008.06788.x.
  5. Vun Y., De’Ambrosis B., Spelman L., Muir J.B., Yong-Gee S., Wagner G., Lun K. Seborrhoeic keratosis and malignancy: collision tumour or malignant transformation? Australas J Dermatol. 2006 May; 47 (2): 106–8.
  6. Rajabi P., Adibi N., Nematollahi P., Heidarpour M., Eftekhari M., Siadat A.H. Bowenoid transformation in seborrheic keratosis: A retrospective analysis of 429 patients. J Res Med Sci. 2012 Mar; 17 (3): 217–21.
  7. Thomas I., Kihiczak N.I., Rothenberg J., Ahmed S., Schwartz R.A. Melanoma within the seborrheic keratosis. Dermatol Surg. 2004 Apr; 30 (4 Pt 1): 559–61.
  8. Birnie AJ, Varma S. A dermatoscopically diagnosed collision tumour: malignant melanoma arising within a seborrhoeic keratosis. Clin Exp Dermatol. 2008 Jul; 33(4):512-3. doi: 10.1111/j.1365–2230.2008.02715.x. Epub 2008, May 6.
  9. Zabel RJ, Vinson RP, McCollough ML. Malignant melanoma arising in a seborrheic keratosis. J Am Acad Dermatol. 2000, May; 42(5 Pt 1): 831–3.
  10. Terada T., Kamo M, Baba Y., Sugiura M. Microinvasive squamous cell carcinoma arising within seborrheic keratosis. Cutis. 2012, Oct; 90 (4): 176–8.
  11. Mitsuhashi Y, Kawaguchi M, Hozumi Y, Kondo S. Topical vitamin D3 is effective intreating senile warts possibly by inducing apoptosis. J Dermatol 2005; 32: 420–423.
  12. Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing thestandard cryosurgery with topical calcipotriene, topical tazarotene, and topical im-iquimod. Int J Dermatol 2004; 43: 300–302.
  13. 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 Apr; 43(4): 300-2.
  14. Lebedeva U.V., Davidov A.B. Сlinical assessment of prevalence of seborrheic keratosis face skin and a neck among oncological patients. Stomatologia 2009.