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M 72, right upper chest, raised keratotic lesion

Deba P Sarma, MD

Omaha

M 72, right upper chest, raised keratotic lesion

Diagnosis:

Seborrheic keratosis with in-situ squamous cell carcinoma

(Malignant seborrheic keratosis)

Comment:

Diagnosis:

Skin, right upper chest, biopsy:

Malignant seborrheic keratosis (In-situ squamous cell carcinoma arising in

seborrheic keratosis)

Ref:

Sharma P, Sarma DP, Adickes ED (2006). Seborrheic keratosis with in-situ

carcinoma changes. Dermatology Online J 12(7):19. PMID: 17459305 [PubMed -

indexed for MEDLINE]

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Seborrheic keratosis with in-situ squamous cell carcinoma changesPoonam Sharma MD, Deba P Sarma MD, Edward D Adickes DODermatology Online Journal 12 (7): 19

Department of Pathology, Creighton University Medical Center, Omaha Nebraska. dpsarma@yahoo.com

We are reporting a rare case of seborrheic keratosis with

Bowenoid changes occurring in an 80-year-old man. The Englishliterature on the topic is briefly reviewed.

Clinical synopsis

An 80-year-old man presented with a long-standing skin

lesion on his mid forehead, clinically thought to be squamous cellcarcinoma. An excisional biopsy was performed. The specimen

consisted of a rounded piece of skin measuring 0.8 cm in maximum

dimension that featured a raised verruciform epidermal lesion.Microscopic examination revealed a raised stuck-on epidermal

neoplasm showing basaloid dark epidermal cells over the deep part

of the lesion. There were several benign squamous eddies

suggesting irritated pattern of seborrheic keratosis. A few horncysts were noted. The superficial part of the lesion showed

papillomatosis and hyperkeratosis (Fig. 1). The benign basaloidsquamous cells gradually blended with areas of markedly

dysplastic squamous cells with numerous mitoses in a disorderlygrowth pattern, indicative of in-situ carcinoma. The entire lesion

also showed areas of acantholysis (Fig. 2).

Figure 1 Figure 2

Figure 1. Low magnification showing seborrheic keratosis

(magnification X 4)

Figure 2. High magnification shows seborrheic keratosis with

several squamous eddies on the right side and dysplastic

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pleomorphic squamous cells of in-situ carcinoma on the left

side (magnification X 40)

Comment

Seborrheic keratosis is a common benign epidermal neoplasm

occurring in about 20 percent of the elderly population. Malignant

transformation of such a tumor is a very rare event. Sloan andJaworsky noted 60 cases of in-situ squamous cell carcinoma

occurring among 4310 cases (1.4 %) of clinically diagnosedseborrheic keratosis [1]. Malignant change seems to occur in the

lesions located in the head and neck, typically exposed to solar

degeneration. In addition to in-situ squamous cell carcinoma,invasive squamous cell carcinoma and basal cell carcinoma arising

in seborrheic keratosis have been reported [2,3]. Malignant

change, mostly in-situ carcinoma, is usually detected on themicroscopic examination of a long-standing seborrheic keratosis

located in the head and neck, and with a recent history of ulceration

or increasing size. Many of these cases are probably histologicallyinterpreted as an in-situ carcinoma because the residual seborrheic

keratosis may be difficult to detect.

References

1. Sloan JB, Jaworsky C. Clinical misdiagnosis of squamous cell carcinoma in

situ as seborrheic keratosis. A prospective study. J Dermatol Surg Oncol 1993;

19:413-416.

2. Yap WM, Tan PH, Ong BH. Malignancy arising in seborrheic keratosis: a

report of two cases. Ann Acad Med Singapore 1997; 26:235-237.

3. Kwittken J. Malignant changes in seborrheic keratosis. Mt Sinai J Med 1974;

41:792-801.

2006 Dermatology Online Journal

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