Malignant Seborrheic Keratosis M 72

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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. [email protected]

    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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