Seborrheic Keratosis
Seborrheic keratosis, a benign growth lesion, is a very common cutaneous lesion encountered in white races in the fourth and fifth decade. They usually form warty proliferations that appear pasted onto the surface, are usually pigmented, and may have a wa
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Sandra Ronger Savle
40.1 Clinical Presentation Seborrheic keratosis, a benign growth lesion, is a very common cutaneous lesion encountered in white races in the fourth and fifth decade. They usually form warty proliferations that appear pasted onto the surface, are usually pigmented, and may have a waxy appearance owing to extruded keratin (Fig. 40.1). The occurrence of this lesion on the vulva is rare, as an isolated lesion or in association with lesions elsewhere. The classical clinical features, distinct keratotic and follicular plugging and
stuck on appearance, disappear because of the friction and maceration typical of this area. The mean age is over 60 years [1]. The differential diagnosis between seborrheic keratosis, malignant melanoma and genital wart is difficult.
40.2 Dermoscopy Features We can see gland openings which created a pseudonetwork. There are multiple milia-like cysts. A cerebriform pattern is noted, like on VHSIL.
40.3 Histopathology
Fig. 40.1 Seborrheic keratosis on the perineum
Broad columns of highly pigmented basaloid cells intermingled with horn cysts. They have delicate fibrovascular cores. Melanin pigment is frequently present throughout the proliferation, and the surface is usually hyperkeratotic. Mitoses are absent or rare. When irritated, there may be prominent inflammation and atypia that is characterized by mild nuclear atypia and a more squamoid appearance. But unlike vulvar HSIL, mitotic figures remain confined to the basal layers, and atypical mitoses are absent [2].
S. Ronger Savle (*) Department of Dermatology and Gynecology, Lyon 1 University and Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France © Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_40
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Sebohrreic Keratosis: Breaking the Myths
• This is a very common cutaneous lesion. • The classical clinical features disappear because of the friction and maceration typical of the vulva. • The lesion sometimes look alike vulvar intraepithelial neoplasia. However, here mitotic figures remain confined to the basal layers and atypical mitoses are absent.
References 1. Giogi V, Massi D, salvini C, Mannone F. Pigmented seborrheic keratoses of the vulva clinically mimicking a malignant melanoma: a clinical, dermoscopic-pathologic case study. Clin Dermatol. 2005;30:17–9. 2. Reutter JC, Geisinger KR, Laudadio J. Vulvar seborrheic keratosis: is there a relationship to human papillomavirus? J Low Genit Tract Dis. 2014 Apr;18(2):190–4.
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