Seborrheic Keratosis

Seborrheic keratosis, often also referred to as senile warts, is a benign skin tumor that occurs primarily in the second half of life. Almost everyone will develop seborrheic keratosis at some point, making senile warts the most common skin tumor.

Seborrheic Keratosis

What is Seborrheic Keratosis?

Seborrheic keratosis is also known as basal cell papilloma. The tumor tends to occur in old age and affects both sexes equally. The tumor is an increased tissue growth of the uppermost skin layers with corneal proliferation and the formation of horny globules in the uppermost layers of the skin. One speaks here of pseudohorny cysts. See beautyphoon for What is Mesiodentes.

The so-called basaloid cells in particular proliferate, i.e. grow faster and in greater numbers. Acanthosis is typical of seborrheic keratosis. Acanthosis is a widening of the spinous cell layer (stratum spinosum) of the uppermost epithelial layer of the skin. The histological picture also shows various characteristic growth patterns.

The keratinocytes, specialized keratin-producing cells of human skin, are often hyperpigmented. So, the keratinocytes in seborrheic keratosis contain excessive amounts of melanin. Orthohyperkeratosis is also typical of basal cell papilloma. The stratum corneum, the horny layer of the skin, is thickened.


The exact cause of seborrheic keratosis is still unclear. On the one hand, it is assumed that the tumors are simply age-related skin symptoms. Genetic predisposition appears to play a role. The influence of external factors such as UV radiation, chemicals or exposure to light is still unclear. In 20 percent of all cases of seborrheic keratosis, a connection to human papillomaviruses could be found.

Human papillomaviruses are viruses that infect the epithelial cells of the skin and cause uncontrolled cell growth there. Age spots are discussed to be the starting point of seborrheic keratosis, since the transitions between the skin spots and the skin tumors are clinically and histologically fluid.

Symptoms, Ailments & Signs

The tumor occurs primarily on the face, upper body, back of the hands and front of the arms. Predilection points on the upper body are the front and rear sweat grooves. The front sweat groove runs in the area of ​​the sternum, the rear sweat groove is the furrow between the shoulder blades. Seborrheic keratosis presents as irregularly shaped tumors that are raised above the level of the skin.

The tumors usually have sharp borders and are brownish to black in color due to the melanin deposits. Colorless variants are also known. In most cases, the basal cell papilloma is rather small. The diameter ranges from a few millimeters to one centimeter. Only in rare cases does the tumor grow larger. The surface of seborrheic keratosis is dull, dull, or warty. In advanced stages there is a rugged surface.

The tumor feels greasy and greasy due to sebum secretions. In bends, for example in the armpit, the seborrheic keratosis can also occur in a stalked manner. If a large number of tumors suddenly appear, this is known as Reader-Trélat syndrome. This can appear in the context of chronic inflammatory dermatoses or, as a paraneoplastic syndrome, provide an indication of an adenocarcinoma of the stomach.

Diagnosis & course of disease

When diagnosing, it is important to differentiate seborrheic keratosis from malignant skin tumors, since seborrheic warts can be confused with basalioma and malignant melanoma. Dermatoscopy is performed in most cases to differentiate. Here, the skin is examined with a reflected-light microscope down to the deeper layers of the skin. If the clinical classification is still unclear after the dermatoscopy, a histopathological examination is carried out.

Tissue is removed from the tumor using a fine biopsy and examined under a microscope. If the tissue removed is the tissue of a seborrheic keratosis, there are histological abnormalities such as the orthohyperkeratosis described above, the pseudohorny cysts or the acanthosis. The prognosis of seborrheic keratosis is good. Since it is a benign skin change, the tumor does not metastasize.

Rarely does recurrence occur after removal. Occasionally, the tumor recurs in a different location. Only in very rare cases does the basal cell papilloma develop into a basal cell carcinoma, an infiltrating skin tumor. The development of a carcinoma in situ, i.e. a localized, malignant tumor, is observed only extremely rarely.


This disease usually causes various skin problems. Complications do not have to occur in every case. Many people have the condition but do not experience any particular symptoms or symptoms. In most cases, this results in reduced aesthetics, so that many patients feel uncomfortable or ashamed of the discomfort.

A reduced sense of self-esteem or an inferiority complex can also occur and have a very negative effect on the patient’s quality of life. The tumor usually remains the same size and does not change. The tumor can cause symptoms, especially on the face or other clearly visible areas. However, there is no pain or other discomfort. If the tumor is in the stomach, it can lead to stomach problems.

In most cases, treatment of the disease is only necessary if the tumor changes color or size. This can be removed. There are no particular complications and the course of the disease is usually positive. The life expectancy is usually not negatively affected by the tumor.

When should you go to the doctor?

As a rule, a doctor should always be consulted with this disease. It cannot heal on its own, so the person affected is always dependent on medical treatment. Above all, early diagnosis with early treatment has a positive effect on the further course of the disease. In order to prevent the tumor from spreading to other regions of the body, regular check-ups and examinations by a doctor are necessary.

A doctor should be consulted if black dots or spots develop on the body. These can occur in different places and should be examined by a doctor. A greasy layer on these spots also often indicated seborrheic keratosis. A doctor should also be consulted if these spots change in shape, color or size. A dermatologist can be consulted. The further treatment then depends on the exact symptoms and their severity. If the tumor is removed early, there are no further complications and there is no reduced life expectancy.

Treatment & Therapy

Normally, no treatment is required for seborrheic keratosis. However, the skin growths are often perceived as visually disturbing or cause pain due to mechanical irritation. If one of these factors applies and the diagnosis is clear, the tumor can be removed. During cauterization, the tumor is removed with an electric snare or a sharp curette. In the eyelid area, the tumor is removed using carbon dioxide.

Other methods of removal are freezing (cryotherapy) or laser removal. Before removing the tumor, a biopsy with histological examination should always be performed. Otherwise there is a risk that a malignant tumor will be overlooked. If you were to remove this malignant tumor using the methods described, the superficial tumor tissue would be removed, but degenerated tissue could remain in the lower layers of the skin and metastasize from there unnoticed.


Since the causes of basal cell papilloma are still unclear, reliable prevention is not possible. In order to be able to distinguish benign seborrheic keratoses from malignant and more dangerous skin tumors, skin examinations should be carried out regularly by a dermatologist. From the age of 35, it is recommended to have a skin cancer screening test every two years.


Seborrheic keratosis, also known as senile warts because it usually occurs in the second half of life, is a benign skin tumor that usually does not require medical treatment. However, if those affected feel particularly uncomfortable with it, cosmetic removal may be considered. However, if the keratoses are in places that are often exposed to mechanical irritation, it is advisable to have the age warts removed.

Especially when putting on and taking off, it can quickly happen that the keratoses tear open due to uncoordinated movements, start to bleed and subsequently become unpleasantly inflamed. In order to ensure that the affected person is benign skin tumors, an examination by a dermatologist makes sense. This will determine the harmlessness of the keratoses by means of a tissue sample.

Normal senile warts do not usually pose a health risk for those affected. However, the focus here is often on the aesthetic aspect. If the keratoses appear on the face, it can put a psychological strain on those affected. In consultation with a dermatologist, there are various ways to successfully remove the keratoses and thus restore the self-esteem of those affected. Medical treatment is also required if the skin tumors change in shape or color.

You can do that yourself

Seborrheic keratosis does not necessarily require treatment, but many people feel uncomfortable with it. Anyone who finds age warts uncomfortable should consider cosmetic removal. This is particularly advisable if the keratoses are in a place that becomes inflamed quickly. When shaving and sometimes when getting dressed, those affected quickly brush against the patches of skin, which then begin to bleed. Here it is important to ensure that the areas do not become inflamed.

As part of self-help, you should therefore never scratch open the warts. An examination by a dermatologist makes sense to ensure that the skin tumors are not malignant. This takes care of an accurate tissue sample.

Normal senile warts do not pose a threat, but they can cause certain discomforts, such as irritation from clothing. Above all, the aesthetic problems are an important aspect for most women and men. It makes you feel unattractive and tries to hide the dark points. In everyday life, the spots on the face are particularly annoying. As long as these do not change their shape and color, there is no health risk, but regular check-ups with the doctor are advisable.