Dermabrasion for Showers of Seborrheic Keratoses

Abstract

Seborrheic keratoses, skin tumors of undetermined etiolo gy, are easily traumatized with consequent local irritation and inflammation, and are cosmetically undesirable. They can occasionally undergo malignant degeneration. A rapid increase in size and number of these lesions is thought by many to be a sign o f internal malignancy. Dermabrasion using a diamond fraise is a simple and fast method for removing multiple seborrheic keratoses with minimal trauma, rapid healing, and good cosmetic results.Seborrheic keratoses, also called seborrheic warts, senile warts, verrucae senilis, basal-cell papillomas,1 are very common in white men and women equally ( Fig. 1). Such lesions usually appear in the fifth decade, but can occur at earlier ages. Their cause is not known. Perhaps they are nevoid anomalies that develop in persons with a genetically determined predisposition for them and thus can be considered in entirety an epithelial nevus tardus.2 An autosomal dominant mode of inheritance has been suggested.3 Their development results from local arrests of maturation of keratinocytes that are normal in other re spects.4 It is questionable if other factors such as internal malignancy, sun exposure or seborrheic dermatitis are oper ative.which malignant degeneration developed upon seborrheic keratoses and of those neoplasias, 26% were basal-cell epi theliomas and 74%, carcinomas in situ. The head was the most common site for the complications.Sudden appearance of seborrheic keratoses with rapid increase in size and number is known as the sign of Leser-Trelat and should arouse suspicion of internal malignancy. In all reported cases of internal malignancy with the sign of Leser-Trelat, the onset of the seborrheic keratoses was less than one year and the patients afflicted were aware of this rapid growth.6 Adenocarcinoma is the most common type of neoplasm found associated and is most frequently intra abdominal.7 Kierland questions the relationship of rapidly developing seborrheic keratoses to malignancy because they occur in the elderly in whom there is an inevitable increased incidence of malignancy and because seborrheic keratoses more commonly occur without m alignancy.8 The validity of the sign of Leser-Trelat remains in question. TREATMENTEvery cutaneous surgeon has a favored method for re moving seborrheic keratoses. There are indeed many methods and any modality of treatment may be an effective one, depending on site and number of lesions to be treated.

Dermabrasion for the Treatment of a Giant Seborrheic Keratosis

“…Dermabrasion has commonly been utilized for correction of cutaneous scars and removal of tattoos but is also useful for removal of superficial cutaneous lesions 1 . This method is best applied to lesions that do not extend below the papillary der‐mis, such as lentigines, verrucous nevi, epidermal nevi, actinic keratosis, and seborrheic keratosis 2 . Trichoepitheliomas, syringomas, adenoma seba‐ceum, and Darier's disease have also been treated by dermabrasion with varying degrees of success 3, 4 …”

1 The History and Evolution of Skin Resurfacing

“…9 Over the next 20 years, dermabrasion was applied to many cutaneous conditions beyond just scars and acne pits, conditions that produce irregularities of the skin such as acne rosacea, rhinophyma, seborrheic keratoses, sebaceous hyperplasia, fibrous tumors of tuberous sclerosis, and discoid lupus erythematosus, just to name a few. 10,11,12,13,14 It was also widely applied in the removal of tattoos. 15 During this period, histological studies showed the significant dermal remodeling that takes place, an effect that is comparable to that seen in laser and deep peels.…”