List of Abbreviations
ICD — International Classification of Diseases.
TERT – Telomerase reverse transcriptase
DHPH3 – Diphthamide Biosynthesis 3
APP – amyloid precursor protein
UV — ultraviolet.
HPV – human papillomavirus
SK — seborrheic keratosis
Terms and Definitions
Seborrheic keratosis (keratoma senile, keratosis senile, senile wart) is a common benign skin condition, an epithelial skin tumor consisting of immature epidermal keratinocytes [1], which occurs, as a rule, in individuals over 50 years of age. Clinical manifestations are variable. Seborrheic keratosis can be localized on any area of the skin. It does not occur on the skin of the palms and soles [2].
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Seborrheic keratosis manifests in various forms, ranging from a pale-colored superficial patch to a brown or black scaly papule or plaque with a characteristic "stuck-on" appearance. In various publications, it is designated by different terms: seborrheic (greasy) or senile keratoma (keratosis or wart), basal cell or pigmented papilloma or epithelioma, seborrheic or verrucous acanthoma, senile papilloma, Unna's seborrheic nevus, seborrheic keratopapilloma, etc. [3,4,5]. Most commonly, the tumors exhibit a multiple growth pattern, leading to significant cosmetic defects. Furthermore, most researchers consider multiple seborrheic keratosis as a paraneoplastic process [6]. In the majority of patients, the initial manifestations of seborrheic keratosis are observed in middle age. The lesions demonstrate gradual growth in both size and number over several years. Eruptions become more widespread as a person ages and are found in almost all adults aged 60 years and older [7].
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
Seborrheic keratosis is a benign proliferation of immature keratinocytes, resulting in the formation of well-demarcated, round or oval flat patches. These lesions usually grow slowly, may increase in thickness over time, and rarely resolve spontaneously.
Seborrheic keratosis is caused by the benign clonal expansion of epidermal keratinocytes. It is believed that there is a genetic component to the development of a large number of seborrheic keratosis lesions. The exact pathogenesis of this skin disorder is currently unknown, but a possible correlation exists with the following factors:
In cases of sporadic seborrheic keratosis, activating mutations in the tyrosine kinase receptor known as fibroblast growth factor receptor 3 (FGFR3) are responsible for the growth of this benign tumor [8].
Activating mutations in the TERT and DHFR3 promoters have been detected in seborrheic keratosis [9]. However, their significance in the development of seborrheic keratosis remains unknown [10].
UV exposure increases the expression of amyloid precursor protein (APP) in skin areas, and this expression also increases with age. APP and amyloid-β42 expression are more pronounced in seborrheic keratosis compared to adjacent normal skin areas. Research findings indicate that an excessive amount of APP may accelerate the development of seborrheic keratosis and serve as an indicator of skin aging and UV-induced damage [11].
Oncogenic mutations frequently develop in the tyrosine kinase receptor/phosphatidylinositol 3-kinase/Akt signaling pathway in seborrheic keratosis, leading to increased sensitivity to Akt inhibition [1].
FoxN1 is a recently discovered biomarker indicating the presence of an oncogenically active, but non-cancerous phenotype in seborrheic keratosis [12].
There are theories regarding the role in the pathogenesis of seborrheic keratosis of Pityrosporum ovale [13], herpes virus type 6A [14], human papillomavirus [15], immunological disorders, and "keratinocyte aging" [16].
1.3 Epidemiology of the Disease or Condition
Seborrheic keratosis is the most common benign skin tumor. Seborrheic keratosis is predominantly observed in adults and elderly individuals, typically in persons over 50 years of age [17,18,19], reaching up to 80% of the population [8].
Although seborrheic keratosis is more common in middle-aged and older patients, it can also be present in young people. There is no difference in prevalence between men and women, and it occurs more frequently in individuals with lighter skin tones.
According to a retrospective cohort study of 10,545 patients over 60 years of age, seborrheic keratosis was the primary reason for teleconsultations with dermatovenereologists. Eighty-nine percent of lesions occur in patients aged 80 years and older [20]. Other studies of dermatological patients have found a similarly high age-related prevalence, as well as a higher mean number and diameter of seborrheic keratosis lesions in the elderly [21]. Seborrheic keratosis can, although much less frequently, develop at a younger age; a study involving 170 individuals aged 15–30 years showed that 24% had at least one lesion, 78% of which were on the skin of the trunk [22].
Recent studies have not revealed significant gender differences in the incidence of seborrheic keratosis, although an observational study showed that men have more lesions on the trunk and arms than women [23,24]. There is a high probability of a family history, especially in individuals with a large number of lesions [25]. SK has an autosomal dominant inheritance pattern with incomplete penetrance [26].
1.4 Features of Coding the Disease or Condition
L82 Seborrheic keratosis
1.5 Classification of the disease or condition
There is no universally accepted clinical classification. The clinical manifestations of seborrheic keratosis exhibit significant diversity.
The histopathological classification includes the following subtypes: acanthotic type, hyperkeratotic type, reticular/adenoid type, clonal type, irritated type, melanoacanthoma, and verrucous SK with keratoacanthoma-like features.
Acanthotic type
This type is the most common and is characterized by pronounced acanthosis, predominantly of basaloid cells. There is moderate papillomatosis and hyperkeratosis. Numerous horny invaginations in cross-sections appear as "pseudohorny cysts." In addition, "true horny cysts" are observed, characterized by abrupt and total cornification with a thin granular layer. Melanocytic proliferation and hyperpigmentation accompany one-third of these lesions [27].
Hyperkeratotic type (papillomatosis)
This variety is characterized by pronounced hyperorthokeratosis and papillomatosis, and may form a cutaneous horn [8].
Reticular or adenoid type.
SKs of this subtype are characterized by thin double rows of reticular acanthosis with mild to moderate hyperkeratosis and papillomatosis. This seborrheic keratosis frequently manifests with hyperpigmentation [28].
Clonal type
Clonal SK is defined by the presence of two distinct clones of basaloid cells. One of them appears as nests of cytologically distinct keratinocytes that expand the spinous layer between the normal acanthotic epidermis. Cytological atypia is observed in approximately 50% of clonal seborrheic keratoses, and in rare cases, seborrheic keratosis progresses to squamous cell carcinoma in situ. This specific type demonstrates mild acanthosis, papillomatosis, and orthohyperkeratosis. The tumor cells are spindle-shaped. In a well-circumscribed tumor, islets of basaloid cell nests are found [29,30,31].
Irritated type
Histological examination reveals spindle-shaped eosinophilic tumor cells. There is a possibility of the presence of dyskeratotic cells [32].
Melanoacanthoma
A hyperpigmented acanthotic type with proliferation of basaloid cells with moderate or even absent hyperkeratosis. Numerous melanocytes are interspersed with numerous melanophages located in the dermis. Unlike conventional seborrheic keratosis, these lesions may appear on the oral mucosa [33].
Verrucous seborrheic keratosis with keratoacanthoma-like features
This is a rare subtype. According to one study, the incidence is 0.8% of all keratoacanthomas. These lesions share characteristic features similar to keratoacanthoma, including a dome-shaped form, sharp borders, a well-differentiated epidermis, and a crater with keratin plug formation, in addition to the classical histological features of SK. The presence of HPV16 was detected [34].
Black dermatosis papulosa
Some authors consider black dermatosis papulosa as a separate disease, however, the histological picture is indistinguishable from the histopathology of SK. The histological characteristics resemble those of reticular or acanthotic seborrheic keratosis [35, 36].
1.6 Clinical presentation of the disease or condition
Clinically, SK has a dull, waxy, verrucous surface and a characteristic appearance. The color of the lesions can vary from light to dark brown, yellow, and gray; they may appear as an isolated lesion or in the form of dozens or even hundreds of lesions. Lesions can occur on any part of the body, except for the palms, soles, and mucous membranes. SK eruptions are often concentrated on the face, scalp, trunk, inframammary folds, arms, and legs. On the back, a "fir-tree" pattern may be observed due to the arrangement of lesions along Blaschko's lines. Itching and/or mild pain may be associated with trauma and inflammation if the lesions are located in skin folds or subjected to constant friction from clothing. As a rule, SK is benign, and the lesions grow slowly. The Leser-Trélat sign (symptom) denotes the sudden appearance of multiple seborrheic keratosis lesions, which indicates a malignant neoplasm, usually associated with gastrointestinal or lung cancer.
Specific clinical variants of seborrheic keratosis include the following [1]:
Stucco keratosis represents an accumulation of small, white, thin, adherent papules that can be observed in some patients. These papules are usually found on the dorsal feet and the skin of the ankle region. Stucco keratosis is a papillomatous keratosis showing no horn cysts or basaloid cells on histological examination.
The acanthotic variant of seborrheic keratosis, known as dermatosis papulosa nigra, may develop in patients with dark skin pigmentation. It is characterized by brown to black papules whose number increases with age, occurring predominantly on the face and neck.
The Leser-Trélat sign is characterized by the abrupt onset of multiple seborrheic keratoses as well as acanthosis nigricans. This sign is associated with various malignancies, such as gastrointestinal and lung cancer.
The pseudo-Leser-Trélat sign is characterized by inflammation of pre-existing seborrheic keratoses following chemotherapy for malignancies, particularly when using drugs such as cytarabine**, docetaxel**, gemcitabine**, or nivolumab**. Patients typically complain of burning and pruritus. Continuation of tumor therapy remains possible in such cases [37].
2. Diagnostics, medical indications and contraindications for diagnostic methods
The diagnosis of SK is usually established through clinical examination. SK is characterized by its unique appearance as a raised, scaly, brown to black papule firmly attached to the skin. This characteristic appearance allows experienced physicians to easily identify the disease.
2.1 Complaints and Anamnesis
It is recommended that patients with suspected SK undergo an initial consultation (examination, assessment) by a dermatovenereologist for the purpose of diagnosis, treatment, and secondary prevention of the disease [1,2].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Comment: patients complain of the presence, appearance, and growth of skin neoplasms, sometimes accompanied by mild pruritus, pain upon trauma, and the appearance of seborrheic keratosis lesions in elderly individuals, typically older than 50 years.
2.2 Physical Examination
For objective clinical manifestations of the disease detected during physical examination, see the section «Clinical Features».
SK lesions resembling melanocytic neoplasms are difficult to diagnose with the naked eye [38].
2.3 Laboratory Diagnostics
Laboratory diagnostic tests are not used.
2.4 Instrumental Diagnostics
It is recommended to perform skin examination under magnification (dermoscopy) for the diagnosis of seborrheic keratosis (SK). Common dermoscopic features of SK include comedo-like openings, milia-like cysts, cerebriform (brain-like) ridges and fissures, "moth-eaten" borders, and hairpin-shaped vessels [39,40].
GIB CLOE 4Grade of Recommendation – C (Level of Evidence – 4)
Comments: The two-step algorithm for dermoscopic diagnosis of seborrheic keratosis combines features into exclusion criteria (pigment network, aggregated globules, and homogeneous pattern with blue pigmentation) and inclusion criteria in the form of fissures and ridges, comedo-like openings, milia-like cysts, and brown fingerprint-like structures [39]. Additional phenomena are also present in the dermoscopic picture: hairpin vessels, moth-eaten borders, crypts, and exophytic papillary structures [40].
It is recommended that patients undergo a skin biopsy and pathoanatomical examination of the skin biopsy (surgical) material to rule out melanoma, squamous cell carcinoma, or basal cell carcinoma of the skin in cases where the clinical or dermoscopic diagnosis is ambiguous; when ulcerated lesions, rapid increase in lesion size, or very large lesions with morphologically diverse surface areas are observed [41].
GIB CLOE 4Grade of Recommendation – C (Level of Evidence – 4)
Comments: incisional biopsy, including punch biopsy or shave biopsy of the neoplasm, or excisional biopsy may be performed.
Histological features of SK include acanthosis, papillomatosis, orthokeratosis, hyperkeratosis, keratin cysts, and keratin pseudocysts. Keratin cysts are keratin pearls localized intraepidermally and released transepidermally, whereas keratin pseudocysts are keratin invaginations of the overlying stratum corneum. Nuclear or cellular atypia is usually absent. Melanocytes and melanin are present to varying degrees depending on the degree of pigmentation [18].
2.5 Other Procedures
Consultations with other specialists
It is recommended that patients presenting with abrupt rapid growth or the appearance of multiple SK lesions undergo an initial consultation (examination, assessment) by an oncologist/pediatric oncologist/pediatric oncohematologist for disease diagnosis [22, 42].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5).
Comments: The Leser-Trélat sign involves the appearance of multiple seborrheic keratoses and is associated with underlying malignancies such as gastrointestinal adenocarcinoma, leukemia, and lymphoma [43]. In this case, a thorough history taking and physical examination, age-appropriate cancer screening, and additional laboratory tests based on the patient's risk factors and history are crucial. Another cause for the sudden appearance of multiple seborrheic keratoses is chemotherapy.
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
Seborrheic keratosis is a benign condition and generally does not require treatment. Removal of seborrheic keratosis lesions is performed for cosmetic reasons or in the presence of lesions that are constantly irritated and cause discomfort to the patient [44].
3.1 Destructive treatment methods
It is recommended that patients with SK receive treatment via local cryotherapy [44, 45].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5).
Comment: this is the most common and accessible treatment method for seborrheic keratosis; the method is effective and generally well tolerated by patients. Liquid nitrogen is used to rapidly freeze or thaw target cells, leading to their death. Currently, there are no established guidelines for freezing or thawing times, and this duration may vary depending on the thickness of the lesion. Thicker lesions may require multiple freeze/thaw cycles to effectively treat the area. Local cryotherapy does not provide pathomorphological confirmation and should only be used for lesions with a low clinical suspicion of malignancy. This method requires a post-procedure care regimen for the treated area; erythema, pain, and blister formation may occur. Post-procedure hypopigmentation or hyperpigmentation of the skin at the treatment site is possible.
It is recommended that patients with SK undergo removal of benign skin neoplasms via electrocoagulation [45].
Level of Recommendation – C Level of Evidence – 2
Comment: the method is used to remove superficial epidermal lesions without penetrating the dermis. Post-procedure skin hypopigmentation or hyperpigmentation in the treatment area, as well as scar formation, are possible. In a study involving 33 patients, electrocoagulation or local cryotherapy was performed to remove seborrheic keratosis lesions. Patient preferences for both procedures were comparable at baseline, and at 2 and 8 weeks. Lesions treated with electrocoagulation showed a higher tendency toward residual hyperpigmentation at 8 weeks compared to those treated with cryotherapy [46].
It is recommended that adult patients with SK undergo ablative laser therapy (laser destruction of skin tissue) under local anesthesia. Ablative laser therapy includes YAG and CO2 lasers: Long-pulsed neodymium laser system (Nd:YAG); Medical CO2 laser system [47, 48].
Level of Evidence CGrade of Recommendation 4Level of Evidence – C (Grade of Recommendation – 4).
Comments: A comparative study was conducted on 42 patients with multiple seborrheic keratosis lesions of the face, neck, and trunk. Patients were treated with either laser or local cryotherapy. The results showed that laser treatment resulted in faster healing and less hyperpigmentation than local cryotherapy [49].
3.2 Topical therapy
Not used for the treatment of SK.
Diet therapy is not indicated.
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not applicable.
5. Prevention and Dispensary Observation
Prevention methods are not available.
It is recommended for patients with SK, in the event of bleeding, ulceration of lesions, multiple new, eruptive, and hyperpigmented rashes, to undergo dispensary follow-up (dispensary consultation/examination by a dermatovenereologist for clinical and instrumental monitoring of new SK lesions; it is necessary to pay attention to the appearance of signs of atypia and/or changes in the clinical parameters of SK lesions in order not to miss the development of a malignant skin neoplasm [42, 50, 51].
GCP CLoE 5Grading of Recommendations Assessment, Development and Evaluation (GRADE) – C (Level of Evidence – 5)
6. Organization of Medical Care
Specialized care is provided by dermatovenereologists, cosmetologists, oncologists, pediatric oncologists, or pediatric hemato-oncologists on an outpatient basis.
7. Additional Information
Advanced age, somatic pathology, and the onset of oncological diseases generally worsen the disease course, contributing to an increase in the size of existing seborrheic keratosis (SK) lesions and the appearance of new ones. Trauma, scratching of lesions, forceful self-removal of hyperkeratotic masses from the lesion surface, and the use of irritants can accelerate the development of oncoproliferative changes within SK lesions. Changes in clinical manifestations of SK, such as bleeding, rapid enlargement of an SK lesion, ulceration at the periphery of SK lesions, and pronounced itching or burning in the area of SK lesions, are indications for repeated consultations with a dermatovenereologist and an oncologist / pediatric hemato-oncologist [22, 42].
Criteria for Evaluating the Quality of Medical Care
№ | Quality assessment criteria | Performance evaluation |
|---|---|---|
1. | Initial visit (examination, consultation) by a dermatovenereologist / oncologist / pediatric hemato-oncologist | Yes/No |
2. | Administration of local therapy and/or local cryotherapy, and/or laser therapy, and/or radiowave destruction (electrocoulation) | Yes/No |
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Appendix A1. Working Group Composition
Potekaev Nikolay Nikolaevich – Doctor of Medical Sciences, Professor, President of the National Alliance of Dermatovenereologists and Cosmetologists, member of the European Union against Sexually Transmitted Infections (IUSTI/WHO), Honorary President of the Euro-Asian Association of Dermatovenereologists (EAAD), Member of the Board of Directors of the European Academy of Dermatology and Venereology (EADV), Corresponding Member of the German Dermatological Society (DDG), Honored Doctor of the Russian Federation, Chief freelance specialist in dermatovenereology and cosmetology of the Russian Ministry of Health, Chief freelance specialist in dermatovenereology and cosmetology of the Moscow City Health Department, Director of the Moscow Center for Dermatovenereology and Cosmetology, Head of the Department of Skin Diseases and Cosmetology at the Faculty of Continuing Medical Education, Pirogov Russian National Research Medical University of the Ministry of Health of Russia. No conflict of interest.
Grekova Yulia Nikolaevna – Doctor of Medical Sciences, Associate Professor, member of the National Alliance of Dermatovenereologists and Cosmetologists, Leading Researcher at the Research Department of Syphilidology and Sexually Transmitted Infections, Ural Research Institute of Dermatovenereology and Immunopathology. No conflict of interest.
Zilberberg Natalya Vladimirovna – Doctor of Medical Sciences, Professor, member of the National Alliance of Dermatovenereologists and Cosmetologists, Chief freelance specialist in dermatovenereology and cosmetology of the Ural Federal District, Deputy Director for Research, Ural Research Institute of Dermatovenereology and Immunopathology. No conflict of interest.
Kokhan Muza Mikhailovna – Doctor of Medical Sciences, Professor, member of the National Alliance of Dermatovenereologists and Cosmetologists, Honored Doctor of the Russian Federation, Head of the Scientific Clinical Department of Dermatology, Ural Research Institute of Dermatovenereology and Immunopathology. No conflict of interest.
Kuklin Igor Aleksandrovich – Doctor of Medical Sciences, Associate Professor, member of the National Alliance of Dermatovenereologists and Cosmetologists, Senior Researcher at the Scientific Clinical Department of Dermatology, Ural Research Institute of Dermatovenereology and Immunopathology. No conflict of interest.
Kungurov Nikolay Vasilyevich – Doctor of Medical Sciences, Professor, member of the National Alliance of Dermatovenereologists and Cosmetologists, Honored Doctor of the Russian Federation, Director of the Ural Research Institute of Dermatovenereology and Immunopathology. No conflict of interest.
Sokolova Anna Viktorovna – Doctor of Medical Sciences, member of the National Alliance of Dermatovenereologists and Cosmetologists, Senior Researcher at the Scientific Clinical Department of Dermatology, Ural Research Institute of Dermatovenereology and Immunopathology. No conflict of interest.
Baranov Aleksandr Aleksandrovich – Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Advisor to the Head of the Research Institute of Pediatrics and Child Health, Petrovsky National Research Centre of Surgery, Professor at the Department of Pediatrics and Pediatric Rheumatology, Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Chief freelance pediatric specialist of the Russian Ministry of Health, Honorary President of the Union of Pediatricians of Russia. No conflict of interest.
Namazova-Baranova Leyla Seymurovna – Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences, President of the Union of Pediatricians of Russia; Past President of EPA/UNEPSA; Head of the Research Institute of Pediatrics and Child Health, Petrovsky National Research Centre of Surgery, Head of the Department of Faculty Pediatrics, Institute of Motherhood and Childhood, Pirogov Russian National Research Medical University of the Ministry of Health of Russia (Pirogov University), Chief freelance pediatric specialist in preventive medicine of the Russian Ministry of Health. No conflict of interest.
Ambarchyan Eduard Tigranovich – Candidate of Medical Sciences, member of the Union of Pediatricians of Russia. No conflict of interest.
Materikin Aleksandr Igorevich – Candidate of Medical Sciences, Head of the Department of Pediatric Dermatology, Head of the Dermatology Department with Day Hospital, Research Institute of Pediatrics and Child Health, Petrovsky National Research Centre of Surgery, member of the Union of Pediatricians of Russia.
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience of these clinical guidelines:
Medical specialists: dermatovenereologist, cosmetologist, oncologist.
Residents and trainees of continuing professional education programs in the specified specialty.
Table 1. Level of Evidence (LoE) grading scale for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference-standard control or systematic reviews of randomized controlled trials with meta-analysis. |
2 | Individual studies with reference-standard control or individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis. |
3 | Studies without sequential reference-standard control, or studies with a reference standard not independent of the evaluated method, or non-randomized comparative studies, including cohort studies. |
4 | Non-comparative studies, case reports. |
5 | There is only a justification of the mechanism of action or expert opinion regarding interventions. |
Table 2. Scale for grading levels of evidence certainty (LEC) for prevention, treatment, and rehabilitation methods (preventive, therapeutic, and rehabilitative interventions)
LoE | Definition |
|---|---|
1 | Systematic review of RCTs with meta-analysis. |
2 | Individual RCTs and systematic reviews of studies of any design, except RCTs, with meta-analysis. |
3 | Non-randomized comparative studies, including cohort studies. |
4 | Non-comparative studies, case reports or case series, case-control studies. |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Scale for grading the levels of evidence (LE) for prevention, diagnostic, treatment, and rehabilitation methods (preventive, diagnostic, therapeutic, and rehabilitative interventions).
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or moderate methodological quality, and their conclusions on the outcomes of interest are consistent). |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or moderate methodological quality, and/or their conclusions on the outcomes of interest are inconsistent). |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent). |
Procedure for updating clinical guidelines.
The mechanism for updating clinical guidelines provides for their systematic revision at least once every three years, as well as upon the emergence of new evidence-based medicine data on the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or in the presence of justified additions/comments to previously approved clinical guidelines, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
These clinical guidelines were developed taking into account the following regulatory legal documents:
Federal Law No. 323-FZ of November 21, 2011, "On the Fundamentals of Protecting Public Health in the Russian Federation" (as amended on July 23, 2025).
Procedure for Medical Care in the Profile "Dermatovenerology", approved by Order of the Ministry of Health of the Russian Federation No. 924n of November 15, 2012.
Order of the Ministry of Health of the Russian Federation No. 168n of March 15, 2022, "On Approval of the Procedure for Conducting Dispensary Observation of Adults" (with amendments and additions).
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
Seborrheic keratosis (senile wart) is a widespread benign skin lesion that occurs predominantly in individuals over 50 years of age (though it may also be present in quite young people), equally often in men and women, and more frequently in people with lighter skin tones. In most cases, SK is benign. The diagnosis is established by a physician during a clinical examination with mandatory dermoscopy. If multiple lesions appear, or if they grow rapidly, bleed, or ulcerate, it is necessary to consult an oncologist.
The disease may manifest as isolated lesions, but in most cases, the rashes are multiple, reaching dozens or even hundreds of lesions, leading to cosmetic defects. Elements can occur on any area except the palms, soles, and mucous membranes, most commonly on the face, scalp, trunk, skin folds, arms, and legs. If lesions are located in skin folds or are subject to constant friction against clothing, itching and/or mild pain associated with trauma and inflammation may occur.
Excessive UV radiation can accelerate the development of SK. When exposed to the open sun, sunscreens must be used.
SK is a benign condition and usually does not require any treatment. Dispensary observation of newly appearing lesions is necessary in order not to miss neoplasms with signs of malignancy.
Removal (destruction) of SK is performed for aesthetic indications or when the lesions cause discomfort to the patient and reduce their quality of life.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
There is no universally accepted rating scale.