Recurring Seborreic Keratosis - WHY?

Paging the marvelous medi-dopers!

I’m not asking for medical advice, I’ve already gotten the bastard frozen off twice, and the dermatologist who did it this time informs me that it’s likely to KEEP coming back, and that even if she actually cut it off, it might STILL keep coming back.

She was unable/unwilling to tell me WHY that is, and seemed to think I was a little unreasonable for wanting to know. :frowning:

So… do you (general you = doctors/medical people) know why it would keep coming back? The packet I got seemed to indicate it was a disorder of the top layer of my skin, so presumably if the top layer of my skin were no longer there (surgery or whatnot) that would solve the problem, but she didn’t seem to think it would.

And of course the internet is (as usual) wildly unhelpful. I’ve read the same standard paragraph about how they’re benign and they get frozen off and bobs-yer-uncle about 20 times now.

Yes, it’s genetic, my mom and grandmother have quite a few. It’s on my face, so it’s going to keep getting froze off as long as it keeps coming back, because I’m not going through life with a giant witches’ wart. I know I’m a bit young for them, but I’ve had it growing slowly since my 20s, and I finally got sick enough of it to freeze it off for the first time about a year-and-a-half ago. It came back SUPER fast this time compared to how slowly it developed originally. Dermatologist was extremely apathetic about that.

So - what’s the straight dope?

So it itched like hell and I scratched it off today, and it’s more interesting on the inside.

It’s got these little spikes of ?? skin? callus? … that poke down of the surface of the skin layer/scab that I peeled off - down into the underneath layers. They’re decently long and all roughly the same height (there’s a few overacheivers).

Funnily enough, on the fresh skin where it came off, there’s very obvious little divots there - like really big pores perhaps - where the spikey things were, and now they’re empty because I picked the scabby surface off.

So what are the spikey bits?

(Also, still curious about the original question.)

I’m not a dermatologist (my familiarity with seborrheic keratoses is their distinctive appearance under the microscope). But it seems that with these lesions and with skin lesions in general, they are more likely to recur with treatment that involves freezing and curetting (as opposed to surgical excision).

Having these things completely excised is about the best guarantee against recurrence, though the likelihood of scarring is increased (an important consideration for facial lesions). New ones can still pop up, though.

I will not attempt to unriddle what goop is left after one picks the scab off*, but seborrheic keratoses are basically made up of two things - an overgrowth of an immature (basaloid) layer of cells, accompanied by cystic mini-spaces filled with keratin (a thick, tough extracellular layer that normally forms at the surface of skin and is thickened in a variety of pathologic circumstances).

*Don’t do that.

Thank you - that was much more informative than my dermatologist was.

If it makes you feel any better, the scab and associated picked off bit was already solidified and loose from my skin - no goop. :smiley:

So from your description, the spikey bits would be possibly the keratin-insides of the cystic spaces? Because the top layer was the brown part (guessing that’s the screwed up basaloid layer) and the spikes were whitish.

That’s very interesting. I had a look at it with a magnifying glass, and I wish I had access to a microscope - can you link me to any places where I can see examples of them magnified?

Zounds! An image search on these thingsis quite educational!

Yeah, mine wasn’t as big or as protruding as most of those were. Also, I’m very glad I don’t have umtybajillion of them on my back. I think I’d freak out.

Sadly all of those pictures (and all the other ones I could find) are of the OUTSIDE of the damn things - I want to see what the shapes on the INSIDE are, and whether mine was on the boring and typical side, or the weird and interesting side of the spectrum.

I also found this. Go down the list until you see “seborrheic keratosis” and click on it to see the image. I think the one labelled as “higher mag” shows what the underside looks like magnified.

Helpful note for other dopers: don’t drink a bunch of gin & then look at these pictures. Just … don’t.

That is awesome - thank you very much! That’s pretty much exactly how mine looks (I mean, less magnified - but you get the idea) with lots of little projections and valleys.

Very cool!

I was just diagnosed with this. They aren’t scary and shouldn’t be too hard to remove yourself, as long as they are relatively small.