Understanding Your Pathology Report: Inflamed Seborrheic Keratosis with History of Basal Cell Carcinoma
Your pathology report shows a benign (non-cancerous) skin growth called an inflamed seborrheic keratosis, which is completely separate from your previous basal cell carcinoma and requires no further treatment beyond the removal that was already performed. 1
What is Seborrheic Keratosis?
Seborrheic keratoses are among the most common benign skin tumors that typically appear during middle age and are characterized by their "stuck on" appearance. 2 These growths:
- Are completely benign and do not transform into cancer 2
- Commonly become pigmented and enlarge with age 2
- Often develop inflammation, which can cause itching and changes in appearance 1, 3
Why "Inflamed" Matters
The inflammation in your seborrheic keratosis explains why it may have looked concerning enough to biopsy. 3 Inflamed seborrheic keratoses:
- Can mimic malignant lesions including melanoma, squamous cell carcinoma, or basal cell carcinoma on visual examination 3, 4
- Are correctly identified by dermatologists only 37.6% of the time before biopsy, even with dermoscopy 3
- Show increased blood vessel formation (91.3% of cases) that can make them appear more worrisome 3
- May develop bluish discoloration (18.3% of cases) that further mimics malignancy 3
The microscopic examination confirmed this is benign, showing the characteristic features: irregular epidermal hyperplasia with uniform keratinocytes, horn pseudocysts, and inflammatory cells in the dermis. 1
Your History of Basal Cell Carcinoma
Your documented history of basal cell carcinoma is noted in the pathology report as clinical context, but this is not related to your seborrheic keratosis. 1 Important points:
- Seborrheic keratoses do not arise from or cause basal cell carcinomas 2
- While rare case reports describe basal cell carcinomas found adjacent to or within seborrheic keratoses (occurring in specialized case series), these represent coincidental findings rather than malignant transformation 5, 6
- The association rate is extremely low and does not indicate that seborrheic keratoses are precancerous 6
What This Means for You
No further treatment is needed for this lesion since it was completely removed during the shave biopsy. 2 The pathology report states "All tissue submitted," confirming complete removal.
Ongoing Skin Surveillance
Given your history of basal cell carcinoma, you should:
- Continue regular skin examinations as recommended by your dermatologist for surveillance of new skin cancers 7
- Monitor for new or changing lesions using the ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter >7mm, and Evolution (change over time) 7
- Seek evaluation for any lesion that changes, bleeds, or doesn't heal 7
- Understand that having one basal cell carcinoma increases your risk for developing additional skin cancers, but seborrheic keratoses themselves are not part of this risk 7
When to Worry About Seborrheic Keratoses
Most seborrheic keratoses never need treatment. 2 However, biopsy or removal is appropriate when: 7, 6
- The diagnosis is uncertain and melanoma cannot be excluded clinically 7
- The lesion is symptomatic (itching, bleeding, or irritation) 1
- The lesion shows atypical features or recent change 4, 6
Your physician made the correct decision to biopsy this lesion given its inflamed appearance and your cancer history, as inflamed seborrheic keratoses are notorious mimics of malignancy. 3, 4