Crusted mole or seborrheic keratosis What is it and how to remove it?

If you are here, it is because you may have noticed a scratchy mole with a greasy or crusty appearance on its surface that has appeared recently. In addition, when you scratch it, you may even notice that part of this "mole" is detached and falls off. If this is the case, it is possible that what you have is a seborrheic keratosis or seborrheic wart.

Seborrheic keratosis or crusted mole

What are crusted moles or seborrheic keratoses?

Seborrheic keratoses are very frequent and fortunately are totally benign. They occur due to overgrowth of the top layer of skin cells called epidermis and is related to different causes that I will explain later. 

The clearest association is with age, as they usually occur in people over 30 years of age. In the end, almost everyone ends up developing at least a few seborrheic warts during their lifetime, as they tend to become more common and more numerous with age. For this reason, they are also known as the "moles of old age". 

Although seborrheic keratoses may first appear in one location and appear to spread to another, they are not contagious. As people age they may simply develop more.

These lesions can be found anywhere on the body except on the soles of the feet or the palms of the hands. In some locations such as the face, seborrheic keratoses can be flat and be a frequent consultation of facial blemishes.

They can appear in isolation as a single lesion, or what is much more common, is that several appear at the same time. In most cases they are brown in color, but they can vary in shade from light skin color to black. Sometimes they become irritated and a crust may appear on them, hence the name crusty mole. 

Seborrheic keratoses in a patient who reported a wart falling off

How do you know if a crusted mole is malignant?

While we know that seborrheic keratoses are not dangerous, there are some lesions that may present as a crusty mole or rough patches on the skin that require some attention. Sometimes, it can be difficult to distinguish a harmless seborrheic keratosis from a dangerous lesion. Something that looks like seborrheic keratosis. could actually be melanoma.

One of the most effective ways to detect melanoma is to learn the ABCDE rule illustrated below.

So, when do I have to go to a dermatologist?

If you have noticed a crusty mole that has some of the following characteristics, it is recommended that you have a visit with your dermatologist. 

  • Some of the characteristics of ABCDE
  • There is a change in appearance of an existing mole
  • There is a single odd-looking mole (seborrheic keratoses are usually multiple).
  • The lesion is irritated, bleeding or persistently painful.
 A dermatologist can diagnose seborrheic keratosis based on its clinical appearance and complement the examination. by dermatoscopic examination. In some cases, a biopsy may be necessary if there are doubts after a proper physical examination.

 

In conclusion, if you have a crusty mole on your skin that worries you, it is always a good idea to go to a specialist and do not attempt to remove the injury by your own means.

What do seborrheic keratoses look like?

Now then, let's look at what is important in this article and you can identify these rough patches on the skin. A seborrheic keratosis is usually easily identified by its appearance. 

Possibly one of the most telling characteristics of seborrheic keratoses is that they appear to have been "stuck on the skin". They may look like a piece of hot brown candle wax that has fallen on the skin. 

Patient with many seborrheic keratoses on the back and a few crusted moles.
Patient who consulted for the first time because for several years he noticed the appearance of multiple pigmented warty lesions all over his body. On physical examination we were able to confirm that these were seborrheic keratoses and we were able to treat him satisfactorily.

Photos of seborrheic keratoses

These rough patches on the skin usually begin as small, rough areas. Over time, they tend to develop a thick, wart-like surface. They may also have a waxy appearance and a slightly raised wart-like surface. Seborrheic keratoses are usually brown, but can also be yellow, white or black. Sometimes patients tell us that they have "dropped a wart on their own" from their skin. 

Dermoscopic photos of seborrheic keratoses

In order to make an accurate diagnosis dermatologists always use a technique called dermatoscopy with polarized light. After making this examination we can affirm that they are benign lesions and we can offer appropriate treatment. Now I leave you some fascinating images made by dermoscopy so you can see what seborrheic keratoses look like. 

Why do I get seborrheic keratoses?

There are several risk factors for the development of seborrheic keratosis and it is important to be aware of them, as some of them are preventable. Among the best known are the following:

  • Advanced age: the condition usually develops in middle-aged people and progressively increases with age.
  • Relatives with seborrheic keratosis: this skin condition is usually hereditary. The risk increases with the number of affected relatives.
  • Frequent exposure to the sun: studies show that skin exposed to the sun is more likely to develop seborrheic keratosis.
  • Pregnancy/hormonal: the development of seborrheic keratoses can be triggered by pregnancy or estrogen therapy. 

What is the treatment of seborrheic keratosis?

In many cases, a seborrheic keratosis does not need treatment. However, most of our patients come to us because they are bothered by them or because they do not like them aesthetically. In addition, a decision may be made to remove any crusty mole that looks suspicious or causes physical or emotional discomfort. 

The most commonly used removal methods for seborrheic keratoses are:

  • Cryotherapy (cryosurgery): uses liquid nitrogen to freeze the tumor and is usually quite effective in removing a seborrheic keratosis. It is not my favorite method because many times we end up freezing the skin around seborrheic keratoses and it can cause skin discoloration. 
  • Electrosurgery: The skin is first anesthetized and then an electrode is used to burn the seborrheic keratosis with electric current. If not done with caution it can lead to scarring and tends to be a slower method than the rest, so it is reserved for when there are few lesions. 
  • Curettage:  The skin is first anesthetized and then a spoon-shaped surgical instrument is used to scrape off the tumor. 
  • CO2 laser: uses a beam of light that allows vaporizing seborrheic keratosis in a very controlled and precise manner. For me it is the method of choice when aesthetics is very important and we want to treat many lesions at the same time. 

 

After removal of a crusted mole

Depending on the size of the seborrheic keratosis it is normal for the skin to become lighter in color for some time at the site of removal. The seborrheic keratoses that we remove will not reappear, but it is possible that new lesions may develop on other parts of the body over time. Therefore, it is necessary to perform "rework" of new keratoses as they appear. 

How to avoid seborrheic keratoses?

Unfortunately, there are no methods to effectively prevent seborrheic keratoses all over the body. But there are some things we can do. 

  • Protection from the sun: Today we know that the sun is one of the risk factors for the development of seborrheic keratoses. If we protect ourselves adequately, the risk of developing more keratosis would decrease and also the risk of developing more keratosis. dreaded skin cancer. 
  • Use creams with retinol or alpha-hydroxy acids (AHA): in areas such as the face can be used creams with skin-renewing compounds such as retinol or AHAs. This will allow us to improve the quality of the skin and secondarily prevent further development of seborrheic keratoses. 
  • See a dermatologist when they are as small as possible: If your concern is aesthetics, the most important thing is to go to your dermatologist as soon as possible to remove these "crusty moles". This way we make sure to do as little damage as possible and no marks will be left from the procedure. 

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Sebastian Podlipnik - Skin cancer

Sebastian Podlipnik

Dermatology Blog

I am a dermatologist and cum laude MD and author of multiple research studies. I specialize in skin cancer, laser technologies and cosmetic dermatology. The intention of this blog is to bring you closer to topics of interest in dermatology and research.

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