|Year : 1983 | Volume
| Issue : 1 | Page : 37-38
S Mathur, JB Narang, AK Gupta
Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
A K Gupta
Guru nanak Eye Centre, L.N.J.P. Hospital, New Delhi 110 002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathur S, Narang J B, Gupta A K. Seborrhoeic keratosis. Indian J Ophthalmol 1983;31:37-8
Seborrhoeic keratosis is a benign skin lesion that occurs in middle aged and older individuals, which mimics malignant lesions, especially squamous cell carcinoma, both clinically and pathologically. Various types of keratotic lesions have been identified, viz., senile and seborrhoeic keratosis, actinic keratosis, verucca vulgaris. keratoacanthoma, inverted follicular keratosis and squamous papilloma. These benign lesions can sometimes be confused with malignancy and may result in unnecessary extensive surgical resection of the tissues. We report one case of seborrhoeic keratosis with an unusual presentation which clinically simulated malignant melanoma.
| Case report|| |
A 70-year old man presented with a history of small pigmented, raised nodular lesion in the right upper lid for 3 year duration. The mass had significantly increased during the last six months and was bleeding for two days prior to admission. The patient was anaemic and had no other evidence of any systemic disease.
Ocular examination showed marked oedema in the entire right upper lid. There was a raised bilobed mass (18 x 15 x 15 mm) in the centre of the upper eye lid just above the cilia line. It was pigmented with areas of ulceration, scab formation, and haemorrhages over the raised area [Figure - 1]. It was firm in consistency with areas of induration all around. The lower lid had a spastic entropion. There was no other ocular abnormality except early lenticular opacities. Considering the advanced age and clinical characteristics, a provisional diagnosis of malignant melanoma was made. The patient was initially treated with local and systemic antibiotics and systemic anti-inflammatory drugs which resulted in susidence of lid inflammation and conjunctival sac infection.
An excisional biopsy was done and the tumor was removed splitting the upper lid at grey line. The lower lid entropion was also corrected by the Blasovic's technique. [Figure - 1]B shows the post operative result after excision of the tumour. The histological examination of the tumour revealed a stuck on lesion with marked acanthosis of the epidermis. Acanthosis was due to the proliferation of basaloid cells which are heavily pigmented and within epidermis numerous keratotic areas were seen with minimal inflammation in the dermis [Figure - 2]. The pathological diagnosis was seborrhoeic keratosis.
| Discussion|| |
Many of the eye lid tumours are likely to be misdiagnosed both clinically and histologically. Kwitko et all have reported benign conditions like senile keratosis, keratoacanthoma, inverted follicular keratosis, and pseudo epithelial hyperplasia, which can be confused with squamous cell carcinoma, The present case was also clinically misdiagnosed as malignant malanoma because of the heavy pigmentation, firm consistency and the bleeding from the tumour mass. The histologic appearance, however, was characteristic of seborrhoeic keratosis.
In some of the lesions due to seborrhoeic keratosis irritation is commonly associated with dermal inflammation causing a swelling of wart sometimes with oozing and crusting. In this event there is a proliferation of squamous cells that may reach the proportions of pseudo-carcinomatous hyperplasia which is sometimes difficult to differentiate from a true squamous cell carcinoma. In this phase, the pathology resembles that of an inverted follicular keratosis and the factors that may lead to the misdiagnosis are the variation in the colour of the lesion due to melanin, firm consistency, indurated margins, presence of fissures and bleeding from the lesion. The other interesting feature is the relatively large size of tumour (I8x15x 15 mm). Though rare, similar large size tumours have been reported earlier.
Kwitko et al have reported three cases of mixed seborrhoeic keratosis and inverted follicular keratosis out of 115 lesions. Gogi et al found three out of 38 cases of eye lid tumours to be cases of seborrhoeic keratosis while Sassani and Yanoff noted 15 such cases in a series of 149 cases of eye lid lesions.
| Summary|| |
A 70 year old man presented with seborrhoeic keratosis which was misdiagnosed because of its clinical resemblence to malignant melanoma.
| References|| |
Kwitko, M.L., Boniuk, M. and Zimmerman, L.E., 1963, Arch. Ophthalmol. 69: 693.
Gogi, R., Nath, K.. Ahuja, L., and Shukla, K. 1979, Ind. J. Ophthalmol. 87 : 810.
Sassani, J.W. and Yanoff. M., 1979, Amen. J. Ophthalmol. 87 :25.
[Figure - 1], [Figure - 2]