Snapshot A 40-year-old woman with no significant past medical history is bothered by several brown moles. She started noticing them in the past year and notes that they have not changed in size. There is one mole in particular that is bothersome to her, cosmetically, because it is large. She denies any family history of skin cancer, but recalls seeing similar moles on her mother. She opts to use cryotherapy to remove the lesions. Introduction Common, benign persistent epidermal proliferations with variable appearances Can mimic malignancies, especially melanoma Genetics can be inherited Epidemiology rare before 30 years old one of the most common benign growths Associated conditions underlying GI or lymphyoid malignancies Leser-Trélat sign: sudden appearance of multiple seborrheic keratoses may indicate underlying malignancy NOT related to actinic keratosis or seborrheic dermatitis (despite the similarity in name) Prognosis no risk for progression to malignancies Presentation Symptoms patients can often scratch off a lesion Physical exam usually multiple lesions variable appearance flat or raised smooth, velvety, or verrucous color ranges from white, pink, brown, or black even within a single lesion, color may vary “stuck on” waxy, greasy appearance common on trunk, face, extremities Evaluation If clinically mimicking skin cancer (e.g., with very dark pigmentation suspicious of melanoma) skin biopsy Differential Melanoma can be mistaken for melanoma Treatment Medical observation only indications most cases are treated with observation alone liquid nitrogen (cryotherapy) indications cosmetic concerns