SKs are one of the most common skin lesions. They occur primarily on the face, scalp, and trunk but may occasionally be found on almost any location on the skin. Many people have just a few but it is not uncommon to see individuals with several dozen or even several hundred. No one knows why some people develop SKs. The tendency seems to run in families. Usually they start showing up in the late 20s or 30s. New SKs continue to arise over one's lifetime.

SKs vary in size from a tiny pinhead to several inches in diameter. They also vary in color from flesh-colored or slightly tan to various shades of brown or occasionally black. They are usually raised above the surface and have a dry or often scaly surface which can sometimes be partially peeled off with a finger. They often look like someone just stuck them on the surface of the skin. This is because they are derived totally from the most superficial layer of the skin, the epidermis.

Black people often have a variant of SKs known as dermatosis papulosa nigra (DPN). These appear as multiple small very dark slightly raised lesions that cluster on the face, especially on the cheeks. Another variant of SKs are stucco keratoses. There appear on the hands, forearms, and lower legs as dozens of white tiny wart-like lesions.

SKs NEVER turn into skin cancer. Despite the fact that they sometimes look warty, hey are not related to warts and they are not contagious. Sometimes they become itchy and/or sore and occasionally they might even bleed if they are scratched or rubbed. Although this can be quite annoying this does not make them turn into skin cancer.


Removal of most SKs is relatively simple. Since they do not have any deep component, removal or destruction of bothersome SKs does not usually leave any significant scar. Small SKs can be treated with LIQUID NITROGEN (LN). LN is a very cold (321 degrees below 0) inert substance that can be applied to the surface of an SK with a Q-tip for several seconds. No anesthesia is required. LN works by creating a small blister just underneath the SK. This blister forms within an hour of treatment, dries up in 7-10 days, and then peels off in one to several weeks depending on the size and location. No wound care is usually needed. LN is usually not used in blacks or darkly pigmented races because there is some tendency for treated areas to remain permanently lighter than their normal skin color.

SKs that are large, thick, inflamed, traumatized, or in delicate areas may also be surgically removed. A small amount of local anesthetic (Lidocaine®) is injected just underneath the lesion. A scalpel is turned sideways and the SK is "shaved" off flush with the skin surface. To control minor capillary bleeding a clear liquid chemical is placed or a minimal amount of cautery is used. A small amount of antibiotic ointment (e.g., Polysporin®) is placed on the wound and an oval band-aid is placed. Small to medium sized Sks treated this way heal very quickly with little or no scarring. There are no restrictions with this type of wound. All SKs that are surgically removed are sent for routine pathologic study.

SKs that are without symptoms and are not felt by the patient to be disfiguring may be safely left untreated. Removal of symptomatic and/or inflamed SKs is usually covered by insurance.



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