Seborrheic keratoses are harmless growths. Actinic keratoses are pre-cancerous. They look similar to patients and are treated very differently.
Seborrheic keratoses are benign and removed largely for comfort or appearance; actinic keratoses are sun-damage lesions that can progress to squamous cell carcinoma and should be treated medically.
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Seborrheic keratoses are extremely common benign growths that increase with age. They look waxy or warty, sit on the surface as if stuck on, and range from tan to almost black. They can catch on clothing or become irritated, which is often why patients want them off.
Actinic keratoses are the result of cumulative sun exposure, which makes them common in South Florida. They are rough, scaly, often easier to feel than to see, and appear on the face, scalp, ears, forearms and hands. A proportion progress to squamous cell carcinoma, so treating them is preventive medicine, not cosmetics.
Dermoscopic examination distinguishes them, and anything atypical is biopsied rather than simply removed.
Cryotherapy freezes the lesion with liquid nitrogen. Quick, done in the room, leaves a small blister that crusts and falls away. This is the workhorse for actinic keratoses and for many seborrheic ones.
Shave removal or curettage takes a raised seborrheic keratosis flush with the skin and allows the tissue to be sent for examination if there is any doubt about the diagnosis.
Electrosurgery is useful for numerous small lesions in one sitting. Field treatment with a topical agent is used when there are widespread actinic keratoses across a sun-damaged area rather than a few discrete spots.
For related benign growths, see skin tag removal and mole removal.
Most sites heal in one to two weeks: a crust forms, then separates. Keep the area clean and moist, avoid picking, and protect it from the sun while it heals.
On medium and darker skin, cryotherapy can leave a lighter patch where pigment cells are affected by freezing, which is why we adjust technique and often prefer curettage on pigmented skin. Discuss this before treatment if you are prone to pigment change.
Larger or repeatedly irritated lesions can leave a flat mark. Sun protection during healing is the single best thing you can do for the final appearance.
See us promptly if a lesion bleeds without being knocked, grows quickly, becomes tender, develops an irregular border or refuses to heal. Those features push us toward biopsy rather than cosmetic removal.
Widespread actinic damage warrants a full-skin examination and a schedule of follow-up, because patients with many actinic keratoses carry a higher lifetime risk of skin cancer. Book a skin cancer screening alongside removal.
Actinic keratosis treatment is a medical service and is generally covered by plans we accept, because these lesions are pre-cancerous. Removing a benign seborrheic keratosis purely for appearance is usually considered cosmetic. See our accepted insurance list.
Cryotherapy stings briefly during freezing and for a short time afterwards. Shave removal and curettage are done with local anaesthetic, so the procedure itself is not painful.
The treated lesion does not usually return, but the tendency to form new ones remains, especially with ongoing sun exposure. Daily sun protection reduces new actinic keratoses.
