Dr Sarma’s guide to mastering seborrheic keratosis,

verruca vulgaris, actinic keratosis and squamous cell

carcinoma

Deba P Sarma, MD
Omaha

LOOK AT THE TOP AND LOOK AT THE BASE,

GET A QUICK ANSWER AND CLOSE THE CASE.

Seborrheic keratosis Actinic keratosis

Squamous cell carcinoma

Verruca vulgaris
Seborrheic keratosis is a benign epidermal tumor arising from the normal
basal cells.
Look at the basal layer: Normal cuboidal cells
Look at the keratin on top: Normal flaky keratin

A dark, basaloid stuck-on epidermal tumor, usually above the epidermal

level composed of uniform small epidermal cells similar to the
normal basal cuboidal cells, surface keratin is normal basket-weave
type. Horn cysts are commonly seen.
 Verruca vulgaris is a benign epidermal tumor induced by
virus.
Look at the basal layer: Normal cuboidal cells (virus affects the suprabasal cells).
Look at the keratin on the top: Compact keratin (wart is tough!)

Well defined mature keratinocytic lesion, compact hyperkeratosis, verruciform

epidermal hyperplasia,peripheral rete ridges pointing to the center, normal cuboidal
basal keratinocytes at the base of the lesion.
Actinic keratosis is a sun-induced dysplastic epidermal lesion.
Dysplasia starts at the basal layer.
Look at the dysplastic basal cells.
Dysplastic squamous cells making abnormal non-flaky keratin on top.
Dermis shows solar degeneration.
Squamous cell carcinoma is a malignant tumor of epidermis arising
from the basal cells…… basal cells are dysplastic……
and keratin is abnormal (non-flaky).
Fronds of neoplastic squamous cells are growing downwards into the
dermis.
About IRRITATED Seborrheic keratosis ! It is irritated but neither dysplastic
nor malgnant.
Look at the basal cells: Normal cuboidal cells!
Look at the top: Compact red keratin.
No epidermal dysplasia.
Eddies ( benign small intraepidermal epithelial nests).

Eddies
SUMMARY

LOOK AT THE TOP AND LOOK AT THE BASE,

GET A QUICK ANSWER AND CLOSE THE CASE.

D Sarma, MD
Omaha