The changing seborrheic keratosis.
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We report three cases of pigmented Bowen's disease that clinically and histologically had features of seborrheic keratoses. We speculate about the mechanism of pigmentation in these lesions and suggest that they arise from pigmented seborrheic keratoses.
The present study reports a case of an occult basal cell carcinoma that arose in seborrheic keratosis. The patient was a fifty-six-year-old male who presented with a dark brown plaque on his back. Clinically, the lesion demonstrated no nodules or ulcerations suggesting that it was malignant. However, histopathological analysis of the lesion revealed an atypical basaloid cell mass that appeared to be a solid basal cell carcinoma beneath and surrounded by a seborrheic keratosis lesion. Thus, the coexistence of basal cell carcinoma and seborrheic keratosis is possible and should be considered when a malignant change in seborrheic keratosis is apparent.
Skin biopsies from 10 patients with seborrheic keratoses were examined by electron microscopy for the presence of Langerhans' cells. Comparing seborrheic keratoses with normal skin of the same patient and with normal skin from controls, neither an increased number of Langerhans' cells nor an increased number of specific granules, Birbeck granules, nor abnormal Langerhans' cells, was found. Melanosomes in a Langerhans' cell were observed in 2 seborrheic keratoses, suggesting phagocytic activity of the Langerhans' cell.
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We report a case of seborrheic blepharitis treated with oral itraconazole during a short period. Direct examination using Parker KOH revealed numerous hyphae and spores of Malassezia in the scale. Low-dose itraconazole pulse therapy (200 mg daily, 7 days a month) was quite effective. This is the second case in which we also observed a unique fungal conformation which looked like tinea versicolor. The evidence strongly suggests that Malassezia is one of the major causative agents of seborrheic blepharitis.