The role of immunosuppression in squamous cell carcinomas arising in seborrheic keratosis.
BACKGROUND
Seborrheic keratoses (SK) are common skin neoplasms considered to be benign. Reports of associated squamous cell carcinoma arising within seborrheic keratosis (SCC-SK) have been described.


OBJECTIVE
To describe the histopathologic characteristics of SCC-SK and identify predisposing factors in formation of these rare lesions.


METHODS
There were 162 cases of SCC-SK in a span of a decade (2003-2014). All of the histopathologic specimens and medical records were reviewed. Data from these patients were compared to a control group with seborrheic keratosis who were matched by age, sex, and location of lesion from the same time period (n = 162).


RESULTS
SCC-SK has the classic histopathologic features of SK, such as hyperkeratosis, parakeratosis, papillomatosis, and pseudohorn cysts. The areas of squamous cell carcinoma were characterized by areas of squamous dysplasia (100%), hypogranulosis (79.6%), squamous eddies (79.6%), solar elastosis (80.9%), and brown pigmentation (59.9%). Patients with a history of immunosuppression had an increased risk for developing SCC-SK (19% vs 3%; P < .01), particularly when inhibition was transplant-associated (10% vs 0%; P < .01).


CONCLUSIONS
This was a single center, retrospective study.


CONCLUSIONS
SCC-SK occurs more often in elderly men with a history of immunosuppression associated with organ transplants.
Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University, Cleveland, Ohio. Electronic address: ruzica.conic@gmail.com.
Ruzica Z
RZ
Conic
Department of Pathology, Edward Hospital, Naperville, Illinois.
Karl
K
Napekoski
Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio.
Heidi
H
Schuetz
Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio.
Melissa
M
Piliang
Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio.
Wilma
W
Bergfeld
Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio; Department of Dermatology and Dermatopathology, University of California Irvine, Irvine, California.
Natasha
N
Atanaskova Mesinkovska
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D017492:Keratosis, Seborrheic / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology
SCC-SK; elderly men; immunosuppression; malignant transformation; seborrheic keratosis; squamous cell carcinomas; transplant