Senile keratoma is a single or multiple benign formation of the skin of elderly people, which is a rounded pigmented plaque with a diameter of up to several centimeters, covered with layers of keratinized epithelium. Senile keratoma is located on the skin of the face, neck, hands and forearms. Possible malignant degeneration of keratoma with the development of basal cell carcinoma or skin cancer. Diagnosis is carried out by examination, dermatoscopy and histological examination. Removal is carried out by radio wave method, laser, electrocoagulation apparatus, liquid nitrogen or necrotizing medications.
The most common senile keratoma occurs in old age. This fact was the reason for the name of this type of keratoma. People with dry skin, whose age has exceeded 50 years, are predisposed to their formation. Some authors point out that senile keratomas are observed more often and in greater numbers in men.
Keratoma formation occurs due to uncontrolled proliferation of the surface layers of the epidermis (basal or spiny), accompanied by keratinization of epidermal cells. The location of senile keratomas mainly in open areas of the body suggests that their appearance is associated with excessive exposure to ultraviolet rays on the skin. In addition, the hereditary nature of the formations is noted.
The formation of senile keratoma begins with the appearance of a small yellowish or brownish spot on the skin. At the beginning, the spot is slightly different from the color of the surrounding skin, but over time it begins to pigment and turns reddish or brown. At the same time, the growth of the spot and its infiltration occurs, which leads to the formation of a small papule protruding above the surface of the skin, the surface of which has small depressions and resembles a thimble. In the process of further growth, senile keratoma acquires its characteristic appearance of a rounded convex plaque. Its size can reach 6 cm in diameter. As a result of hyperkeratosis, the surface of the plaque is covered with horny scales. There are multiple horny cysts on it, formed as a result of blockage of hair follicles. When the scales are removed from the keratoma surface, an infiltrated and bleeding surface opens under them.
A favorite localization of senile keratoma is the skin of exposed areas of the body: the back of the hands, arms, face and neck. They are much less common on the trunk. Education can be single, but often has a multiple character.
Senile keratoma is characterized by slow development and a long course. Her spontaneous disappearance is possible. In some cases, keratoma is transformed into a cutaneous horn — a cone-shaped horn outgrowth slowly growing in length.
The tendency to slow but constant growth can lead to the fact that senile keratoma will reach large sizes and become a noticeable cosmetic defect, especially if it is located on the skin of the face. The course of senile keratoma can be complicated by the constant appearance of more and more new keratomas. This causes a certain discomfort to the patient, because keratomas are convex formations and due to this they are easily injured.
However, the most formidable complication of senile keratoma is its malignancy. Senile keratoma refers to benign neoplasms of the skin. But, according to research conducted in dermatology, it can undergo malignant degeneration in 9-15% of cases. The transformation of senile keratoma into squamous cell skin cancer or basal cell carcinoma is possible. Such a change in education can be facilitated by its regular injury or excessive UV irradiation.
To diagnose senile keratoma, a dermatologist conducts a visual examination of the formation and dermatoscopy. When examining the formation under magnification, characteristic depressions and horny cysts are revealed on its surface. If a malignant process is suspected, an urgent consultation with a dermatooncologist, a siascopy and an ultrasound of the formation is necessary.
Histology of senile keratoma is usually performed after its removal. The pattern of proliferation of keratinocytes and melanocytes of the thorny layer, parakeratosis and nuclear polymorphism is characteristic. The difference from seborrheic keratosis is the absence of horny and basaloid cells. The detection of atypical keratinocytes indicates the beginning of malignant transformation.
Differential diagnosis of senile keratoma is carried out with an ordinary wart, seborrheic keratosis, papillomas, follicular keratoma, Bowen’s disease, basal cell carcinoma, melanoma and various types of pigment nevi: blue nevus, complex pigment nevus, Setton nevus, borderline pigment nevus, etc.
Removal of senile keratoma is possible with the help of laser, electrocoagulation, radio wave method, cryodestruction, solkoderm and by surgical excision. If the keratoma is multiple in nature, the patient is additionally prescribed a course of treatment with aromatic retinoids.
Electrocoagulation easily removes senile keratoma, but does not allow histological examination. To prevent relapse at the end of the operation, cauterization of the keratoma base is performed. Cryodestruction with liquid nitrogen can also be complicated by relapse. It is optimal to freeze the formation followed by curettage.
Laser removal can be carried out in two ways: by laser valorization or by using a laser beam as a scalpel. The latter method makes it possible to conduct histology of the removed keratoma to confirm its goodness. Radio wave removal of senile keratoma also gives good results (absence of scar, minimum of relapses). Surgical excision is indicated if its malignant transformation or large size of the formation is suspected. Removal with the help of necrotizing pharmaceuticals (a complex of acids for external use) can be used for multiple keratomas and is carried out in several stages. However, it does not protect the patient from the possibility of relapses.