: A Rare Tumor
Article Information
Junhui Jeong, MD, PhD1Seborrheic keratosis (SK) is a common, benign, cutaneous skin tumor of the elderly patients. It is commonly observed in the head, neck, trunk, and extremities except the palms and soles. Its occurrence in the auricle has been reported even more rarely than in external auditory canal. We experienced rare SK in the auricle that was completely removed and did not recur.
A 65-year-old man visited our clinic complaining of a left auricular mass for the past 10 years, which recently began slowly growing. The patient reported that there was no pain or itching in the lesion. He had no known history of trauma or excessive exposure to ultraviolet light. He also had no familial history of this type of lesion and it was only in the auricle. The mass appeared as a brownish, papillomatous, verrucous lesion, about 2 cm × 2 cm, located at the cavum concha, cymba concha, and crus of the helix (Figure 1). Considering the possibility of malignancy, complete excisional biopsy was planned under local anesthesia.
Figure 1. A brownish, papillomatous, verrucous mass is shown at the cavum concha, cymba concha, and crus of the helix.
Intraoperative frozen pathology suggested it to be a benign lesion such as seborrheic keratosis (SK). After excluding the possibility of malignancy, the lesion was removed completely with the shave excision method. In permanent pathologic diagnosis, hyperkeratotic and acanthotic SK was reported. Histologically, the lesion showed acanthosis and papillomatosis with hyperkeratosis. The epidermis showed proliferation of basaloid and squamoid cells. Several pseudohorn cysts were present (Figure 2). After 1 month, the excised skin was well healed with application of antibiotic ointment. After 1 year, there was no recurrence or complication.
Figure 2. Histopathologic image shows hyperkeratosis, papillomatosis, and proliferation of basaloid cells (arrow) and pseudohorn cyst (arrowhead; hematoxylin–eosin, ×100).
Seborrheic keratosis is a common, benign, cutaneous skin tumor of the elderly patients.1-3 It is commonly observed in the head, neck, trunk, and extremities except the palms and soles.1-4 Its occurrence in the auricle has been reported even more rarely than in external auditory canal.
Seborrheic keratosis is also known as seborrheic verruca, seborrheic wart, verruca senilis, senile wart, basal cell acanthoma, benign keratoacanthoma, and basal cell papilloma.1 It presents as solitary or multiple, round-to-oval, coin-like plaques of variable size and can present on many sites of the body.1,5 It is rare and unusual in the external auditory canal2,4 and even rarer in the auricle. To date, 6 cases of auricular SK have been reported in the English literature. It is more prevalent among Caucasians, and there is no prevalent difference between men and women. It is thought that SK increases with age.1
The pathophysiology of SK has not yet been established, but ultraviolet exposure, human papillomavirus infection, and hormonal effects have been associated with it.2 Seborrheic keratosis involves monoclonal tumors and autonomous neoplasms rather than simple epidermal hyperplastic disease. The fibroblast growth factor receptor 3 gene and p110 α subunit of phosphoinositide 3-kinase oncogene mutations are reported to be involved in the pathogenesis of SK.1
There are several histologic microscopic subtypes of SK, which consist of acanthotic, hyperkeratotic, adenoid or reticulated, clonal, irritated, inverted follicular keratosis, and melanoacanthoma types.2 Acanthotic, hyperkeratotic, and adenoid are the major subtypes, of which acanthotic is the most common.1
There are several benign and malignant diseases that should be differentiated from SK, such as actinic keratosis, solar lentigo, fibroma, verruca vulgaris, keratoacanthoma, basal cell carcinoma, squamous cell carcinoma, and melanoma.1,2 It is important to evaluate the possibility of malignancy when a lesion suspicious of SK is detected. It has been reported that basal or squamous cell carcinoma has coexisted with SK.3 However, SK in the external auditory canal and auricle has not been reported to be associated with concomitant malignancy.4
The treatment of choice for SK is removal using various methods including curettage, cryotherapy, laser ablation, topical vitamin D, and complete excision.1 Although SK is benign, considering its potential local recurrence and concomitant malignant features, close follow-up is necessary.2
Seborrheic keratosis in the auricle is rarer than in the external auditory canal; however, due to its location, it is easier to detect it in the auricle than in the external auditory canal. When the lesion is suspicious of malignancy, complete removal should be performed. In all excised cases, pathologic confirmation is mandatory to evaluate malignancy.
Authors' Note
The institutional review board of National Health Insurance Service Ilsan Hospital exempted the review of this study (NHIMC 2018-07-003).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iD
Junhui Jeong, MD, PhD 
https://orcid.org/0000-0002-1592-261X
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