Seborrheic Keratosis:
Seborrheic keratosis is a noncancerous scaly growth on the skin. It is very common in those over the age of 40. Some transplant recipients appear to develop many of these growths. They can have a variety of appearances ranging in color from white to skin colored to brown to black. They all generally have a waxy scale (appearance that candle wax has been dropped on the skin.) Many appear as if they have been stuck onto the skin like a sticker or piece of bubble gum. They will occasionally peel off the skin and then regrow. They can become irritated (itch or feel tender). They do not require treatment because they are noncancerous and noninfectious so will not spread if left untreated. If they are tender, irritated, or bothersome cosmetically, they can be removed with liquid nitrogen treatment or scraped off with a sharp instrument.

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Transplant Keratosis:
This is a type of "medical slang" used by many physicians to describe a poorly medically/scientifically characterized spot thought to be a combination of seborrheic keratosis and wart. They are scaly bumps. Often flesh colored to pink to tan in color. They tend to increase in number as the time from transplantation increases. They begin as individual spots and progress to coalesce into plaques. They commonly affect the dorsum of hands, forearms and face, but can involve the complete skin surface. Treatment is difficult, because commonly a very large surface area is involved. Moisturizers soften these scaly areas, especially a moisturizer that contains a bit of lactic acid (often 12.5%). Treatment with liquid nitrogen is effective for discrete areas of involvement.

Porokeratosis:
This is a spot on the skin that generally appears as an irregular plaque with central atrophy and a prominent peripheral thread-like scale. There are several different types of porokeratosis, however, in transplant recipients the most common type is disseminated superficial porokeratosis (DSP) and disseminated superficial actinic porokeratosis(DSAP). These generally occur on the extremities, especially in sun-exposed areas. They are symmetrical and can appear in crops of hundreds of lesions. Early spots may be very small scaly bumps that gradually increase in size with the peripheral thread-like scale becoming more prominent. The lesion may be flesh colored, brown or red. Many lesions may coalesce to the point that they appear just as dry skin. These can be asymptomatic or may itch and burn. They may be exacerbated by exposure to the sun. They can fluctuate in severity; spontanteously regressing or rarely progressing into a malignant variant of porokeratosis, or into a squamous cell carcinoma. Treatment options include liquid nitrogen, topical retinoids, topical immunomodulators, 5-fluorouracil, electrodesiccation and curettage and rarely excision.

Sebaceous hyperplasia:
This is a spot that consists of prominent oil (sebaceous) glands in the skin. It appears as a yellow/orange/red bump with central indentation. Pressure to the sides of the spot may result in the expression of a yellow material. These are very common on the face. It is important to avoid application of oil containing products to the face so as to avoid exacerbation of the spots. Treatment is for cosmetic reasons and may consist of liquid nitrogen, hot cautery, curettage, excision, chemical peels and occasionally retinoids.

International Transplant Skin Cancer Collaborative
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