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Seborrheic Keratosis vs. Melanoma

Many patients present with dark, irregular, sometimes irritated SKs and worry that they are melanomas. SKs can show many of the features of a malignant melanoma, including an irregular border and variable pigmentation. The key differential diagnostic features are the surface characteristics. Melanomas have a smooth surface that varies in elevation and in color, density, and shade. SKs preserve a uniform appearance over their entire surface. Examination with a hand lens is very helpful. Melanomas do not have horn pearls on or under the surface. Many SKs occur in sun-exposed areas.