Long-Standing Seborrheic Keratosis of the Scalp

Seborrheic keratosis (SK) is a common benign epidermal tumor that frequently arises in elderly patients. Although it is usually straightforward to diagnose, atypical long-standing or pigmented lesions on the scalp can mimic malignancies such as melanoma or pigmented basal cell carcinoma. We present the case of an 82-year-old man with a slowly enlarging verrucous plaque on the left temporo-parietal scalp that has been present for at least 20 years. The lesion was asymptomatic but demonstrated dark pigmentation and irregular borders, prompting histopathologic evaluation. Biopsy confirmed SK, and the lesion was completely removed by shave excision and curettage. This case highlights the diagnostic challenge posed by long-standing pigmented scalp lesions and emphasizes the importance of clinicopathologic correlation to exclude malignancy.