When Skin Lesions Raise Concern: A Case of Seborrheic Keratosis, Warts, and Notalgia Paresthetica in a 65-Year-Old Female
At Village Dermatology in Katy and Houston, Texas, we often see patients who present with skin lesions that have changed in size, color, or texture. While many of these lesions turn out to be benign, timely evaluation is essential for diagnosis, peace of mind, and effective treatment. In this blog post, we review the case of a 65-year-old female who visited our clinic for assessment and management of multiple skin concerns, including suspicious lesions on the left shoulder and posterior neck.
Patient Overview
A 65-year-old woman came to our dermatology clinic as a new patient with a primary concern of enlarging, darkening lesions on her left shoulder and the back of her neck. These lesions had been present for several months and were moderately bothersome to her.
During her comprehensive full-body skin exam — including scalp, face, ears, chest, abdomen, back, and extremities — several dermatologic conditions were identified using a dermatoscope.
Diagnosis and Management
1. Seborrheic Keratosis (L82.1)
These common, benign growths often appear as waxy, "stuck-on" brown or black papules. The patient had several seborrheic keratoses on her body, consistent with age-related skin changes.
Plan:
Counseling: These growths are harmless and do not require treatment unless irritated.
Patient Education: We explained that these are benign and often increase with age.
2. Irritated Seborrheic Keratosis (L82.0)
In contrast to typical seborrheic keratoses, the patient had four inflamed lesions on her upper back. These showed signs of irritation, including crusting and tenderness.
Plan:
Cryotherapy: Four lesions were treated with liquid nitrogen (2 freeze-thaw cycles).
Patient Counseling: Discussed symptoms, treatment outcomes, and when to return if lesions persist or side effects occur.
3. Verruca Vulgaris (Common Warts, B07.8)
The patient had a cauliflower-like wart on her right anterior shoulder.
Plan:
Cryotherapy: One lesion was treated with liquid nitrogen.
Topical Treatment: Recommended salicylic acid for follow-up care.
Counseling: Explained that warts are viral and may spread or recur.
4. Notalgia Paresthetica (R20.2)
The patient reported mild discomfort and itching on her trunk, attributed to notalgia paresthetica — a nerve-related condition.
Plan:
Topical Hydrocortisone 2.5%: For flare-ups, applied twice daily for 2 weeks.
Non-Medication Strategies: Recommended Sarna cream, capsaicin cream, and avoiding scratching.
Counseling: This condition often relates to spinal nerve irritation and may need further evaluation if persistent.
Why Early Dermatologic Evaluation Matters
In this case, multiple types of skin lesions — both benign and symptomatic — were discovered during the initial evaluation. While none of the growths were cancerous, their appearance and evolution raised concern for the patient. Prompt assessment allowed for appropriate reassurance, treatment, and education.
Early dermatology visits help differentiate between harmless skin changes and those that need medical intervention. At Village Dermatology, serving Katy and Houston, Texas, we emphasize patient-centered care with thorough exams and evidence-based management.
Are You Concerned About Skin Lesions?
If you notice new or changing skin lesions, schedule an appointment with Village Dermatology. Whether it’s a common seborrheic keratosis or something more complex like notalgia paresthetica, our board-certified dermatologists are here to help.
📍Locations: Katy, TX and Houston, TX
📞 Contact us today to schedule your full-body skin exam and ensure your skin health is in expert hands.
