Seborrheic Keratosis of Male Breast: A Case Report of Skin Problem Rare at Breast Clinic

Seborrheic keratosis is a benign skin disease occurring mostly over the sun exposed areas of the body. This dermatological problem is rare in the region of nipple areola complex. Most of the breast surgeons are unaware of this disease. The authors are describing a rare surgical encounter where a provisional diagnosis of breast polyp was made. He was further investigated to rule out any underlying breast malignancy. Finally, excision biopsy revealed the diagnosis. A prior suspicion of this disease could have avoided the need for all these complex investigations.


Introduction
Seborrheic Keratosis (SK) is a benign tumor of the skin. The lesion typically appears as superficial verrucous plaque with stuck on to the surface appearance. They are more common with advancing ages and are usually seen over sun exposed areas of the body [1]. Their occurrence over the covered areas is infrequent but reported. However, to the best of author's knowledge it is still not reported on nipple and areola complex of the male breast. The breast surgeons are practically unaware of this disease and therefore can prescribe expensive tests to rule out the malignancy.
We report this case as it is rare at this site. It will add to the pool of diseases occurring over the nipple and areola complex of the breast. An aware surgeon can avoid complex procedures to reach the diagnosis.

Case Report
A 47-year-old man came to the Surgery OPD with chief complaint of growth over the left Breast for 10 years. It was detected incidentally as a small lesion near the outer margin of the left nipple areola complex. It slowly but progressively enlarged to its present size of 3 cm × 3 cm ( Figure 1). On examination it was a firm, non-tender, verrucous plaque, stuck to the skin surface through a narrow short pedicle. A provisional diagnosis of left breast polyp was made.
The ultrasound of the breast and mammography were advised to rule out any underlying breast malignancy. The reports came out to be normal. Finally, excision biopsy was performed ( Figure 2) to reach the diagnosis.
The histopathology report came out to be seborrheic keratosis with no evidence of malignancy. The findings were based on the presence of hyperkeratosis, papillomatosis with basaloid proliferation and presence of pseudo-horn cysts on microscopic examination.
Following excision, the wound healed normally and the stitches were removed on 10 th post-operative day. No recurrence was noticed till 3 months when he was lost to monthly follow up at surgery OPD.

Discussion
Seborrheic keratosis is seen most commonly over the sun exposed areas like head and neck region. It is less frequent over the sun protected areas of the body. The search of English language literature shows that the disease has not been reported on the nipple and areola complex of the male breast. However, the same has been reported in a female by Narsimha et al. in 2013 [2].
A rare condition called Leser-Trelat sign, a paraneoplastic syndrome, has been omitted from the discussion. It is associated with acute onset multiple Seborrheic Keratosis all over the body. It is not a chronic condition and therefore has been excluded.  skin lesion with verrucous surface and a stuck on the skin appearance doesn't have too many clinical differential diagnosis. It's rare at this site, but if a surgeon is careful it can be easily labelled as seborrheic keratosis.

Conclusion
No rare or common breast lesion can mimic seborrheic keratosis. This is probably the first report of the disease in areola region of the male breast. A surgeon should be aware of this to save his patients from the costlier and complex investigations.