Atypical Hyperkeratotic Seborrheic Keratosis Mimicking Granuloma Faciale: Diagnostic Challenges and Histopathological Insights – A Case Report

Atypical Presentation of Hyperkeratotic Seborrheic Keratosis Mimicking Granuloma Faciale

Abstract

Seborrheic keratosis (SK) is among the most common benign epidermal neoplasms, yet its clinical
heterogeneity can obscure diagnosis, particularly when it mimics rarer inflammatory or neoplastic
dermatoses. Hyperkeratotic variants lacking classic verrucous features present a particular diagnostic
challenge. This case is presented to highlight the diagnostic pitfalls of atypical hyperkeratotic seborrheic
keratosis and to emphasize the critical role of histopathological evaluation in distinguishing it from
clinically similar facial dermatoses.

We describe a 40-year-old woman with a two-year history of a solitary, indurated, erythematous plaque on
the right cheek. The lesion was pruritic, slowly progressive, and devoid of hallmark features of SK. The
initial diagnostic considerations included granuloma faciale. However, histopathological evaluation of a
biopsy specimen revealed marked acanthosis, papillomatosis, orthokeratosis, and horn cysts, confirming
a diagnosis of hyperkeratotic seborrheic keratosis (HSK).

This case highlights the diagnostic complexities posed by atypical SK variants and the critical role of
histopathology in distinguishing SK from clinically similar dermatoses such as granuloma faciale. Accurate
diagnosis is essential to avoid unnecessary interventions and to guide appropriate management.

Keywords: Granuloma Faciale Mimicry, Histology, Atypical Seborrheic Keratosis, Diagnostic
Challenges.