A rare case of pigmented seborrhoeic keratosis of scalp

Seborrheic keratosis (SK) is a prevalent hyperkeratotic dermatological condition characterized by benign proliferation of epidermal keratinocytes, typically occurring in the middle to advanced stages of life. While the trunk is the primary site for lesions, they can also manifest on the extremities, face, and scalp. Although SK is typically benign, there can be morphological overlap with malignant skin lesions, necessitating meticulous differentiation for an accurate diagnosis. This case report describes a 63-year-old male presenting with scalp swelling that was, initially suspected to be malignant. However, histopathological examination revealed pigmented seborrheic keratosis, prompting the need for a comprehensive management approach. Surgical excision with a rotational flap cover was performed successfully, highlighting the importance of precise diagnosis and management in addressing cutaneous lesions. The exact etiology of SK remains elusive, with potential genetic associations implicated in its pathogenesis. Although treatment may not always be necessary, various modalities are available for lesion removal or symptom management, with surgical intervention reserved for cases exhibiting signs of malignancy. Clinicians should be aware of the atypical presentations of SK and, emphasize the need for a multidisciplinary approach involving dermatologists, pathologists, and surgeons for optimal outcomes.