DIY Fingernail Surgery for Seborrheic Keratoses

Hello and welcome. I'm Dr George Lundberg, and this is At Large at Medscape.

In 1991, at the age of 58, I experienced the sudden appearance and rapid growth of an irregular, asymptomatic, pigmented lesion on my face below my right eye.

My dermatologist in Chicago clinically diagnosed it as a seborrheic keratosis (SK). It was subsequently confirmed by microscopic examination and excised by shave technique. It scabbed and healed, leaving a faint scar. It has not recurred.

This began my journey through many more SK lesions of the skin of my neck, my chest, my abdomen, my groin, my axilla, my back, and occasionally my arms and legs. They do not seem to be sun-related. Some grow quickly, some slowly; some get hard, some stay soft; all remain asymptomatic and are simply "there." They don't hurt anything and, after a while, seem to stop growing and involute to firmness. The dermatologic descriptor of therapy would be "cosmetic." The clinical and gross pathologic descriptor: They look "stuck on."

So, on a whim, around 2005, I stuck my fingernail under the edge of one and pulled. It came off rather easily, but it did bleed a bit. I washed the iatrogenic wound with soap and water (it stung a little) and let it air dry and heal. "Rinse and repeat"; I did, many times. They usually scab over and heal without a scar of any kind. None ever showed evidence of "post-op" infection. Occasionally, I have found a small recurrence; if raised, I simply scrape it off as well.

As I have aged, the frequency of recognizable new, raised SKs has slowed and almost stopped, although flat pigmented skin blotches (not "stuck on"; no substance to scrape off) have increased. I reported on this in 2006, in a Medscape column and in Medscape General Medicine , a Medline-indexed medical journal. I received several comments and criticisms at the time, and what follows are my replies to some of these comments.

Thank you for your article on seb keratoses. I have been picking them off of my patients for years, by way of showing them that this is a benign and harmless lesion.... Thank you, Ed, especially for your additional comments, including not charging for this.
I find your piece embarrassing and unworthy of your Internet service. The use of fingernail surgery is to be condemned as it is a bacterially contaminated area.... Well, Philip, I guess we — based on clinical experience and science as documented in references — disagree.
Hell, George, I've been scraping off my SKs with my fingernails for 30 years. Thanks, old Texas pathologist friend Dub.
I'm glad to hear that someone else is doing this and having the same success as me! I first tried this technique in elementary school. Of course, I had no idea what that big brown lesion was. When it came off, I thought for sure something bad would happen. But nothing ever did....Thanks, Mary.
I had one on my face which a plastic surgeon had offered to remove until I found that scraping it with my fingernails got rid of it. It kept coming back and I kept scraping it off until it eventually gave up. No scar, as you say. I have tried with others but they are probably the wrong type as they either hurt or won't come off. I think it may be that lack of pain when you try to do this is a sign that you are dealing with a seborrheic keratosis. Thanks, Charles. If it resists scraping or hurts, quit; probably not an SK.

The 25-year follow-up was published in 2016. There are 29 comments at the end of this Medscape publication. Here are a few.

I thought I was the only one doing "fingernail surgery" on my SK. I think it is beyond the scope of practice of a retired nurse-midwife but who's going to sue me? LOL! Thank you, Judith.
Thank you for sharing your cost-effectIve, innovative self-care treatment of SKs! Thank you, MM.
That is disgusting. Sorry, Jaime.
I agree wholeheartedly with your approach. As a plastic surgeon who has dealt with both benign and malignant skin lesions for over 30 years, I frequently use the fingernail test to demonstrate to patients that an SK can be lifted at the edges, thus it is "stuck on" to the skin, not growing from deeper, therefore it is a benign lesion. They often ask if it is safe for them to remove them with their fingernails, and I tell them that it is. At that point many will admit to having already done that many times! Thank you, John.
Just read the article. Did a couple of mine last night! Thank you, Anthony.
Could it be associated with malignancy such as renal carcinoma? Sorry, Tareq; this relationship, if any, does not apply to sporadic SKs.

A number of commenters cited their use of hydrogen peroxide to soften hard SKs and ease removal. Probably a good idea.

The usual Medscape reader has probably not read a recent column in my blog Curious Dr. George. In addition, oncology journalist Ron Piana describes his own self-treatment of what was probably a nasty oral leukoplakia, which rapidly disappeared after application of hydrogen peroxide. That report led me to a Canadian group that reports on using topical hydrogen peroxide to successfully eradicate other, actually dangerous, precancerous actinic keratoses (AKs).

So, if you are worried that you might mistake an SK for an AK, you might try peroxide first. Obviously, I write this now because my 15- and 30-year follow-up on my personal SK therapy has been successful. Let me close with another quote from Dr Bruce Polender in 2016: Dr Lundberg has proven that less is often better than more.

That's my opinion. I'm Dr George Lundberg, at large for Medscape.

George Lundberg, MD, is contributing editor at Cancer Commons , president of the Lundberg Institute, executive advisor at Cureus, and a clinical professor of pathology at Northwestern University. Previously, he served as editor-in-chief of JAMA (including 10 specialty journals), American Medical News, and Medscape.

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