Not a Mole: Seborrhoeic Keratoses, Sebaceous Hyperplasia, Syringomas and Xanthelasma, and How Each Is Treated

Reviewed by Dr Eugene Lim | MBBS, Dr Cindy’s Medical Aesthetics, Singapore. Fully registered with the Singapore Medical Council, practising alongside Dr Cindy Yang.

You noticed it in the bathroom mirror, under the brighter light, and you are fairly sure it was not there two years ago. A brown, slightly raised patch on the temple that looks as if it has been pressed onto the skin. Your mother called it a mole. A colleague called it an age spot. A skincare counter sold you a brightening cream for it, and six weeks later it is exactly the same.

Or it is the soft, yellowish bumps across the forehead that you have squeezed for a year because they look like whiteheads. Nothing comes out.

Or the cluster of tiny firm bumps under your eyes that a facial therapist tried to extract and could not. Or a flat yellow patch at the inner corner of the eyelid that has been quietly growing.

None of these is a mole, and none is acne. They are four different benign growths, each with its own cause, appearance and treatment options. This article sets out how to tell them apart, how a doctor distinguishes them from other skin growths, how they can be treated, and why recurrence is possible.

Why these four are grouped together

Seborrhoeic keratoses, sebaceous hyperplasia, syringomas and xanthelasma have little in common biologically: an overgrowth of keratinocytes, an enlarged oil gland, a benign sweat-duct tumour, and deposits of lipid-laden cells within the skin.

They belong in one article for four practical reasons.

All four are benign. These conditions are not skin cancers. Patients usually seek treatment because of their appearance, but correct diagnosis still matters because other lesions can sometimes resemble them.

All four are routinely mislabelled. Seborrhoeic keratoses are called moles or age spots, sebaceous hyperplasia is mistaken for adult acne, syringomas for milia, and xanthelasma for a fatty lump. The wrong label leads to the wrong treatment.

Creams generally do not remove an established lesion. Treatment, when wanted, usually involves physically removing, reducing or destroying the lesion with a procedure appropriate to its depth and location.

Recurrence is possible. Some lesions can recur at a treated site, particularly when deeper components remain. Others may be successfully removed at one site while new lesions continue to develop elsewhere because the underlying tendency remains.

If you are unsure whether a pigmented growth is a mole at all, our guide to what a normal mole looks like covers the features worth checking. For skin tags, moles, milia and warts side by side, see the field guide to small skin growths.

Seborrhoeic keratosis: the “stuck-on” brown patch

A seborrhoeic keratosis is a benign proliferation of keratinocytes, the predominant cells of the epidermis. Its characteristic surface is why it often looks and feels as though it has been stuck onto the skin from above.

What it looks like. A well-defined patch or plaque from a few millimetres to several centimetres across, ranging from light tan through brown to almost black. The surface may be waxy, smooth, rough or warty, sometimes with small pits and keratin plugs visible on close examination. Raised lesions can catch on clothing.

Where and when. Seborrhoeic keratoses become increasingly common with age and frequently occur on the face, scalp, chest, back and shoulders.

A Korean study of 303 men aged 40 to 70 found seborrhoeic keratoses in 78.9 per cent of participants in their forties and 98.7 per cent of those aged 60 and above, with sun exposure identified as a contributing factor [1]. Those figures describe that particular study population rather than East Asian populations generally.

Dermatosis papulosa nigra. Dermatosis papulosa nigra, or DPN, is considered a variant of seborrhoeic keratosis. It presents as multiple small, dark brown or black papules, particularly on the face and neck, and is more common in people with more deeply pigmented skin. There is often a family history.

It is frequently mistaken for a collection of small moles.

How it differs from a mole. Seborrhoeic keratoses are growths of keratinocytes, whereas melanocytic moles are proliferations of melanocytes.

A typical seborrhoeic keratosis has a waxy, keratotic or “stuck-on” surface. A typical mole tends to have a smoother surface, although there is enough overlap that appearance alone is not always sufficient for diagnosis.

How it differs from melanoma, and why that still matters. Some seborrhoeic keratoses can become very dark, irregular or irritated and resemble melanoma or another skin tumour.

A lesion that is changing, bleeding without an obvious reason, persistently crusted, unusually irregular or simply does not look like the patient’s other lesions deserves medical assessment.

If the diagnosis remains uncertain or suspicious features are present, cosmetic laser treatment is not the next step. The lesion is referred for specialist assessment so that biopsy or another appropriate diagnostic procedure can be performed if necessary.

Flat brown marks that are neither. A completely flat, evenly pigmented brown mark without the characteristic texture of a seborrhoeic keratosis may instead be a solar lentigo or another form of pigmentation. These are covered in the pigmentation treatment article.

How it is treated. Several established methods can remove seborrhoeic keratoses, including ablative laser, curettage, shave removal and cryotherapy.

At Dr Cindy’s Medical Aesthetics, seborrhoeic keratoses are assessed and, where appropriate, are usually treated with an ablative laser. The laser removes the lesion in a controlled manner while limiting unnecessary treatment of the surrounding skin.

The clinic offers laser removal of skin growths at both Orchard and Tampines.

Tissue from a routine benign seborrhoeic keratosis treatment is not automatically sent for histological examination. A lesion with suspicious or diagnostically uncertain features follows a different pathway and is referred for specialist assessment rather than simply treated cosmetically.

The consideration in more deeply pigmented skin. Any procedure that creates inflammation can leave post-inflammatory hyperpigmentation, particularly in more deeply pigmented skin.

Treatment therefore has to balance sufficient removal with unnecessary tissue injury. Temporary darkening or, less commonly, a lighter mark can occur after treatment, and this possibility is discussed before the procedure.

Sebaceous hyperplasia: the whitehead that never empties

Sebaceous hyperplasia is an enlargement of normal sebaceous glands. Enlarged glandular lobules around a hair follicle create the characteristic small dome on the surface.

What it looks like. A soft, yellowish or skin-coloured papule, often around 2 to 5 millimetres across, frequently with a small depression in the centre corresponding to the follicular opening.

There is often more than one, scattered across the forehead, temples, cheeks or nose.

Who gets it, and why squeezing fails. Sebaceous hyperplasia becomes more common with age and is particularly common on the face.

It is frequently mistaken for acne, but the structures are different. A comedone contains accumulated keratin and sebum within a follicle. Sebaceous hyperplasia is enlargement of the sebaceous gland itself.

There is therefore no plug that can simply be squeezed out.

For genuine comedones and whiteheads, the acne treatment article covers what works.

The look-alike that matters. Basal cell carcinoma can sometimes resemble sebaceous hyperplasia, particularly when it presents as a small pale or skin-coloured facial papule.

A solitary lesion that continues to grow, repeatedly bleeds, develops a persistent crust or looks noticeably different from surrounding lesions should be assessed rather than assumed to be sebaceous hyperplasia.

Where the diagnosis is suspicious or uncertain, the lesion is referred for specialist assessment rather than treated cosmetically with laser.

How it is treated. Several procedural approaches are used for sebaceous hyperplasia, including electrodesiccation and ablative laser.

At Dr Cindy’s Medical Aesthetics, suitable sebaceous hyperplasia is usually treated with an ablative laser. The aim is to flatten the enlarged gland while controlling the amount of injury to the surrounding skin.

Treatment is available at both Orchard and Tampines.

Why it can come back. Sebaceous hyperplasia arises from enlarged sebaceous glands that extend below the visible surface. Flattening the surface does not necessarily eliminate every component of the enlarged gland.

A treated lesion can therefore recur, and patients who are prone to sebaceous hyperplasia may also develop new lesions elsewhere over time.

The goal is effective flattening with an acceptable cosmetic result rather than simply treating as deeply as possible.

Syringomas: the bumps under the eyes that will not extract

Syringomas are small benign tumours arising from eccrine sweat ducts. They sit within the dermis, which is why they feel firm and cannot be extracted like milia.

What they look like. Clusters of small, firm papules, usually around 1 to 3 millimetres across and skin-coloured to slightly yellow. They most commonly occur around the lower eyelids and upper cheeks and are often symmetrical.

They are more common in women, often appear from adolescence or early adulthood, and are reported more frequently in some Asian populations.

They are usually asymptomatic.

The milia confusion. A milium is a superficial keratin-filled cyst that can be opened and extracted. A syringoma is a benign growth within the dermis and contains nothing that can simply be squeezed out.

Repeatedly attempting extraction therefore achieves little except inflammation.

The milia seed removal article covers milia, including those occurring around the eyes.

How they are treated, and why it is difficult. Syringomas sit deeper than milia, and that creates the central treatment problem: treating too superficially may leave much of the lesion behind, while treating too aggressively increases the risk of scarring or pigment change.

Several methods have been used, including ablative lasers and electrodesiccation.

At Dr Cindy’s Medical Aesthetics, suitable syringomas are usually treated with an ablative laser in a controlled manner. The goal is to reduce and flatten the visible lesions while limiting unnecessary injury to the surrounding eyelid skin.

Complete disappearance cannot be promised. Some lesions may need more than one treatment, and recurrence is possible because syringoma tissue can remain within the dermis.

Where another treatment session is appropriate, a repeat session can be scheduled four weeks or more after the first once the treated skin has healed sufficiently.

Syringoma treatment is available at both Orchard and Tampines.

The eyelid consideration. Lower-eyelid skin is particularly thin, so treatment has to be conservative.

Temporary redness, swelling, crusting and post-inflammatory pigmentation are possible. Less commonly, a lighter mark or scar can occur. The balance between flattening the syringoma and protecting the surrounding skin is therefore more important than pursuing maximum treatment depth in one session.

Xanthelasma: the yellow plaque on the eyelid

Xanthelasma consists of collections of lipid-laden cells within the skin around the eyelids. Unlike the other three conditions in this article, its appearance can sometimes prompt a discussion about blood lipids as well as cosmetic treatment.

What it looks like. A soft, flat or slightly raised yellow to yellow-orange plaque, usually near the inner corners of the eyelids. It is often bilateral and tends to enlarge gradually.

It is usually painless.

Why a doctor asks about cholesterol. Xanthelasma can occur in people with normal lipid levels as well as those with dyslipidaemia.

Because abnormal lipid levels are found in a substantial proportion of patients, checking a lipid profile is reasonable, particularly when the patient’s levels are not already known.

A large Danish population study also reported an association between xanthelasma and increased cardiovascular risk independent of measured cholesterol levels [3]. That is an association at the population level rather than proof that the eyelid plaque itself causes cardiovascular disease.

The practical point is simple: treating the visible plaque and assessing cardiovascular risk are separate issues. Removing xanthelasma does not treat abnormal blood lipids, and improving blood lipids does not necessarily make an established plaque disappear.

How it is treated. Several methods are used clinically, including ablative laser, chemical treatment with trichloroacetic acid and surgical excision, depending on the size, depth and location of the plaque.

At Dr Cindy’s Medical Aesthetics, suitable xanthelasma is usually treated with an ablative laser. The lesion is treated progressively while protecting the surrounding eyelid skin.

Treatment is available at both Orchard and Tampines.

Large, deep, unusually positioned or otherwise unsuitable lesions may require a different approach or specialist referral.

Recurrence. Xanthelasma can recur after treatment. Published recurrence rates vary substantially because they depend on the treatment method, lesion characteristics, follow-up period and study population.

Patients should therefore think of treatment as removal of the plaque that is present rather than a guarantee that xanthelasma can never appear again.

Why the mark is discussed first. Eyelid skin is thin and highly visible. Redness, swelling, crusting and temporary pigmentation can follow treatment.

More deeply pigmented skin can develop post-inflammatory hyperpigmentation after treatment, while excessive treatment depth carries a risk of hypopigmentation or scarring.

The aim is therefore not simply to remove as much tissue as possible in one pass. It is to achieve useful clearance while preserving the eyelid skin.

A note on the small red ones

Cherry angiomas, the bright red papules that commonly appear on the trunk and other areas with age, belong to a different group altogether. They are benign vascular lesions rather than keratinocyte, sebaceous, sweat-duct or lipid-related growths.

A vascular laser can target the blood vessels within them.

The clinic’s yellow-light laser at 577 nm targets oxyhaemoglobin within superficial vessels. The clinic describes cherry angioma removal on its service page and the yellow-light laser itself in a separate article.

How a doctor tells them apart from a mole in the room

The first distinction comes from looking at the lesion as a whole: its colour, surface, texture, location, distribution and history.

Surface and feel. A waxy or warty “stuck-on” surface suggests seborrhoeic keratosis. A soft yellowish dome with a central depression suggests sebaceous hyperplasia. Multiple firm skin-coloured papules around the lower eyelids suggest syringomas. A soft yellow plaque near the inner eyelid suggests xanthelasma.

These are useful patterns, not home diagnostic tests. Real lesions do not always reproduce textbook appearances perfectly.

Distribution. Distribution provides another clue. Symmetrical clusters beneath both eyes are characteristic of syringomas. Multiple yellowish domes across the forehead can fit sebaceous hyperplasia. Yellow plaques around the inner eyelids fit xanthelasma.

Again, the pattern supports the diagnosis rather than proving it.

When the appearance does not fit. A lesion that changes significantly in size, shape or colour, repeatedly bleeds, develops persistent ulceration or crusting, or simply looks unlike the patient’s other growths deserves closer assessment.

The same applies when the doctor cannot confidently establish that a lesion is benign.

In that situation the plan changes. A suspicious or diagnostically uncertain lesion is not simply destroyed with a cosmetic laser. It is referred for specialist assessment so that biopsy or another appropriate diagnostic procedure can be performed if necessary.

How doctors approach pigmented lesions and choose removal methods is discussed in the mole removal guide, while the clinic’s mole removal service page lists changes that should prompt an appointment.

Recurrence, realistic expectations and aftercare across the four

What returns, and why. Recurrence is different for each condition. A treated seborrhoeic keratosis may clear successfully while new seborrhoeic keratoses appear elsewhere with age. Sebaceous hyperplasia can recur because the enlarged gland extends below the visible surface. Syringomas can persist or recur because they sit within the dermis. Xanthelasma can also recur after apparently successful treatment.

The useful expectation is therefore not “one treatment means these can never return.” Treatment deals with the lesions that are present. Whether another treatment is needed later depends on the condition and the individual.

What healing looks like. After laser treatment, small treated areas commonly develop a crust or scab. The clinic’s published guidance for laser-treated skin growths gives approximately 3 to 5 days for smaller scabs and around 7 to 10 days for larger ones, with healing varying according to the site and treatment depth.

Follow the prescribed aftercare, keep the treated area clean as instructed and allow the scab to separate naturally rather than picking it off.

The mark. A newly healed treatment site can initially look pink, red, lighter or darker than the surrounding skin. Post-inflammatory hyperpigmentation is more common in more deeply pigmented skin and may take considerably longer to fade than the initial wound takes to heal.

Sun protection is particularly important once the treated surface has healed because UV exposure can worsen persistent pigmentation. A brown mark that remains after healing can be assessed separately, and the pigmentation article explains the treatment options.

Three things patients commonly get wrong

“They are age spots, and a whitening cream will lift them.” A seborrhoeic keratosis is a growth of keratinocytes, not simply excess pigment sitting within otherwise normal skin. A pigmentation product may be appropriate for some flat pigmented conditions, but it does not physically remove an established seborrhoeic keratosis. That is why identifying the lesion comes before choosing the product.

“They are acne.” Sebaceous hyperplasia is enlargement of sebaceous glands, while syringomas are benign sweat-duct tumours. Neither is simply a blocked pore. Acne treatments therefore do not remove them in the way they can treat comedonal acne. Persistence is one clue. Acne lesions evolve, while sebaceous hyperplasia and syringomas can remain in essentially the same locations for long periods. But duration alone does not diagnose a growth. A persistent or changing bump still needs to be identified correctly.

“Once treated, they never return.” No procedure can make that promise across these four conditions. A lesion can recur if part of it remains, and some people continue to develop new lesions because the underlying tendency remains. That is why the consultation includes a discussion of recurrence as well as removal.

What a consultation involves

The consultation begins with the history: when the growth appeared, whether it has changed, whether it bleeds, crusts, hurts or itches, and what has already been tried.

For xanthelasma, the discussion also includes whether blood lipids have been checked and whether further assessment of cardiovascular risk is appropriate. The doctor then examines the growth and considers its surface, colour, texture, distribution and history. The first question is not which laser setting to use. It is whether the lesion is what it appears to be and whether cosmetic treatment is appropriate.

If it is a benign seborrhoeic keratosis, sebaceous hyperplasia, syringoma or xanthelasma suitable for treatment, Dr Cindy’s Medical Aesthetics usually uses an ablative laser. The doctor explains why that method suits the lesion, what the treated area is likely to look like while it heals, the possibility of pigmentation or another residual mark, and the chance that further treatment may eventually be needed.

Where appropriate, several lesions can be treated during the same session.

Assessment and treatment of these four benign growths are available at both Orchard and Tampines.

Routine benign seborrhoeic keratosis treatment is not automatically sent for histological examination. If a lesion instead has suspicious or diagnostically uncertain features, cosmetic destruction is not the next step. The patient is referred for specialist assessment and tissue diagnosis where appropriate.

For syringomas, more than one treatment may be required. Where another session is appropriate, it can be scheduled four weeks or more after the previous treatment once the skin has healed.

For xanthelasma, the visible plaque and the question of blood lipids are treated as separate issues. Removing the plaque addresses its appearance; checking and managing abnormal lipids addresses the patient’s broader health.

You leave knowing what the growth is, whether treatment is appropriate, what the treatment is intended to achieve, what the healing period is likely to look like, and what recurrence realistically means for that particular condition.

Where to be seen, and who sees you

Dr Cindy’s Medical Aesthetics assesses benign skin growths of this kind and, where suitable, treats them. Its published laser removal of skin growths service covers moles, skin tags, warts and milia, and the growths in this article are assessed at the same appointment.

Orchard. 360 Orchard Road, #05-06 International Building, Singapore 238869. Monday and Thursday 11.30am to 7pm, Tuesday, Wednesday and Friday 10am to 8pm, Saturday 10am to 3pm. Closed Sunday and public holidays.

Tampines. 1 Tampines Central 5, #07-01 CPF Tampines Building, Singapore 529508. Monday to Friday 11.30am to 9pm, Saturday 10am to 7pm. Closed Sunday and public holidays.

Assessments are carried out by the clinic’s doctors: Dr Cindy Yang, founder and medical director; Dr Eugene Lim, fully registered with the Singapore Medical Council; and Dr Grace Su, a general practitioner working in aesthetic and lifestyle medicine.

Some presentations belong with a dermatologist or a hospital skin clinic from the start: any dark or changing lesion with a feature suggestive of melanoma or basal cell carcinoma, a lesion that has already been biopsied as atypical, a personal or family history of melanoma, a xanthelasma that is large or sits on the eyelid margin and needs an ophthalmic surgical approach, and any growth in a child that is changing quickly.

In any clinic you consider, look for a doctor registered with the Singapore Medical Council, an examination of the lesion itself with a dermatoscope, a method chosen for the type of growth and its depth, tissue sent for histology whenever a lesion is removed because of any suspicious feature, and a plain statement of the expected mark and healing time before anything is done.

Dr Cindy’s Medical Aesthetics has assessed and treated benign skin growths in Singapore skin since 2010, and states the likely mark and the chance of recurrence before any lesion is touched.

Frequently asked questions

What is seborrhoeic keratosis and is it dangerous?

A seborrhoeic keratosis is a benign overgrowth of the cells that make up the outer layer of the skin. It looks stuck on: a waxy, tan to almost black patch with a slightly greasy or warty surface, on the face, chest, back or scalp. It begins in the forties and multiplies with age, and in a study of Korean men aged 40 to 70 it was close to universal by 60. It is benign. A very dark, irregular one overlaps in appearance with melanoma, so a lesion with any suspicious feature is examined by a doctor.

What is sebaceous hyperplasia and how is it treated?

Sebaceous hyperplasia is an enlarged oil gland. It forms a soft yellowish papule of 2 to 5 mm with a small dip in the centre, usually several of them across the forehead, temples and cheeks, from the forties onward. It is commonly mistaken for acne, and squeezing does nothing because the lump is the gland itself. Treatment destroys or removes the gland: electrodesiccation, an ablative laser taken down to the level of the gland, or a shave removal. A treatment that flattens only the surface leaves the gland to regrow.

What is xanthelasma and can it be removed?

Xanthelasma is a deposit of lipid-laden cells in the skin of the eyelid, usually a soft yellow plaque near the inner corner of the upper lid, enlarging slowly over years. It can be removed by an ablative laser, by a precisely applied chemical peel, or by surgical excision for a large or thick plaque. Roughly half of patients with xanthelasma have raised blood lipids, so a doctor will suggest a lipid profile. Treating the plaque does nothing for the lipids, and both are addressed separately.

How are syringomas treated?

Syringomas are benign sweat-duct tumours sitting in the deeper layer of the skin, usually as clusters of firm 1 to 3 mm papules on the lower eyelids. Because they sit in the dermis, they cannot be extracted. The standard approach is an ablative laser in controlled passes under a local anaesthetic, taking each lesion down until the skin is flat, or electrodesiccation with a fine needle for small numbers. The realistic expectation is flattening more than disappearance, and a proportion return over one to two years.

Which skin bumps come back after treatment?

All four can return, for different reasons. Sebaceous hyperplasia regrows within months when the gland below the surface is left behind. Syringomas return over one to two years because tumour tissue remains below the treated depth. Xanthelasma recurs most often of the four, because the tendency to deposit lipid in the eyelid skin persists, and sooner when raised lipids stay untreated. A treated seborrhoeic keratosis rarely returns at the same site, and new ones continue to appear with age.

References

1. Kwon OS, Hwang EJ, Bae JH, et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol Photoimmunol Photomed 2003;19(2):73-80.

2. Simmons BJ, Griffith RD, Falto-Aizpurua LA, Bray FN, Nouri K. Light and laser therapies for the treatment of sebaceous gland hyperplasia: a review of the literature. J Eur Acad Dermatol Venereol 2015;29(11):2080-2087.

3. Christoffersen M, Frikke-Schmidt R, Schnohr P, Jensen GB, Nordestgaard BG, Tybjaerg-Hansen A. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ 2011;343:d5497.