History:

 A 52-year-old man has a pigmented lesion on the lower back which has been suddenly increased significantly in size and height in last two weeks.

A long standing seborrheic keratosis with a darkly pigmented papillated fissured waxy verrucous walnut’s shell-like surface. On magnification, the surface is scaly-crusted and the base and the tumor have a red hue! These findings are consistent with irritated (inflamed) SK. The sudden enlargement was due to irritation (inflammation). The lesion was excised in toto under local anesthetic and primarily sutured. Histopathological report was consistent with irritated SK.