This patient's lesion is a seborrheic keratosis. Seborrheic keratoses are benign skin lesions that commonly occur in older persons. They typically have a waxy or scaly texture and often have a “stuck-on” appearance. They are usually oval and brown and may occasionally itch or bleed.

Dermatofibromas are benign firm brown or reddish papules that most commonly occur on the lower extremities. They generally lack the scale seen with seborrheic keratoses. They extend deeper into the skin than seborrheic keratoses and exhibit the “dimple sign” when squeezed.

Malignant melanomas may occasionally resemble seborrheic keratoses, and thus lesions that are questionable should be removed and sent for histologic evaluation. Although some features of seborrheic keratoses may be suggestive of malignant melanoma, such as elevations above the skin and inconsistent coloration, melanomas tend to progress more rapidly, are darker in color, have more blurred borders, and lack the scaly “stuck-on” appearance characteristic of seborrheic keratoses.

Pigmented basal cell carcinomas may mimic seborrheic keratoses, but they tend to be more translucent and less scaly.

Solar lentigines (“liver spots”) are flat brown macules that occur on sun-exposed skin of older persons, particularly the face and dorsal hands rather than the trunk. They resemble large freckles.