Seborrheic keratoses are the most common benign epidermal tumors in the older population, presenting as well-circumscribed, waxy, “stuck-on” papules or plaques. While benign, seborrheic keratoses display heterogeneous clinical and histologic features that may mimic melanoma and other cutaneous malignancies. Dermoscopy and non-invasive imaging, such as confocal laser scanning microscopy and optical coherence tomography, improve diagnostic accuracy, though biopsy remains essential for atypical lesions. Oncogenic mutations in fibroblast growth factor receptor 3 and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha underlie seborrheic keratosis pathogenesis without conferring malignant potential. Management is conservative, with treatment guided by cosmetic or symptomatic concerns.