Somatic activating fibroblast growth factor 3 (FGFR3) mutations in human skin can cause seborrheic keratoses, one of the most frequent skin tumors in man. However, details of the involved mechanisms remain elusive. We analyzed 65 acanthotic seborrheic keratoses with varying vertical diameters for FGFR3 mutations using a SNaPshot s multiplex assay. Immunohistochemistry was performed for Ki-67, bcl-2 and FGFR3 protein in all seborrheic keratoses and 19 normal skin samples. FGFR3 mutations were detected in 37 of 65 seborrheic keratoses (57%). These mutations were found both in flat (initial) and thick seborrheic keratoses. FGFR3 mutations were significantly associated with increased age and localization on the head and neck (Po0.01). Ki-67 expression was significantly higher in seborrheic keratoses than in normal epidermis independent of the FGFR3 status (Po0.001). Furthermore, FGFR3 mutations were associated with an increased expression of bcl-2 and FGFR3 protein (Po0.05). Our results indicate that FGFR3 mutations can occur early in the pathogenesis of at least a subset of seborrheic keratoses. Increased age appears to be a risk factor for these mutations. Keywords: seborrheic keratosis; acanthosis; FGFR3 mutation; bcl-2; Ki-67 Seborrheic keratoses represent one of the most common skin tumors in man. Their prevalence increases with age. Seborrheic keratoses are detected in 80-100% of people over 50 years. 1,2 Affected individuals can show large numbers of lesions. Yeatman et al reported an average number of 69 seborrheic keratoses/person in people aged more than 75 years. Seborrheic keratoses are typically localized on the head, the trunk and the extremities with the exception of the palms and soles. They present as well-demarcated brownish plaques and later may show a verrucous surface. Their horizontal diameter ranges from a few millimeters to several centimeters. Three major histologic subtypes are known including acanthotic, hyperkeratotic and adenoid seborrheic keratoses variants. 3 Common histological features are acanthosis, papillomatosis and hyperkeratosis along with a varying degree of pigmentation. The vertical diameter (tumor thickness) of seborrheic keratoses varies considerably. Flat (initial) seborrheic keratoses frequently show gradual vertical growth within years. 3 However, malignant transformation is a very rare event in seborrheic keratoses, and the reported cases may also represent collision tumors of seborrheic keratoses and other epidermal malignancies such as basal cell carcinoma and squamous cell carcinoma. 4 Although seborrheic keratoses are very common tumors and represent one of the most disfiguring signs of skin aging, their pathogenesis is only marginally understood. Recently, activating FGFR3 mutations in the epidermis were shown to be involved in the development of seborrheic keratoses. 5 Transgenic mice expressing the S249C FGFR3 mutation in the basal layer of the epidermis under the control of the keratin 5 promoter developed thickening of the skin and verrucous skin tumors