Layered Keratin

Hyporeflective, coarse texture with areas of hyperreflectivity Parallel keratin filaments in a mesh structure, spaces between fibres limit scattering causing darker appearance Hyperreflective areas inside plaque indicate disruption to keratin organisation Hyperkeratotic layering on an invasive squamous cell carcinoma

Loose Keratin

Hyperreflective, smooth homogenous texture Diffuse/Undefined border Amorphous arrangement of keratin fibrils in a seborrheic keratosis Can appear brighter or darker depending on how compressed the keratin is