Benign and Malignant Skin Tumors

Terms in this set (36)

Benign Tumors
Seborrheic Keratosis
Skin Tags
Dermatofibromas
Lipomas
Epidermal Inclusion Cysts
Actininc Keratosis
Nevi
Seborrheic Keratosis
Non-cancerous growths of the epidermis
Are rapidly growing skin cells that mix with oil and produce a raised papule or plaque (epidermal hyperplasia)
People develop these as get older.
Can sometimes resemble melanoma
Signs and symptoms of Seborrheic Keratosis
Brown, tan or black
Have a scale
Vary in size
Appear to be stuck or pasted onto the skin
Have a warty appearance
Most commonly appear on chest or back, but can be anywhere
Are generally asymptomatic
Treatment of Seborrheic Keratosis
If it doesn't bother them you don't have to do anything
Liquid nitrogen
Curettage
Shave biopsy
* Note that some SK's are very suspicious looking and can at times resemble melanomas. *
Skin Tags
Over growth of skin cells
AKA polyp
Genetically related
Are very common. Affect 25 % of population
Commonly seen in overweight individuals
S&S of skin tags
Soft, skin colored, brown or tan, round, pedunculated papule
Constricted at base
Asymptomatic, unless it gets caught on clothes or jewelry
Most common on neck
Also seen in intertriginous(fold) areas
Treatment of skin tags
Scissor Excision
Cryosurgery
Electrodessication
No treatment is necessary. Only if becomes a problem for patient
Dermatofibroma
Very common, hard round pink or brown nodule, usually occurring on the extremities
"Dimple Sign"
Probably caused by minor trauma or bug bite or shaving
Women> Men
May be tender
Pts are worried about these!
Diagnosis and Treatment of Dermatofibromas
Physical Exam
Discrete, firm, pink papules
Look for dimpling or puckering of the lesion
Has persisted for many years without change

Treatment
Kenalog injections (steroids) - ?
Shave biopsy - ?
Full excision
Lipoma
Benign neoplasm of fat cells
Are generally asymptomatic
Round, moveable and soft
May sometimes occur in area of constant irritation (ie belt line)
Complete excision if becomes bothersome
Epidermal Inclusion Cysts
AKA Sebaceous cyst
Oil producing gland gets clogged and fills with sebum and keratin
May get infected or rupture
Round, hard, mobile papule, nodule
Overlying punctum
Malodorous
Treatment for epidermal inclusion cysts
If the lesion is non inflamed
Do excision
I & D can lead to return of EIC

If inflamed
I & D
Intralesional steroid
Topical and Oral Antibiotics - if infected
Actinic Keratosis
Single or multiple scaly lesions on sun exposed skin of adults
AKA pre skin cancers spots
Have potential to become Squamous cell carcinoma
S&S of Actinic Keratosis
Generally appear on ears, nose, face, back of hands
Feel like sand paper
Pink scale
Some spots may be tender.
History is of scaly spot that comes and goes
If people have one, they will generally develop more.
Actinic Keratosis treatment
Liquid nitrogen
5-Fluorouracil Cream (ie Effudex, Carac)
Other creams; Picato (ingenol mebutate) used for 3 days; Soloraze (diclofenac sodium), Aldara (imiquimod) for areas with numerous AK's
Electrodessication & Curettage
Shave biopsy
Benign Nevus
Melanocytic nevus
Halo Nevus
Congenital Nevus
Blue Nevus
Dysplastic Nevus or atypical nevus
Melanocytic nevus
Normal mole
Small, well circumscribed, with a well defined border
May be flat or elevated
Single shade of pigment from beige or pink to dark brown
Melanocytic nevus junctional and compound
Junctional nevus
Moles at junction of epidermis and dermis
Often appear at a very early age

Compound nevus deeper moles
Moles can get bigger and get a dermal component

BOTH OF THESE MOLES ARE BENIGN
Halo Nevus
An ordinary common nevus with a hypo-pigmented "halo" around it
Occurs when the immune cells (which normally fight off infection) attack a mole for reasons unknown
Will generally undergo spontaneous involution
May be associated with vitiligo
Congenital nevus
A Nevus that is present at or near birth and remain throughout life
Generally are large
Many are associated with hair growth
Risk of developing into melanoma
The larger the congenital mole the greater the risk of developing melanoma.
Blue nevus
Dark blue to black sharply defined papule

Deeper pigment due to large amounts of melanin pigment within the deeper dermis.

Commonly seen in Asian decent

If it is a new lesion, should be evaluated to rule out melanoma.
Dysplastic nevi/atypical nevi
Moles with an abnormality that can transform to a melanoma
Tend to be larger than .5 cm with ill defined borders and irregular pigmentation
Dysplastic nevi risk factors
Many moles on the body
Family history of melanoma
Other documented dysplastic nevi
Fair skin
History of sun exposure
Increase risk of melanoma
Basal Cell Carcinoma
Most common type of skin cancer

Grows at a very slow rate!

Locally invasive and destructive, but rarely metastasizes. Very unlikely unless your immune sys is comprimised

Malignancy from epidermal basal cells
Etiology and Epidemiology of BCC
Most often > 50 y/o
Caucasian
Fair skinned with light hair and light eyes
Develop after years of extensive sun exposure
Signs and Symptoms of BCC
Generally asymptomatic

May bleed, become crusty, ulcerate

Generally small, shiny, "pearly" papule. Usually will see telangiectasia

On the back and chest - may be red and shiny

Located most frequently on face, ears, dorsum of hands
Treatment of BCC
First do shave or punch biopsy

When confirm diagnosis
Excision
Electrodessication and curettage (NOT on FACE)
MOHS surgery tissue sparing procedure commonly used for the face the neck the hands
Topical immune modulators for superficial BCC
Radiotherapy
Squamous Cell Carcinoma
Malignant tumor of keratinizing epidermal cells that builds up over time

May arise from actinic keratosis

Can destroy normal tissue and has the potential to metastasize

Can see in pts s/p organ transplants
Signs and Symptoms of SCC
Generally asymptomatic
Pink papule or plaque with thick scale Generally with erosion or ulceration
Sun exposed areas (ie face, ears, lips, back of hands)
Treatment for SCC
Excision
Electrodessication and curettage (NOT on FACE)
MOHS surgery
Malignant Melanoma
Malignancy of melanocytes
Most serious form of skin cancer
Frequently metastasize to regional lymph nodes, lung, liver or the brain
Features of Melanoma
A - asymmetry not symmetrical
B - border irregular borders
C - color multiple or changing colors
D- diameter larger than pencil eraser
E - evolution
Features of melanoma continued
Females- most common on legs

Males - most common on upper back

If a mole, itches, burns, bleeds or changes in anyway, a biopsy needs to be done

"Ugly duckling sign"
Risk factors for melanoma
Fair Skin
Atypical nevi in sun exposed and sun protected areas
PMH of Melanoma
Hx of blistering sunburn
Prognosis of Melanoma
Tumor thickness is single most important prognostic factor

A melanoma within epidermis holds a good prognosis

A melanoma on extremity has more favorable prognosis than those found on head, neck
Treatment for Melanoma
EARLY detection
Wide excision
Surgical Oncologist (Sentinel LN biopsy)
Chest x-ray
CBC, Liver function
Frequent skin exams usually every few months.
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