Benign and Malignant Skin Tumors

Terms in this set (36)

Seborrheic Keratosis
Skin Tags
Dermatofibromas
Lipomas
Epidermal Inclusion Cysts
Actininc Keratosis
Nevi

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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