How Likely Is A Skin Lump Be Benign

The vast majority of skin tumours are benign. There are a few very mutual benign skin tumours. It is very common for doctors to be asked about such lesions and very often advice is sought when consulting well-nigh something else (or quite often outside formal consultation).

Diagnosis

Appraise the history of the lesion's appearance and growth.
Carefully examine the lesion. Allow the advisable time, light and perhaps magnification, to identify such tumours correctly.
Have sufficient cognition to differentiate these from skin cancers and particularly cancerous skin tumours.
Be aware of the limits of i'due south noesis in this field.
Consider the amount of sun exposure the patient is generally subjected to (eg, people who work mainly outside) and the site of the lesion (cancers are more likely on sun-exposed areas, such equally the face).^[one]
Refer for diagnosis or biopsy lesions where there is any doubt of their nature. See the National Establish for Health and Care Excellence (Dainty) guidance - under 'Referral', below.

Experience in Australia, the country with the world'south highest incidence of skin cancer, shows that adequately trained primary intendance practitioners in open-admission skin cancer clinics can diagnose a wide range of skin lesions, with high specificity and moderate-to-loftier sensitivity.^[two] A 2008 written report was critical of minor surgery in the Uk and suggested there was room for improvement.^[3]A useful arroyo is to subdivide lesions into the categories below and diagnosis on the basis of further discriminating features.

          Macular or slightly raised (papular) lesions.
Frankly papular lesions.
Lesions beneath the epidermis (not related to bony or deeper structures).
        

It must be borne in heed that such a schema works simply for common benign skin lesions and that there are many rarer lesions that will nowadays differently. If the diagnosis is unclear, or the lesion has an atypical appearance, dermatological referral and/or biopsy of the lesion should be considered.

The tumours listed practise non include the full range of beneficial dermatoses which produce skin lesions but non necessarily skin tumours (for case, psoriasis, acne vulgaris, discoid lupus erythematosus, neurofibromatosis, pyoderma gangrenosum, necrobiosis lipoidica diabeticorum and many others).

Macular or slightly raised papular lesions

Naevi

These can be defined every bit confining, well-defined congenital lesions, also known as moles.
They announced and evolve from the historic period of ii years up to 60 years. They are more common on the caput, neck and body.
Only very rarely practise they undergo malignant change.
At that place is a great deal of variability in size, shape and amount of hair present. Naevomelanocytic naevi are the most common and are categorised into three dissimilar subtypes:
- The junctional naevi are characterised past melanocytic proliferation limited to the basal epidermis with minimal elevation.
- The compound naevus is believed to represent an intermediate step in the evolution of the melanocytic naevus. Components of both dermal and junctional naevi are establish simultaneously.
- Intradermal naevi are the nigh common type of adult naevus. These may exist papillary, pedunculated, or flat and are often hairy. They are often multiple. The melanocytes in this subtype are entirely within the dermis and have irregular margins. While the junctional naevus can accept a reputation for degeneration into malignant melanoma, the intradermal naevus does not.
Special subtypes include the blue naevus:
- These are discrete lesions located in the head and neck (occasionally on the arms). 1 variety (cellular blue naevus) occurs on the buttock and sacrococcygeal areas.
- The blue naevus has abundant melanin pigment. It is located entirely within the dermis and no epidermal or junctional component is present.
- They can be misdiagnosed as beneficial gristly histiocytomas.
- A cancerous variant of the blue naevus does exist.

Campbell de Morgan spots (or cherry angiomas)

Campbell de Morgan spots are common in adults.
They are asymptomatic caused vascular lesions of unknown aetiology.
Treatment is for corrective purposes merely and may be by shave excision, laser ablation, electrodesiccation or cryotherapy.

Dermatofibroma

Dermatofibroma are considered to be a benign tumour, or may correspond a fibrous reaction to minor trauma and insect bites.
They are firm raised papules or nodules. They vary in colour from brown to purple and red.
They occur anywhere just are seen most usually on the lower limb. Fitzpatrick's sign may exist used to help diagnosis (dimpling of the lesion beneath the pare when bailiwick to bilateral compression, ie gently pinching the lesion on either side).
The lesions may resemble melanomas, so biopsy may be necessary to confirm the diagnosis.
Occasionally the lesion may be removed for cosmetic reasons.
Multiple dermatofibromas may exist seen in association with autoimmune disorders such as systemic lupus erythematosus, or in patients who are immunocompromised.

Actinic keratosis^{[4, 5]}

Actinic keratosis is known every bit solar keratosis and senile keratosis.
They are rough, scaly, erythematous papules or plaques found on dominicus-exposed areas.
A diversity of treatments is available. Excision is mostly unnecessary.

Sebaceous (senile) hyperplasia

Sebaceous hyperplasia is mutual in center-aged and older patients.
It presents as soft, xanthous, dome-shaped papules, some of which are centrally umbilicated.
They unremarkably occur on the face only sometimes touch the vulva.
They are of no clinical significance, although they tin announced similar to early on basal cell carcinomas.
Handling with electrodesiccation or light amplification by stimulated emission of radiation ablation is successful; oral isotretinoin has been used in patients with multiple lesions.
Biopsy may be required if the diagnosis is uncertain.

Frankly papular lesions

Seborrhoeic keratosis

Seborrhoeic keratoses are brown or black lesions which appear to be 'stuck on' to the surface of the skin.
They occur most commonly on the trunk and scalp but may be constitute anywhere.
The incidence of the lesions increases with age.
They may be mistaken for melanomas, although melanomas have a greater range of colour.
They are usually asymptomatic just may itch or become inflamed after friction from clothing.
Biopsy should exist undertaken if the diagnosis is in any doubt.
They may be treated for corrective reasons with cryotherapy.
A sudden onset or increment in the number of lesions may signal an underlying malignancy, usually of the stomach, colon or breast - this is known as the Leser-Trélat sign, a paraneoplastic dermatosis. Occasionally, the sign is seen in people who have no detectable malignancy.^{[six, vii]}
Typical appearance of seborrhoeic keratoses

Seborrhoeic keratosis

Inverted follicular keratosis

Probably an inflammatory variant of seborrhoeic keratosis.
It is normally establish on the confront (typically the upper eyelid) and other lord's day-exposed areas in elderly patients.
They are caused lesions and tend to be solitary. They present as a papule or nodule.
Treatment with uncomplicated excision is acceptable.

Keratoacanthomas

Keratoacanthomas are rapidly growing papular lesions, oft with a central umbilicated keratinous core which may exist expelled after several weeks, leaving a hypopigmented scar.
They are ordinarily unmarried and occur in sun-exposed areas, mainly in older patients.
Total excision is the treatment of choice, as they are histologically similar to squamous cell carcinoma and tend to leave a prominent scar later on they accept undergone spontaneous involution. Smaller lesions can be treated with electrodesiccation and curettage or blunt autopsy.
Radiotherapy is an option for patients with recurrence or large lesions.
Intralesional fluorouracil is a treatment selection where in that location is a big lesion in an expanse on which information technology would be difficult to achieve excision with a expert corrective result - eg, the eyelids or nasolabial fold.^[viii]
Typical appearances of keratoacanthoma

Skin tags (acrochordons)

These are establish in approximately 25% of people, the numbers increasing with age and obesity.
They are an expanse of hyperplastic epidermis and are frequently found in areas where friction occurs - eg, the cervix, axillae and inguinal region.
They may exist treated for corrective reasons or considering of irritation.
They are of no pathological significance in adults but in children may herald the evolution of naevoid basal cell carcinoma syndrome.^[9]

Pyogenic granuloma

Pyogenic granuloma are besides known as granuloma telangiectaticum and an association with trauma is frequent.
They are speedily proliferating solitary lesions with a tendency to bleed. They are ordinarily less than i cm in diameter.
Excision biopsy is ordinarily recommended.

Cutaneous horn

This is as well known as cornu cutaneum.
It is a feature of hyperkeratotic lesions including actinic keratosis, seborrhoeic keratosis, verrucae and epidermoid carcinoma.

Lesions beneath the epidermis

Lipomas

Lipomas are the most commonly seen subcutaneous tumours.
They may occur anywhere on the body, are made up of adipocytes and have a firm rubbery consistency.
They are commonly asymptomatic, although may crusade symptoms due to mechanical pressure on underlying structures such as fretfulness.
Removal is not generally required for other than cosmetic reasons.
Lipomas which occur on the thigh and are greater than v cm in diameter should be referred for specialist opinion to rule out liposarcoma.

Sebaceous cyst (epidermoid, epidermal, inclusion or keratinoid cysts)

Sebaceous cysts are round cysts filled with keratin and which communicate with the skin through a small round keratin-filled plug. The term sebaceous is a misnomer, as the sebaceous glands do not grade any part of the lesion.
They range in size from a few millimetres to several centimetres and normally occur on the face, back and breast.
Rupture of the cyst wall commonly occurs resulting in an inflammatory reaction.
They may be removed either because of recurrent infection, or because of their advent. They may either exist removed intact, or by expressing the contents of the cyst through a modest incision and then removing the cyst wall.
Dermoid cyst is a variant of the sebaceous cyst. Excision is the treatment of selection.

Uncommon benign skin tumours

Trichilemmoma

Trichilemmoma are a more than rare form of beneficial skin tumour.
There is an associated condition chosen Cowden's disease (when institute with tumours of mouth, breast, thyroid and gut).
A rare carcinoma variant of trichilemmoma is known equally trichilemmal carcinoma.

Naevus sebaceous of Jadassohn

These are epithelial naevi and are built hamartomas with a yellowish orangish colour. They are raised slightly with a waxy appearance.
They have various elements within them (including sebaceous, apocrine).
They are usually present on the scalp and face up and slowly overstate.
They accept a risk of becoming cancerous. Therefore, complete surgical excision is the treatment of option.

Trichoepithelioma

These are uncommon pink or flesh-coloured benign lesions on the face and scalp (occasionally the trunk and cervix).
They appear during adolescence and may exist familial.
They should be treated with complete surgical excision.

Pilomatrixoma

This is an uncommon variation of the epidermal cyst occurring on the neck, head and arms of children and young adults.
Information technology typically presents as a solitary subcutaneous nodule with attachment to the pare. In that location is a history of episodes of inflammation and pain.
Handling is by excision. The capsule is very friable.
A rare cancerous form exists (the malignant pilomatrixoma or pilomatrix carcinoma).

Pseudoepitheliomatous hyperplasia

It can be difficult to distinguish from squamous carcinoma.
Another term for this lesion is pseudocarcinomatous hyperplasia.
An important feature is a history of trauma and irritation.
A conservative approach is warranted but, if there is any doubt, treat it as for squamous carcinoma with appropriate margins of excision.

Referral

Information technology is worth because Overnice guidance on referral if cancer is suspected:^[ten]

Refer a patient presenting with skin lesions suggestive of skin cancer or in whom a biopsy has confirmed skin cancer to a team specialising in skin cancer.
Malignant melanoma of skin:

Skin lesion (pigmented and suspicious) with a weighted seven-point checklist score of iii or more: refer people using a suspected cancer pathway referral (for an appointment within two weeks).
Skin lesion (pigmented or not-pigmented) that suggests nodular melanoma: consider a suspected cancer pathway referral (for an appointment inside 2 weeks).

Squamous cell carcinoma:

Skin lesion that raises the suspicion of a squamous cell carcinoma: consider a suspected cancer pathway referral (for an appointment within two weeks).

Basal cell carcinoma:

Skin lesion that raises the suspicion of a basal cell carcinoma: consider routine referral.
Only consider a suspected cancer pathway referral (for an appointment within two weeks) if at that place is particular concern that a delay may have a meaning impact, because of factors such as lesion site or size.

Source: https://patient.info/doctor/benign-skin-tumours

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How Likely Is A Skin Lump Be Benign

Diagnosis