Skin & Soft Tissue Lesions

Skin & Soft Tissue Lesions


Common Benign Skin and Soft Tissue Lesions

  1. Sebaceous cyst (also known as epidermoid cyst): A prevalent benign skin lesion appears as a painless firm swelling under the skin with a punctum attached to the skin surface. Sebaceous cysts contain keratin materials and usually occur on the face, neck, or torso. Sometimes this keratin material may escape through the punctum as cheesy material with a distinctive odor. Occasionally an infection can occur, and the cyst can become inflamed and painful. Treatment is by surgical excision to remove the entire cyst altogether as any remnants may cause the cyst recurrence. For sebaceous cysts that occur in the face, it is necessary to perform the surgical excision meticulously to minimize scar formation.


  1. Skin Tags: Skin tags are small skin-coloured swellings that are attached to the skin by slender stalks. Skin tags usually occur on eyelids, neck, armpit, and groin. Skin tags are benign skin growths that are harmless but may cause irritation and aesthetic concern. Treatment options include laser ablation, electrocautery, or surgical excision.


  1. Seborrheic Keratosis: A common benign skin lesion that occurs in some people as they get older. The lesions are usually black or brown and appear waxy, scaly, and slightly raised. They typically occur on the face and trunk. Treatment options include excision, laser ablation, or electrocautery.


  1. Keratoacanthoma: Appears as a firm, dome-shaped nodule with a central keratotic plug. Usually presents as an isolated lesion on the face or hand. It can grow rapidly within a few weeks and follow by spontaneous regression and resolution. Keratoacanthoma may resemble squamous cell carcinoma of the skin, and histopathology examination of the tissue specimen is required to differentiate the two. Treatment is by surgical excision and histopathology examination of the tissue.


  1. Lipoma: Lipoma is a common benign swelling consisting of fat cells present as a soft and rubbery lump under the skin. The swelling is painless and slow-growing and usually located in the neck, shoulders, back, abdomen, and limbs. Lipoma is not harmful, but it may restrict movement or cause cosmetic concerns. Treatment is by surgical excision or liposuction.


  1. Xanthelasma: Xanthelasma is a yellowish patch in the skin that consists of cholesterol deposits. Xanthelasma usually occurs around the eyelids and presents as a painless yellowish patch that is slowly enlarging. It is a harmless benign lesion, but patients may concern about the appearance. Laser ablation is useful for small lesions, and surgical excision is the treatment of larger lesions.


  1. Moles (nevi): Moles are common skin growths. They usually appear as dark brown or black spots on the skin. Moles consist of clusters of pigmented cells in the skin. The medical term for mole(moles) is nevus(nevi). Some moles first appear during early childhood and change their appearance as time passes. It is usual for an adult to have 10-40 moles in their body at any one time. Most of the moles are benign, but they can become cancerous (melanoma) in a minority of cases. Suspicious signs that a mole is cancerous include asymmetric shape, irregular borders, uneven color, large diameter, and the mole is changing in size, shape, and color. It is necessary to biopsy the suspicious lesion to determine the diagnosis and plan for further treatment. However, most moles are benign, and for these benign lesions, the standard therapies are laser ablation for small moles or surgical excision for larger moles.


  1. Milia: Milia are tiny bump-like cysts that typically appear on the cheeks and lower eyelids. Milia often appear in groups, and they are white or yellow. Milia occur when keratin becomes trapped under the skin. Milia are benign and painless, but patients may be concerned with the appearance. Milia can occur in all age groups, including babies and newborns. Treatment options include laser ablation, deroofing, or diathermy.


  1. Syringomas: Syringomas present as multiple small skin bumps that typically occur on the eyelids and adjacent areas in the face. Syringoma is skin-coloured, and each measured 1-3mm. Syringomas are benign swelling arise from sweat ducts. Usually, patients present with no symptoms but are concerned with the appearance of the lesions. The treatment of choice is laser ablation.


  1. Sebaceous hyperplasia: Sebaceous hyperplasia is a benign growth of the sebaceous glands. Sebaceous hyperplasia commonly occurs in middle-aged to elderly patients and appears as multiple yellowish shiny bumps on the forehead, face, and nose. They are painless and usually 2-4mm in diameter. Sebaceous hyperplasia is harmless, but patients may concern about its appearance. Treatment is by laser ablation or electrocautery.


  1. Dermatofibroma: Dermatofibromas are benign skin nodules that usually develop on the legs, arms, or the back. They are brown or skin-coloured and feel hard. Dermatofibromas typically are painless and grow slowly. The dimple sign is a characteristic finding where digital pressure produces a central dimpling over the lesion. A biopsy is often necessary to exclude malignant lesions that mimic dermatofibroma. Treatment of dermatofibroma is by surgical excision.


  1. Pyogenic granuloma: Pyogenic granuloma presents as a shiny red lump with a raspberry-like surface. The cause of pyogenic granuloma is the abnormal proliferation of capillary blood vessels. Although they are benign, pyogenic granulomas can cause discomfort and profuse bleeding. The lesions most commonly occur on the head, face, torso, hands, especially fingers and feet. Treatment options include surgical excision, laser ablation, or diathermy.


  1. Neurofibroma: Neurofibroma is a type of soft tissue tumor that arises from the nerve under the skin. It presents as a soft skin-colored lump on the skin. Neurofibroma can present as a single localized lesion or multiple in a diffuse pattern (in a condition called neurofibromatosis). Neurofibroma usually can be diagnosed clinically, but sometimes may need a biopsy. Small lesions are put under observation and may not need any treatment. For larger lesions that cause pressure effects on the surrounding structure or if the patient is concerned with the appearance, surgical excision is a treatment option.



Malignant Skin Cancer

  1. Basal cell carcinoma: Basal cell carcinoma is a common skin cancer that usually presents as a nodule that grows slowly or a sore that won’t heal. Basal cell carcinoma occurs most frequently on sun-exposed skin, such as the face. Basal cell carcinoma is a localized, slow-growing tumor, and distant spread is rare. The most important risk factors of basal cell carcinoma are chronic exposure to sunlight. Avoidance and protection from sunlight reduce the risk of basal cell carcinoma. A biopsy is required to confirm the diagnosis, and treatment is by surgical excision to remove the tumor.


  1. Squamous cell carcinoma: Squamous cell carcinoma is the second most common form of skin cancer after basal cell carcinoma. Squamous cell carcinoma arises from the squamous cells, and the lesions may present in many appearances, such as angry red patches, sores, wart-like skin lesions, or raised growths with a central depression. Risk factors of squamous cell carcinoma include chronic sun exposure and weakened immune system. Certain premalignant skin disorders, such as actinic keratosis and Bowen’s disease, also increase the risk. Squamous cell carcinoma can aggressively invade and destroy adjacent tissues and spread to regional lymph nodes and distant organs. A biopsy is required to confirm the diagnosis. Treatment is by wide excision for complete tumour removal. The patient may require additional chemotherapy, radiotherapy, targeted drug therapy, or immunotherapy if distant metastasis occurs.


  1. Melanoma: Melanoma is the most severe and aggressive type of skin cancer. Melanoma arises from melanocytes in the skin (cells that produce pigment in the skin). Melanomas can develop anywhere in the body but most commonly occur in sun-exposed areas such as the face, arms, legs, and the back. However, the lesions can also occur in other regions such as the sole, palm, or fingernail beds. Melanoma may arise from an existing mole, or it can arise from otherwise normal skin. Moles with certain features are associated with a higher risk of becoming melanoma. These features include moles with an asymmetrical shape and irregular borders, changing color, lesion larger than 6mm, and moles that exhibit changing signs and symptoms. Risk factors of melanoma are excessive exposure to sunlight and ultraviolet (UV) light, fair skin, moles that show risky features mentioned above, family history, and compromised immune system. It is necessary to do a biopsy to confirm the diagnosis and assess the melanoma depth and extent. The primary treatment is wide excision to remove the primary tumour. If the tumour had spread, management is additional treatments to remove regional lymph nodes, followed by chemotherapy, immunotherapy, or target therapy.


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