Benign Neoplasms in Practice

Benign Neoplasms in Practice

• Nevi (Melanocytic Nevi): Benign, even color and distribution. Biopsy if appearance changes. Composed of melanocytes. Usually less than 1 cm, tan to brown. Can be symptomatic (itching, bleeding, etc.). Considered normal unless clinically atypical, irritated, or cosmetic concerns.

• Seborrheic Keratosis: Common benign tumor in those over 40. Appearance "stuck on", various colors (pale brown to dark brown). Velvet or verrucous texture. Often not a concern unless irritated.

• Solar Lentigo: Benign, sun-induced lesion (liver spots). Pigmented (yellow, brown, or black), flat or slightly raised, typically found on sun-exposed areas.

• Verruca Vulgaris (Warts): Viral infection, common on hands and knees. Rough, hyperkeratotic surface.

• Epidermal Inclusion Cyst: Most common cutaneous cyst. Flesh-colored nodule, firm, central pore. Often asymptomatic, can discharge foul-smelling material.

• Cherry Hemangioma: Common vascular proliferation with age. Small red macules or papules, can sometimes be violet. May bleed with trauma. Not usually a concern unless bothersome or indicative of another condition.

• Acrochordon (Skin Tag): Small, soft, pedunculated papules. Often found in areas of friction (neck, axillae, groin). May fall off spontaneously. Usually not a concern unless bothersome.

• Sebaceous Hyperplasia: Overgrowth of sebaceous glands, common in older age. Associated with oily skin.

• Dermatofibroma: Unknown etiology, often forms in scar tissue or following trauma. Firm, pea-sized nodule, usually asymptomatic except if irritated.

• Milia: Keratin-filled cysts, common in infants and adults. Small, pearly, superficial lesions, usually on the face.

• Stucco Keratosis: Thickening of epidermis, most common in men, appears after age 40, "stuck on" appearance. Usually asymptomatic, white or yellowish.

• Fibrous Papule: Relatively common benign papule found often on the face, around nose and mouth, in those 20-30 years of age.

• Keloid and Hypertrophic Scars: Overgrowth of scar tissue. Keloids expand beyond the injury, whereas hypertrophic stay within the original wound.

• Lipoma: Benign fatty tumor. Soft, firm, usually painless, and easily movable.

Atypical Mole (Dysplastic Nevus)

• Background: Clinical and histologic definitions are controversial, potentially inherited or acquired throughout lifetime, require monitoring.

• Presentation: Exhibits ABCDE criteria (asymmetry, border irregularity, color variation, diameter>6mm, evolving/enlarging). Frequently on sun-exposed areas.

• History: Personal and family history of melanoma, sun exposure.

• Differentials: Malignant melanoma, melanocytic nevus, seborrheic keratosis.

• Treatment: Full body exam, patient counseling, photography, monitoring for progression. Surgical shave biopsy, excision with margins.