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Skin TumorsSkin TumorsBenign and Benign and MalignantMalignant
ByBy
Peter D. Hino, M.D.Peter D. Hino, M.D.
Benign Tumors Benign Tumors Derived from Derived from Superficial Superficial EpidermisEpidermis
Seborrheic KeratosisSeborrheic Keratosis
More common in More common in the elderlythe elderly
Often pigmentedOften pigmented Variable sizeVariable size ““Barnacle-like” Barnacle-like”
appearanceappearance Usually Usually
asymptomaticasymptomatic
Stucco Seborrheic Stucco Seborrheic KeratosisKeratosis
Primarily on the Primarily on the extremities, extremities, especially distallyespecially distally
Often small 2-3mm Often small 2-3mm white plaques that white plaques that are easily lifted offare easily lifted off
KeratoacanthomaKeratoacanthoma Rapidly evolving tumor, Rapidly evolving tumor,
often in the matter of often in the matter of weeks, possibly of viral weeks, possibly of viral originorigin
Composed of Composed of keratinizing squamous keratinizing squamous cellscells
More common in fair More common in fair skinned, elderly peopleskinned, elderly people
May resolve May resolve spontaneously over a spontaneously over a period of 2 to 12 monthsperiod of 2 to 12 months
Epidermal NevusEpidermal Nevus
Nevus ComedonicusNevus Comedonicus
Acrochordon Acrochordon (Skin tags)(Skin tags)
Occur in Occur in approximately 25% approximately 25% of males and femalesof males and females
Occur in the axilla, Occur in the axilla, neck and inguinal neck and inguinal regionregion
Increase with age Increase with age beginning the 20s up beginning the 20s up into the 50sinto the 50s
Few to multipleFew to multiple
Benign Tumors Benign Tumors Derived from the Derived from the
Epidermal Epidermal AppendagesAppendages
Epidermoid CystEpidermoid Cyst
Epidermoid CystEpidermoid Cyst
Common, affecting Common, affecting young and middle young and middle age adultsage adults
Usually seen on Usually seen on the head, neck and the head, neck and trunktrunk
Often can identifiy Often can identifiy a punctuma punctum
Cyst contains Cyst contains keratinkeratin
Pilar CystsPilar Cysts
Sebaceous HyperplasiaSebaceous Hyperplasia
Found on the faceFound on the face Singular to Singular to
multiple in numbermultiple in number Usually 2-3mm up Usually 2-3mm up
to 6mm with to 6mm with umbilicationumbilication
Often begin to Often begin to appear in the 30s appear in the 30s and increase with and increase with ageage
Nevus Sebaceous of Nevus Sebaceous of JadassohnJadassohn
HidrocystomaHidrocystoma
SyringomasSyringomas
Sweat duct tumorsSweat duct tumors More common in More common in
femalesfemales May first appear in May first appear in
adolescence, but adolescence, but more often in the more often in the third decadethird decade
Found around eyelids Found around eyelids and are skin colored and are skin colored to yellow in to yellow in appearanceappearance
Eccrine PoromaEccrine Poroma
Tumor arising from Tumor arising from the eccrine duct the eccrine duct epitheliumepithelium
Often on the soles Often on the soles and palmsand palms
Tend to be moist, Tend to be moist, red and exophyticred and exophytic
Clear Cell AcanthomaClear Cell Acanthoma
A scaly plaque or A scaly plaque or nodule that has an nodule that has an accumulation of accumulation of glycogen glycogen containing cellscontaining cells
Most common on Most common on the lower limbsthe lower limbs
Usually solitary Usually solitary and may persists and may persists for yearsfor years
Benign Benign Melanocytic Melanocytic
TumorsTumors
NevusNevusA benign cluster of melanocytic A benign cluster of melanocytic
cells arising as a result of cells arising as a result of proliferation of melanocytes at the proliferation of melanocytes at the dermo-epidermal junction. These dermo-epidermal junction. These may all remain in contact with the may all remain in contact with the basal layer (the junctional nevus) basal layer (the junctional nevus)
or may become dettached from the or may become dettached from the basal layer and lie free in the basal layer and lie free in the dermis (the compound and dermis (the compound and
intradermal nevus).intradermal nevus).
Halo NevusHalo Nevus
Spitz NevusSpitz Nevus A compound nevus A compound nevus
seen most commonly seen most commonly in children and with in children and with lesser frequency in lesser frequency in adultsadults
They appear suddenly They appear suddenly and the color is caused and the color is caused by increased by increased vascularityvascularity
Its pathological Its pathological features can be difficult features can be difficult to distinguish from to distinguish from malignant melanomamalignant melanoma
Blue NevusBlue Nevus
An area of blue-black dermal pigmentation An area of blue-black dermal pigmentation produced by an aberrant collection of pigment produced by an aberrant collection of pigment producing melanocytesproducing melanocytes
The brown pigment absorbs the longer wavelength The brown pigment absorbs the longer wavelength of light and scatters blue light (Tyndall effect)of light and scatters blue light (Tyndall effect)
Extend into the deep dermis, often occur on Extend into the deep dermis, often occur on extremities and the dorsum of the handextremities and the dorsum of the hand
Benign Tumors Benign Tumors Derived from Derived from
Mesodermal TissueMesodermal Tissue
DermatofibromaDermatofibroma Can occur on any part Can occur on any part
of the body, most of the body, most common on the lower common on the lower extremities, to a lesser extremities, to a lesser degree on the upper degree on the upper extremities and trunkextremities and trunk
May be single or May be single or multiplemultiple
Usually pink or brownUsually pink or brown Commonly 6mm or lessCommonly 6mm or less Hard consistencyHard consistency
Fibrous PapuleFibrous Papule
Small facial papule with a fibrovascular Small facial papule with a fibrovascular contentcontent
Usually seen on or next to the noseUsually seen on or next to the nose Usually singular but on occasion can be Usually singular but on occasion can be
multiplemultiple
KeloidKeloid
An exaggerated An exaggerated reparative reparative fibroblastic fibroblastic response to injury response to injury of the skinof the skin
Genetic tendencyGenetic tendency Most commonly Most commonly
found on the ears, found on the ears, neck and trunkneck and trunk
Cherry AngiomaCherry Angioma
Pyogenic GranulomaPyogenic Granuloma A vasular nodule that A vasular nodule that
develops rapidly, with develops rapidly, with a glistening moist a glistening moist surfacesurface
Often may appear at a Often may appear at a site of recent traumasite of recent trauma
Composed of Composed of proliferating proliferating capillaries in a loose capillaries in a loose stromastroma
Bleeds easilyBleeds easily
LipomaLipoma
Premalignant Premalignant TumorsTumors
Actinic KeratosisActinic Keratosis Hyperkeratotic lesions Hyperkeratotic lesions
occurring in sun occurring in sun exposed adult skinexposed adult skin
May exist in a May exist in a premalignant state for premalignant state for yearsyears
Often begin as an area Often begin as an area of increased vascularity of increased vascularity with the surface with the surface becoming roughbecoming rough
May progress to May progress to squamous cell squamous cell carcinomacarcinoma
Actinic CheilitisActinic Cheilitis
Squamous Cell Carcinoma Squamous Cell Carcinoma in situin situ
(Bowen’s Disease)(Bowen’s Disease) A persistent, A persistent,
progressive, progressive, nonelevated, red, nonelevated, red, scaly or crusted scaly or crusted plaqueplaque
An intraepidermal An intraepidermal proliferation on proliferation on exposed and exposed and nonexposed areas of nonexposed areas of the bodythe body
Often mistaken for Often mistaken for eczema or psoriasiseczema or psoriasis
Epidermal Epidermal MalignanciesMalignancies
Superficial Basal Cell Superficial Basal Cell CarcinomaCarcinoma
Basal Cell CarcinomaBasal Cell Carcinoma
Most common form Most common form of skin cancerof skin cancer
Usually appears on Usually appears on sun damaged skinsun damaged skin
Pearly appearance Pearly appearance with superficial with superficial telangiectasiastelangiectasias
Rarely metastasizesRarely metastasizes Derived from basal Derived from basal
cell layer of the cell layer of the epidermisepidermis
Pigmented Nodular Basal Pigmented Nodular Basal Cell CarcinomaCell Carcinoma
Sclerosing Basal Cell Sclerosing Basal Cell CarcinomaCarcinoma
Squamous Cell Squamous Cell CarcinomaCarcinoma
Squamous Cell Squamous Cell CarcinomaCarcinoma
Often in older fair Often in older fair skinned personsskinned persons
Hyperkeratotic Hyperkeratotic and often ulceratesand often ulcerates
SCC is separated SCC is separated into two groups into two groups based on based on malignant malignant potentialpotential
In Situ Malignant In Situ Malignant MelanomaMelanoma
Melanoma cells Melanoma cells confined to the confined to the epidermisepidermis
Lack in invasion Lack in invasion may persist for may persist for months to yearsmonths to years
Simple excision is Simple excision is often curativeoften curative
Superficial Spreading Superficial Spreading MelanomaMelanoma
Superficial Spreading Superficial Spreading MelanomaMelanoma
Most common in Most common in middle agemiddle age
Develops anywhere Develops anywhere on the body, back in on the body, back in both sexes and legs both sexes and legs in femalesin females
Haphazard Haphazard combination on combination on colors but may be colors but may be uniformly brown or uniformly brown or blackblack
Acral Lentinginous Acral Lentinginous MelanomaMelanoma
Most common in Most common in blacks and orientalsblacks and orientals
Appears on the Appears on the palms, soles palms, soles terminal phalanges terminal phalanges and mucous and mucous membranesmembranes
The tumor is very The tumor is very aggressive and aggressive and metastasizes earlymetastasizes early
Nodular MelanomaNodular Melanoma Occurs in the fifth or Occurs in the fifth or
sixth decadesixth decade More frequent in males More frequent in males
with a ratio of 2:1with a ratio of 2:1 Found anywhere on the Found anywhere on the
bodybody Most frequently Most frequently
misdiagnosed because misdiagnosed because it can resemble a blood it can resemble a blood blister, hemangioma, blister, hemangioma, dermal nevus or polypdermal nevus or polyp
Amelanotic MelanomaAmelanotic Melanoma