Siti Nurul Afiqah binti Johari 10-6-95

BENIGN SKIN TUMOR

Anatomy of skin

Classificationa) Skin appendages or skin adnexa, such as:• Hair follicles, sebaceous and sweat glands

b) Common cyst – sebaceous cyst, dermoid cyst

c) Soft tissue tumor – lipoma, fibroma, neurofibromatosis

d) Epidermal tumor as will be explained in precancerous lesion e) Moles (naevi)

Skin AppendagesSebaceous hyperplasia

Sebaceous adenoma

Cylindroma

Trichoepithelioma

Common CystSebaceous cyst (epidermoid cyst)

It is a retention cyst that is caused by the blockage of sebaceous gland duct.

• The cyst lined with stratified squamous epithelium contain a grayish white material

• Often found on scalp, trunk, face, any hairy areas of the body except the palm and the sole

Clinical features:• Slowly growing cyst and often painless• If infected or inflamed, it becomes red, painful

and tender to touch • Cyst forms a small, well defined cystic swelling

usually fixed to overlying skin at one point, freely movable, central punctum may be seen

• Lesion may be solitary or multiple• Sometimes it attains a large size

Treatment depends on its clinical state;• Incision and drainage• Complete excision of the cyst

Dermoid cyst• Dermoid cyst is lined by stratified squamous

epithelium filled with sebaceous material • Could occur anywhere in the body. If in the

skin, mostly on the face, neck or scalp

sc

Types

Congenital (sequestration)

Acquired (implantation)

Tubulodermoid

Teratomatous dermoid

Inclusion dermoid

Clinical features:

Sequestration dermoid: presents at birth but not appear clinically except after few years when cyst begins to extend (slowly growing), usually occur at fusion lines, painless mass, intense inflammation may occur if cyst rupture spontaneously or because of trauma

Implantation dermoid: occurs secondary to punctured wounds which displace some epithelial cells into sc tissues. Mainly in the fingers, palm and sole. Cyst usually small and tense and sometimes scarred overlying skin

Treatment : Excision of cyst

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Cheesy content inside the cyst

Soft Tissue TumorLipoma

Lipomas are benign aggregates of slowly growing adipocytes

• most common subcutaneous soft tissue tumor• Incidence 1:1000 persons, > in young males

Clinical features:• Most common as a painless slowly growing solitary

swelling• Multiple lipomatosis could occur• Present anywhere on the body (subcutaneous,

subfascial, intermuscular, submucosa, retroperitoneal)

• May contain other tissue as fibrolipoma or angiolipoma

• O/E : well circumscribed mass of variable sizes, soft in consistency, lobulated surface, slippery edges, non tender (unless they grow compressing an underlying nerve)

Multiple lipomatosis

Dercum’s disease (adiposis dolorosa) is tender fat deposits especially on trunk

Complications are rare include:

1. Degenerative changes lead to liquefaction and calcification2. Malignant transformation (liposarcoma)can occur in retropertoneal lipoma

Treatment:• Small, asymptomatic lipomas

require no treatment

• Definitive treatment is surgical excision

Indication to excise lipomas:1. Mostly for cosmetic reasons2. To evaluate their histology when

liposarcomas must be ruled out3. When they cause symptoms4. Become larger than 5cm, exhibit

malignant behavior, located mainly of thigh, shoulder, retroperitoneum

FibromaBenign tumor composed of fibrous or

connective tissue

• Can grow in all organs, arising from mesenchyme tissue

Hard fibroma (fibroma durum)

• In skin it is called dermatofibroma (mc painful skin tumor)

• Common cutaneous nodule of unknown etiology, > in females

• Firm pigmented nodule usually on the lower legs, arms

• Special form is keloid

Soft fibroma (fibroma molle)

• Fibroma with a shaft (acrochordon, skin tag)

• Represents as hyperplastic dermis either pedunculated or sessile

• Most common sites are axilla, neck, inguinal region

• No malignant threat

Treatment: - No treatment unless for cosmesis or liability to trauma- Surgical excision under local anaesthesia or by

laser/radiowave/electrocoagulation/cryotherapy

Elliptical excision of adermatofibroma on the arm

Removal of acrochordon

NeurofibromaNeurofibromatosis is a proliferative condition of the endoneurium of nerves associated with tumor formation. These tumors occur under the skin and throughout the nervous system.

a) Solitary neurofibroma – between the age 20-50 yrs. Usually found in sc tissue affecting nerves of upper limb, mobile sideways, forming a small elongated firm tender swelling. Cystic degeneration may occur

Rx: tumor should be completely excised

b) Generalized neurofibromatosis (Von Recklinghausen’s disease)

• Autosomal dominant disorder with widespread affection of nerves

• Preceded with multiple café-au-lait spots, increase in size and number over time

• Freckling in the arm pit/groin region during childhood adolescence

• Subcutaneous or cutaneous neurofibromas all over the body surface (small, slowly growing, painless,rubbery skin lesions, movable sideways but not in line of nerve)

Rx: Excision of all tumors is impossible. Complete resection indicated only for very large tumors, painful or tumors producing pressure symptoms.

Moles (Naevi)Melanocytes migrate from neural crest to the basal epidermis during embryogenesis.When this melanocytes layer in epidermis they form a simple mole. Melanocytes that aggregate in the dermis or at dermoepidermal junction are called nevus cells.

Classifications :- Lentigo- Junctional- Compound- Intradermal

• Lentigos: small, sharply circumscribed pigmented macules which are marker for sun damage and some systemic syndromes. Solar lentigenes >common in fairer skin

• Junctional naevus: deeply pigmented macule or papule occurs commonly in childhood and adolescence. Represents dermoepidermal proliferation of naevus cells usually progress to form compound or intradermal with advancing age. No malignant potential.

• Compound naevus: maculopapular pigmented lesion becomes prominent during adolescence. Represent a junctional proliferation of naevus cells with nest and columns in dermis.

• Intradermal naevus: faintly pigmented papules in adults showing no junctional proliferation but a cluster of dermal melanocytes.

• Blue naevus: benign skin lesion 4x > common in children typically affecting face and extremities

• Halo naevus: halo of depigmentation around any benign nevus represents an antibody response to melanocyte. Depigmentation is important as it may also be a feature of MM. It is assoc. with vitiligo.

Treatment of nevi:- Nevi are virtually always benign before

puberty- Indicated for cosmetic reasons, subject to

trauma or if there are alerting signs of change