Medical & Surgical Dermatology

Common Growths

Many common growths develop on people's skin. While the cause is often poorly understood, it is known that some are associated with aging, and others are inherited. Benign (non-cancerous) lesions are not life threatening, but people often have these lesions removed for cosmetic reasons. A lesion may be removed for medical reasons if cancer is suspected. When a lesion bleeds or causes pain, inflammation, or irritation, it also is typically removed.

Dermatofibroma

Dermatofibromas are pink, dull red, or darkly pigmented and resemble a mole (nevus). They are usually small, but can attain the size of a peach pit. Dermatofibromas are firm and pucker or dimple when pinched. They occur most commonly on the legs of women and can be annoying since they are easily nicked with shaving. Dermatofibromas represent a scar-like reactive process that may be induced by a trauma, such as an insect bite. They can be removed surgically or flattened by freezing (cryosurgery).

Prurigo Nodularis

Prurigo nodularis is a thickened, rough, tumor-like, sometimes scaly lesion that often causes intense itching. It is not a true growth; it is a reactive process due to scratching. The exact cause of the intense itching remains unknown. Since it can be confused with squamous cell carcinoma, a type of skin cancer, a skin biopsy is sometimes necessary. Occasionally, prurigo nodularis is associated with an underlying medical condition such as eczema, kidney failure, or cancer. Treatment is difficult and may consist of cortisone injections placed directly into the growth, cortisone tapes, creams, ointments, freezing, anti-itch medication, or curettage (scraping).

Keratoacanthoma

Keratoacanthoma is a fast-growing, cone-shaped, flesh-colored lesion that is considered a variant of squamous cell carcinoma, a type of skin cancer, and is often confused with invasive squamous cell carcinoma. It destroys surrounding tissue and, in rare cases, metastasizes (spreads to other parts of the body). These lesions usually develop on the extremities. Treatment consists of surgically removing the growth, which is sent to a laboratory for microscopic examination.

Pyogenic Granuloma

Pyogenic granulomas are small pink or red lesions formed by many blood vessels. With minor trauma, the lesions bleed easily. They may arise spontaneously or develop after an injury. These growths occur at any age and in both sexes, but are more common in children. Those which form during pregnancy in the gingiva (gums) usually disappear spontaneously after delivery. The most efficacious treatment is to surgically shave and cauterize them with an electric needle. Other treatment methods used are surgical removal and electrocautery, cryosurgery (freezing), and laser surgery.

Epidermoid and Pilar Cysts (Sebaceous Cysts)

A cyst is a benign growth that forms when an inner lining or sac fills with a cheesy material. Epidermoid cysts have a central opening from which a rancid material can be expressed. If they are located in the upper layers of the skin, they may have a yellow or white appearance and have prominent overlying blood vessels. Epidermoid cysts most commonly occur on the face, neck, and back. Pilar cysts are primarily located on the scalp. Inheritance may play a role in patients with multiple lesions. Epidermoid cysts may arise following surgery or injury to the skin. If a cyst enlarges rapidly and ruptures, a boil-like lesion results that usually requires treatment with an antibiotic and surgical removal of the sac. It is easier to remove the cyst when it is not inflamed. This may prevent the possibility of infection. If a cyst begins to enlarge rapidly, becomes inflamed, breaks down, or becomes painful, it should be examined by a dermatologist immediately.

Milia

Milia can be thought of as miniature epidermoid cysts. They frequently occur on the face as single or multiple pinpoint white lesions and are common in older woman. The cause is unclear, but they may arise following injuries to the skin or surgery. The most effective treatment is extraction, which can be performed in a dermatologist's office.

Sebaceous Gland Hyperplasia


Appearing as small white or yellow lesions, sebaceous gland hyperplasia occurs on the faces of people with oily skin. The lesions may have prominent tiny blood vessels and can resemble basal cell carcinoma, a type of skin cancer; therefore, a skin biopsy may be performed. Treatment of sebaceous gland hyperplasia includes electrosurgery, cryosurgery (freezing), laser surgery, and photodynamic therapy (photoactive chemicals and a light source).

Digital Mucinous Pseudocyst

These lesions are bluish in color and extrude a clear, thick material when punctured. They most commonly occur in the skin overlying the base of the fingernail and may interfere with nail growth causing a nail groove to develop. These lesions are not true cysts, but represent a degenerative process of the skin in which the sticky, jelly-like substance accumulates. Treatment includes surgical removal and/or cortisone injections.

Lipoma

A lipoma is a fatty tumor that lies deep in the skin and appears as a soft lump. Occasionally, lipomas are tender to the touch but usually do not cause other symptoms. Malignant (cancerous) transformation rarely occurs. Lipomas may be small or quite large and develop in adults as single or multiple lesions. These tumors do not require treatment unless they become large and uncomfortable or exquisitely tender. Treatment consists of surgically removing the lipoma or liposuction.

Xanthelasma

These lesions develop on the eyelids and are yellowish or whitish in color due to lipid (fat) deposits in the skin. They may occur in individuals with normal lipid levels, or they can be associated with a lipid-metabolism disorder, especially high cholesterol levels. People with xanthelasma should be evaluated for elevated or abnormal cholesterol and triglycerides. Treatment options include surgery, electrosurgery, cryosurgery, laser surgery, and the application of acids.

Syringoma

Syringomas are small (2 millimeter) lesions of sweat gland ducts. They occur most often in women, form frequently on the lower eyelid, and are usually skin colored. The lesions also may be white. They are asymptomatic (do not hurt or itch). Treatment includes electrosurgery, surgical removal, laser surgery, and dermabrasion.

Trichoepithelioma

Trichoepitheliomas are small skin-colored lesions that occur most commonly on the face and neck and may resemble basal cell carcinoma, a type of skin cancer. The cause is not completely understood. These tumors represent the body's attempt to form hair follicles and shafts. In some people, they can become quite numerous and large, and interfere with everyday function if they occur in areas such as the ear canal or eye region. These can be removed with surgery, laser treatment, or dermabrasion.
 

Neurofibroma

A neurofibroma may resemble a non-colored mole, but is often very soft. These lesions are usually asymptomatic (do not hurt or itch), but may be tender to the touch. The benign growths are derived from nerve sheath cells in the skin. They may be removed surgically if they are annoying. When there are numerous neurofibromas, patches of pigmentation, and freckling in the armpits, the individual may have an inherited disorder called neurofibromatosis. There are many forms of this disease, which may be associated with brain tumors and internal neurofibromas that can become malignant. Such patients require close monitoring and genetic counseling.

Hemangioma (Cherry Angioma)

Hemangiomas are benign growths consisting of numerous small blood vessels. The typical lesion is small, red, and occurs most commonly on the torso of adults; however, a hemangioma can develop anywhere on the body. Some may become the size of a pencil eraser and be purple in color. Individuals may develop hundreds of lesions. Usually asymptomatic (do not hurt or itch), larger lesions may bleed and require removal. Many methods may be used to remove these lesions, including excision, electrosurgery, and laser surgery.

Seborrheic Keratoses and Verrucous Acanthoma

These lesions have a wart-like appearance, and may be smooth or flat. They can range in color from skin-colored to jet black. If they have a mixture of brown and black colors, they can resemble an atypical mole or melanoma, a lethal form of skin cancer, and a biopsy may be performed. In general, seborrheic keratoses are quite common and numerous. If one is extremely large and thick, it is known as a verrucous acanthoma. Most frequently seen in older individuals, seborrheic keratoses may be inherited. In people with skin of color, they often appear as small black lesions around the eyes (dermatosis papulosa nigra). Lesions may be removed for cosmetic reasons or if they are associated with intense itching, irritation, or bleeding. Treatment includes cryosurgery (freezing), shaving, curettage (scraping), and electrodessication (burning).

Nevi (Moles)

Molesmay be pigmented or skin-colored. They arise in the pigment producing cells (melanocytes) of the skin and can be congenital (present at birth). Moles more commonly develop throughout childhood. Nevi may be flat or elevated and grow to about the size of a pencil eraser. They can develop any place on the body, and may disappear with time. A changing or irregular mole may indicate cancer. All moles should be examined by a dermatologist, and suspicious lesions should be biopsied. Moles also may be removed if they become irritated and for cosmetic reasons. Any mole that grows, changes in shape or color, or bleeds should be evaluated by a Water’s Edge Dermatology practitioner

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