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