Benign tumors

Verruca seborrhoica

are papilomatous changes which come from epidermis and they are seen in older persons

Clinical picture :

Changes are seen after 50. years of life, but there are juvenile changes. Those changes are usually
in seborrhoic region of face, chest and back, abdomen and intartrigrous regions. In the beginning
those are round or oval macules,shaply demarcated, yellow or dark color and smooth surface.
Later they become elevated papilomatous changes which are 2-3 cm in diameter and color is
from dark to black.The surface is rough cover with greasy squamos epithelium which is easily
removed. There is malignant transformation and there is not regression.

Differential diagnosis : Verruca vulgaris, pigmented naevus, BCC, MM

Treatment : liquid nitrogen,surgery,

Epidermoid cysts

they appear during the cystic expansion of folicles. There are two forms.

Epidermal cysts

come from upper part of follicle (infudibulum). Histological wall of cyst looks like epidermis has
granulous layer and produces keratin. They ate localized on face, neck, upper part of chest. They
are seen as pastous node coverd with normal skin. There is small depression trough which an
filament can be squeezed. They become bigger. They burst and infect.

Pillar cysts

Come form deeper part of follicle. Histological they look like follicular epidermis. They are
localized on scalp. They look like epidermal cysts but they are more firm.

Treatment : surgery, and removal of wall of cyst

Dermatofibroma

is firm demarcated intraepidermal node which represents reactive hyperplasia of connective

tissue during trauma (insect bite,scrating).
Clinical picture :

Changes are seen in adults. They are localized on lower but rarely on upper extremities and
trunk. They are seen as solitary or multiple nodules and they are connected with skin. They can
be below the level of the skin or above. Skin is pigmented and keratotic. Treatment is not
neseceserry.

Molluscum pendulum

comes from connective tissue cells, papilomatous appearance and it is seen after 50 year of life.
Changes are localized on neck, axille as smooth surface creations size 1-2mm to1cm. Changes
are normal color or pigmented. They should be differentiated from soft nevus. Treatment is
electro surgery.

Granuloma pyogenicum

is benignig hemangioma which is seen in young persons and childern localized on fingers and
face. It is seen few days or week after an injury, as the light-red eleveted tumor.

Differential diagnosis is MM.

Treatment: surgery

Lipoma

is benign mescenchimal tumor which comes form fat tissue. It is seen in young and middle age
persons, more in woman. Predielection sites are neck,trunk and extremities. Changes are
subcutanous,soft demarcated nodules which are movable towards surface and skin is unchanged.
They can be few centimeters, and sometime painful. They are treated surgicaly (estetic regions)

Xantoma

is relatively benign tumor which are seen in increased concentration of plasmic lipoproteins and
during storage of macrophanges which have lipid material.

Xantomelasma

is seen on the inner side of eyelids as demarcated yellow or orange elevated or flat plaques. In
one third of patients there is hypercholesterolemia. Treatment- metabolic disorder , surgery
Xantoma tuberosum

are most commonly seen on places which are exposed to trauma (knees, elbows,joints). Changes
are seen as papules or nodules yellow or orange color. They are seen in II and III type of
hyperlipoproteinemie. They rarely retrieve eve after regulation of metabolic disorder.

Xantoma erptiuvim

it appears abruptly, and changes are localized on extensore surfaces of the extremities and trunk.
They look like yellow or pink papules on erythematous base. The patients have high triglicerids.
Treatment- metobolical disorder.

Keloid

are cutaneous tumor which appear because of increased activity of fibroblasts. They are seen on
the place of injury (burn lesion,surgical wounds, inflammated lesions of skin, vaccination) when
reparation of tissue exceed the borders of damage. They can be spontanous in acne. Predelection
sites are auriculim, shoulders, peristernal region. First change is erythematous firm papule which
is sensitive. They are seen 3-4 months after injury. Later they become pigmented and firm.They
should be differentiated from hypertropic scars.

Treatment- triamicilon acetonid, liqid nitrogen, surgery

Skin tag

is a very common, soft, skin-colored or tan or brown, round or oval, pedunculated papilloma
(polyp) it is usually constricted at the base and may vary in size from >1 mm to as large as 10
mm. Occurring in the middle aged and elderly. Histologic findings include a thinned epidermis
and a loose fibrous tissue stroma. Usually asymptomatic but occasionally may become tender
following trauma or torsion and may become crusted or hemorrhagic. More common in females
and in obese patients and most often noted in intertriginous areas (axillae, inframammary, groin)
and on the neck and eyelids. It occurs in acanthosis nigricans and metabolic syndrome. May be
confused with a pedunculated seborrheickeratosis, dermal or compound melanocytic nevus,
solitary neurofibroma, or molluscum contagiosum. Lesions tend to become larger and more
numerous over time, especially during pregnancy. Following spontaneous torsion
autoamputation can occur. Management is accomplished with simple snipping with scissors,
electrodesiccation, or cryosurgery.

Milium

is a 1- to 2-mm, superficial, white to yellow, keratin-containing epidermal cyst, occurring

multiply, located on the eyelids, cheeks, and forehead in pilosebaceous follicles. The lesions can
occur at any age, even in infants. Milia arise either de novo, especially around the
eye, or in association with various dermatoses with subepidermal bullae or vesicles (pemphigoid,
porphyria cutanea tarda, bullous lichen planus,epidermolysis bullosa) and skin
trauma (abrasion, burns, dermabrasion, radiation therapy). Incision and expression of contents
are the method of treatment.

Keratoacanthoma

KA is a special lesion; formerly considered a pseudocancer it is now regarded by most as a

variant of SCC. A relatively common, rapidly growing epithelial tumor with potential for tissue
destruction and (rare) metastasis; however, in most cases there is spontaneous regression.
HPV -9, -16, -19, - 25, -37 have been identified in KAs; other possible etiologic factors include
UVR and chemical carcinogens (pitch, tar). Age of onset over 40 years. Male: female ratio 2:1.
A dome-shaped nodule with central keratotic plug (Fig. 11-15). Firm but not hard. Skin-colored,
slightly red, brown. Removal of keratotic plaque results in a crater. Predilection for sun-exposed
sites. Multiple KAs occur. Spontaneous regression in 612 months in most cases. However, local
or visceral metastases have been detected. Histopathology: not always possible to rule out
highly differentiated SCC. Treatment is by excision.