Noncancerous, Precancerous and Cancerous Tumors

Xanthelasma

Tiny (1-2 mm) yellowish plaques that are slightly raised on the skin surface of the upper or lower eyelids. Xanthelasma is caused by tiny deposits of fat in the skin and is often associated with abnormal blood fat levels (hyperlipidemia). Xanthelasma is a kind of minute harmless growth of tissue. Xanthelasma typically appears in or near the eyelids. Under the microscope, Xanthelasma can be seen to be composed of lipid-laden foam cells. These cells, termed histiocytes, contain lipid material in their cytoplasm (the nonnuclear zone of the cell). The word "xanthelasma" is made up of "xanth-" from the Greek roots "xanthos" (yellow) and "elasma" (plate) = a yellow plate, so called because these are yellow plaques.

Dermatosis Papulosa Nigra (DPN)

Dermatosis papulosa nigra (DPNs) are very common benign brown warty papules that appear in African Americans and other patients with dark skin phototypes, DPNs usually affect the cheeks, neck, and upper chest. DPNs are a type of seborrheic keratosis. Many patients request removal of DPNs, particularly when multiple or large, due to their unsightly appearance.

Poikiloderma of Civatte (POC)

Poikiloderma of Civatte (POC) is a condition that is attributable to chronic sun exposure of the neck and the chest. The severity of findings is dependent on the duration and intensity of sun exposure, constitutive skin color (Fitzpatrick skin type), and the capacity to tan.

Solar Keratosis

These single or multiple, discrete, dry, rough, adherent scaly lesions occur on the habitually sun-exposed skin of adults, usually on a background of dermatoheliosis. Erythematous macules and papules with coarse, adherent scale become confluent on this bald scalp with dermatoheliosis. These hyperkeratoses are yellowish-greyish and have a tinge of hemorrhage; gently abrading lesions with a fingernail usually induces pain, even in early subtle lesions, a helpful diagnostic finding.

Acute Sunburn

Sunburn is an acute, delayed, and transient inflammatory response of normal skin after exposure to UVR from sunlight or artificial sources. By nature it is a phototoxic reaction. Sunburn is characterized by erythema (Fig. 10-1) and, if severe, by vesicles and bullae, edema, tenderness, and pain. This image shows painful, tender, bright erythema with mild edema of the upper back with sharp demarcation between the sun-exposed and sun-protected white areas. Note large atypical melanocytic nevi. The patient is at risk for developing malignant melanoma.

Sunburn (Second-Degree)

Sunburn (Second-Degree): Your skin type affects how easily you become sunburned. People with fair or freckled skin, blond or red hair, and blue eyes usually sunburn easily. Your age also affects how your skin reacts to the sun. The skin of children younger than 6 and adults older than 60 is more sensitive to sunlight. Skin that is red and painful and that swells up and blisters may mean that deep skin layers and nerve endings have been damaged ( second-degree burn). This type of sunburn is usually more painful and takes longer to heal.

Sunburn (First-Degree Burns)

Sunburn (First-Degree Burns): A sunburn is skin damage from the sun's ultraviolet (UV) rays. Most sunburns cause mild pain and redness but affect only the outer layer of skin ( first-degree burn). The red skin might hurt when you touch it. These sunburns are mild and can usually be treated at home. Your skin type affects how easily you become sunburned. People with fair or freckled skin, blond or red hair, and blue eyes usually sunburn easily. Your age also affects how your skin reacts to the sun. The skin of children younger than 6 and adults older than 60 is more sensitive to sunlight.

Sunburn

Sunburn: Sunburn is an inflammation of the skin that develops in response to exposure to ultraviolet (UV) radiation from the sun or from tanning beds and booths that emit UV radiation. Sunburn is manifested by reddened, painful skin that may develop blisters. Sunburn early in life increases one's risk of developing skin cancers later in life such as melanoma, basal cell carcinoma, and squamous cell carcinoma. Sunburn can also lead to drying and premature wrinkling of the skin. Sunburn can be prevented by limitation of sun exposure and use of sunscreen products. Sunscreens with a sun protection factor (SPF) of at least 15 are recommended for most people.

Neurofibromas

Neurofibromas (NFs) are benign, soft, pink, neuromesenchymal tumors that can be solitary or multiple. Solitary tumors are not associated with systemic findings. Multiple NFs are associated with neurofibromatosis types I and II, both neurocutaneous disorders with important systemic manifestations including malignancies. Plexiform NFs are seen in patients with neurofibromatosis type I. Multiple neurofibromas on the left face.

Neurofibromatosis

Neurofibromatosis: A genetic disorder of the nervous system that primarily affects the development and growth of neural (nerve) cell tissues, causes tumors to grow on nerves, and may produce other abnormalities. Neurofibromatosis (NF) consists of two very different disorders: neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2).

Neurofibromatosis (Neurofibromas)

Neurofibromatosis, neurofibromas. Skin-colored soft papules and nodules on the back are neurofibromata appearing in late adolescence in a patient with neurofibromatosis.

Neurofibromatosis (Crowe's Sign)

Neurofibromatosis, Crowe's sign. Axillary freckling in a child with neurofibromatosis.

Neurofibromatosis (Café au lait)

Neurofibromatosis, café au lait macule. Well-demarcated uniform brown macule on the buttock of a patient with neurofibromatosis.

Epidermal Nevus

Epidermal nevus (EN) is a benign hamartomatous growth. It presents as a group of verrucous, closely grouped, skin-colored to brown papules often in a linear arrangement following the Lines of Blaschko. It develops primarily in childhood. There are several variations of EN including localized nevus unius lateris. Systematized EN, EN syndrome, and inflammatory verrucous epidermal nevus (IVEN). In this photo is a young man with an epidermal nevus limited to his neck nape.

Spitz Nevus

Spitz nevus. A 1-cm raised red dome-shaped nodule that suddenly appeared on the shoulder of a child.

Compound Nevus

Compound nevus. Slightly raised nevus with regular borders and pigment.

Blue Nevus

Blue nevus. Blue-black 4 mm lesion on the cheek of a child.

Congenital Nevi

Congenital nevi are moles that are present at birth. These birthmarks have a slightly increased risk of becoming skin cancer depending on their size. Larger congenital nevi have a greater risk of developing skin cancer than do smaller congenital nevi. All congenital nevi should be examined by a health care provider and any change in the birthmark should be reported. If a dermatologist believes a mole needs to be evaluated further or removed entirely, he or she will either remove the entire mole, or first take just a small tissue sample of the mole to examine thin sections of the tissue under a microscope (a biopsy). This is a simple procedure. (If the dermatologist thinks the mole might be cancerous, cutting through the mole will not cause the cancer to spread.)

Pigmented Nevi

Pigmented nevi (moles) are growths on the skin that usually are flesh-colored, brown or black. Moles can appear anywhere on the skin, alone or in groups. Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. Moles may darken after exposure to the sun, during the teen years and during pregnancy. In most cases, health care professionals can diagnose birthmarks based on the appearance of the skin. If a mole exhibits potentially cancerous changes, a biopsy may be performed

Dysplastic Nevi (Atypical Moles)

Dysplastic nevi: Atypical moles whose appearance is different from that of a common ordinary mole. Dysplastic nevi tend to be larger than ordinary moles, have more irregular borders, are often mixed in color and present in large numbers. A dysplastic nevus can give rise to malignant melanoma.

Congenital Nevomelanocytic Nevus

Congenital nevomelanocytic nevus; “split” of the eyelid. A sharply demarcated, brown plaque, involving the upper and lower eyelids in a 45-year-old Asian female. Nevomelanocytes migrate from the neural crest to the skin after the 10th week in utero but before 24 weeks when splitting of eyelids occurs.

Junctional Nevus

Junctional nevus. Two uniformly brown small macules, round in shape with smooth regular borders.

Halo Nevus

Halo nevus. Raised red-brown nevus with a depigmented halo surrounding it.

Dysplastic Nevus

Dysplastic nevus: An atypical mole whose appearance is different from that of a common ordinary mole. Dysplastic nevi tend to be larger than ordinary moles, have more irregular borders, are often mixed in color and present in large numbers. A dysplastic nevus can give rise to malignant melanoma.

Angiofibroma (Forehead)

Angiofibroma is a descriptive term for a group of lesions with different clinical presentations but with the same histopathology. These lesions include fibrous papule, facial angiofibroma, pearly penile papule, adenoma sebaceum, periungual fibroma, and Koenen's tumor. Generally, an angiofibroma presents as 1 to 5 mm skin-colored to erythematous dome-shape papule on the face. When it presents as multiple facial lesions, it can be associated with tuberous sclerosis or multiple endocrine neoplasia type 1 (MEN 1). Angiofibroma. Fibrous plaques on the forehead in an adult patient with tuberous sclerosis.

Angiofibroma (Facial)

Angiofibroma is a descriptive term for a group of lesions with different clinical presentations but with the same histopathology. These lesions include fibrous papule, facial angiofibroma, pearly penile papule, adenoma sebaceum, periungual fibroma, and Koenen's tumor. Generally, an angiofibroma presents as 1 to 5 mm skin-colored to erythematous dome-shape papule on the face. When it presents as multiple facial lesions, it can be associated with tuberous sclerosis or multiple endocrine neoplasia type 1 (MEN 1). In this photo is a patient with numerous facial angiofibromas. He is noted to have associated tuberous sclerosis

Dermatofibroma

Dermatofibroma: A common type of benign skin tumor that is small, slow-growing, typically firm, red-to-brown and most often on the legs. Also called a fibrous histiocytoma. They can grow up to about 1 cm (less than a half inch) in diameter. A dermatofibroma consists of a proliferation of scar-like tissue within the deeper layers of the skin (dermis). The cause of dermatofibromas is unknown. They are usually single but sometimes may be multiple. Simple excision is curative.

Moles

Moles are growths on the skin that are usually brown or black. Moles can appear anywhere on the skin, alone or in groups. Most moles appear in early childhood and during the first 20 years of a person's life. Some moles may not appear until later in life. It is normal to have between 10-40 moles by adulthood. As the years pass, moles usually change slowly, becoming raised and/or changing color. Often, hairs develop on the mole. Some moles may not change at all, while others may slowly disappear over time.

Syringoma

Syringoma: A benign (non-cancerous) skin tumor that derives from eccrine cells, specialized cells that are related to sweat glands. The skin lesions usually appear during puberty or adult life, and consist of small bumps one to three millimeters in diameter that form underneath the surface of the skin. The most frequent site is the eyelids and around the eyes, but other areas of the body can also be affected. There may be only one or a few lesions in a localized area, or numerous lesions covering a wide area. Syringomas more frequently affect women and do have an hereditary basis in some, but not all, cases. They are also associated with Down syndrome, Marfan syndrome, and Ehlers-Danlos syndrome. Treatment of syringomas can be a problem, depending on their number and location. One method that seems to be effective and creates minimal scarring is the use of a hair removal electric needle; another promising technique uses a CO2 laser.

Skin Tag

A skin tag is a benign, pedunculated lesion the color of the skin or darker, occurring at intertriginous sites.

Skin Tags

Skin tag: A small tag of skin that may have a stalk (a peduncle). Skin tags may appear on the skin almost anywhere although the favorite locales are the eyelids, neck, armpits (axillae), upper chest, and groin. Invariably benign, this tiny tumor of the skin usually causes no symptoms unless repeatedly irritated as, for example, by the collar. Treatment may be done by freezing with liquid nitrogen or by cutting off with a scalpel or scissors if the skin tag is irritating or cosmetically unwanted. Medically, a skin tag can be termed an acrochordon or a cutaneous papilloma. But it is far better known as a skin tag.

Epidermal Inclusion Cyst (EIC)

Epidermal inclusion cyst (EIC), also known as sebaceous cyst and epidermoid cyst, is the most common cyst of the skin. It ranges in size from a few millimeters to a few centimeters and originates from the follicular infundibulum. Its contents are a cheesy, malodorous mixture of degraded lipid and keratin. It often ruptures, with associated pain and inflammation. Pictured is an elliptical excision around an epidermal inclusion cyst punctum.

Cutaneous Horns

The cutaneous horn appears as a funnel-shaped growth that extends from a red base on the skin. It is composed of compacted keratin (the same protein in nails). The size and shape of the growth can vary considerably, but most are a few millimeters in length. Squamous cell carcinoma is often found at the base. It usually occurs in fair-skinned elderly adults with a history of significant sun exposure.

Desmoplastic Melanoma

Desmoplastic melanoma. A flat nodule with bluish-red and brown portion in an elderly male; lesions often are surrounded by a macular portion resembling lentigo maligna.

Lipoma 2

Familial lipoma syndrome, an autosomal dominant trait appearing in early adulthood, consists of hundreds of slowly growing nontender lesions. Adipositas dolorosa, or Dercum's disease, occurs in women in middle age; there are multiple tender, not circumscribed but rather diffuse fatty deposits. Benign symmetric lipomatosis, which affects middle-aged men, consists of many large nontender, coalescent poorly circumscribed lipomas, mostly on the trunk and upper extremities; they coalesce on the neck and may lead to a “horse-collar” appearance. Shown here are multiple lipomas on the lower arm in a 50-year-old male patient. In this patient lesions were symmetric and were also found on the trunk and lower extremities.

Lipoma 1

Lipomas are single or multiple, benign subcutaneous tumors that are easily recognized because they are soft, rounded, or lobulated and movable against the overlying skin. Many lipomas are small but may also enlarge to 6 cm. They occur especially on the neck, trunk, and on the extremities but can occur anywhere on the body. Lipomas are composed of fat cells that have the same morphology as normal fat cells, and there is a connective tissue framework. Angiolipomas have a vascular component and may be tender in cold ambient temperature. These often require excision, whereas other lipomas should be excised only when considered disfiguring. Liposuction can also be performed when liposomas are soft and thus have only a minor connective tissue component.

Syringomas

Syringomas are benign adenomas of the eccrine ducts. They are 1- to 2-mm, skin-colored or yellow, firm papules that occur mostly in women, beginning at puberty; they may be familial. The lesions, most often multiple rather than solitary, occur most frequently around the eyelids and on the face, axillae, umbilicus, upper chest, and vulva. The lesions have a specific histologic pattern: many small ducts in the dermis with comma-like tails with the appearance of “tadpoles.” The lesions can be disfiguring, and most patients want them removed; this can be done easily with electrosurgery. This figure shows symmetric eruption of 1-2 mm skin-colored, smooth papules on the upper and lower eylids.

Keratoacanthoma 2

Keratoacanthoma - Erythematous, dome-shaped tumor with a large, central, keratotic plug of 6-weeks duration. The lesion cannot be distinguished clinically from squamous cell carcinoma.

Keratoacanthoma 1

Keratoacanthoma (KA) is a special lesion, a pseudocancer, occurring as an isolated nodule, usually on the face, and mimicking squamous cell carcinoma. Unique features are its rapid growth rate, much faster than that of an SCC, and also its spontaneous remission over a period of several months.

Lentigo Maligna Melanoma

Lentigo Maligna Melanoma: One of the four clinical types of malignant melanoma and the slowest growing one. It typically begins as a patch of mottled pigmentation that is dark brown, tan, or black on sun-exposed skin, such as on the face.

Malignant Melanoma

Malignant melanoma. Less than 2 percent of all melanomas occur during childhood. Nonetheless, attention must be paid to signs and symptoms suggestive of this potentially fatal disease. Variegations of color are of particular concern. Irregular or notched borders, bleeding, and ulceration are other signs of malignant change. The patient may give a history of itching, and the parents may have noted rapid growth of the lesion. Because the prognosis of a melanoma is most closely related to the thickness of the lesion at the time of treatment, emphasis should be on early diagnosis.

Squamous Cell Carcinoma with Central Hyperkeratosis

Squamous cell carcinoma. A round nodule with central hyperkeratosis, firm and indolent. This lesion cannot be distinguished clinically from keratoacanthoma; it is easily distinguished from nodular BCC because BCC does not develop hyperkeratosis.

Squamous Cell Carcinoma (Calf)

Squamous cell carcinoma in situ: Bowen's disease. A large, sharply demarcated, scaly, erythematous plaque simulating a psoriatic lesion on the calf.

Squamous Cell Carcinoma 2

Squamous cell carcinoma. A round nodule with central hyperkeratosis, firm and indolent. This lesion cannot be distinguished clinically from keratoacanthoma; it is easily distinguished from nodular BCC because BCC does not develop hyperkeratosis.

Squamous Cell Carcinoma 1

Squamous cell carcinoma: Cancer that begins in squamous cells -- thin, flat cells that look under the microscope like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of hollow organs of the body, and the passages of the respiratory and digestive tracts. Squamous cell carcinomas may arise in any of these tissues. The word "squamous" came from the Latin squama meaning "the scale of a fish or serpent."

Merkel Cell Carcinoma

Merkel cell carcinoma: An infrequent but highly malignant type of skin cancer. Characteristically starts in a sun-exposed area (of the head, neck, arms or legs) in whites 60-80 years of age as a firm, painless, shiny lump that can be red, pink, or blue in color and vary in size from less than a quarter of an inch (a half cm) to more than two inches (5 cm) in diameter. The tumor grows rapidly and often metastasizes (spreads) to other parts of the body. Even relatively small tumors are capable of metastasis, particularly to the regional (nearby) lymph nodes. Merkel cell carcinoma follows an aggressive course like that of melanoma, and has a predilection to spread to (in order of frequency) liver, bone, brain, lung, and skin. The prognosis (outlook) is accordingly poor. "Merkel" is often misspelled as "Merkle." The disease is named for the German anatomist and pathologist Friedrich Sigmund Merkel (1845-1919) and is also called neuroendocrine carcinoma of the skin.

Basal Cell Nevus Syndrome

Basal cell nevus syndrome. Numerous basal cell epitheliomas on the neck of a child.

Basal Cell Carcinoma (Advanced Nodular BCC)

Basal cell carcinoma. This is a farther advanced nodular BCC. A solitary, shiny, nodule with large telangiectatic vessels on the ala nasi, arising on skin with dermatoheliosis.

Basal Cell Carcinoma (Nose)

Basal cell carcinoma. A smooth, pearly tumor with telangiectasia on the nose. Tumor feels hard, is well defined, and is asymptomatic.

Basal Cell Carcinoma (Ear)

Basal cell carcinoma, pigmented. A nodule with irregular borders and variegation of melanin hues, easily confused with a malignant melanoma. Features indicating BCC are the areas of translucency and surface telangiectasia.

Basal Cell Carcinoma

Basal cell carcinoma: The most common type of skin cancer, a disease in which the cancer cells resemble the basal cells of the epidermis, the outer layer of the skin. Basal cell carcinomas usually appear as the classic "sore that doesn't heal." A bleeding or scabbing sore that seems to get somewhat better, then recurs and starts to bleed, may be a basal cell carcinoma. Most basal cell carcinomas are on the face and neck where the skin is exposed to sunlight. However, a fair number show up on parts of the body such as the abdomen, leg, and scalp exposed to little or no sunlight. Basal cell carcinomas typically are locally invasive. They tend to burrow in locally and not metastasize (spread) to distant locations. Small basal cell carcinomas can be removed by being scraped and burned (electrodesiccation and curettage). Larger basal cells can be removed by surgery. Basal cell carcinomas on the scalp, ears, and sides of the nose, as well as those which have come back after being treated, are treated best by Mohs surgery. One basal cell carcinoma means an increased risk of developing another. Prudent sun precautions and annual skin checkups by the doctor are advisable.

Actinic Keratosis (Solar Keratosis)

Actinic keratosis: A small rough spot on skin chronically exposed to the sun, precancerous, can develop into a skin cancer called squamous cell carcinoma, a process that typically takes years. Actinic keratoses occur most frequently in fair-skinned people. Common locations are the face, scalp, back of the neck, upper chest, forearm and back of the hand. Prevention is by minimizing sun exposure. Treatments include cryosurgery (freezing them with liquid nitrogen), cutting them away, burning them, putting 5-fluorouracil (5-FU) on them, and photodynamic therapy (which involves injecting into the bloodstream a chemical that collects in actinic keratoses and makes them more sensitive to exposure to a specialized form of light).

Seborrheic Keratoses

Seborrheic keratosis (SK) are the most common benign cutaneous tumors, and in adults SK are warty, keratotic skin growth that first present after the fourth decade. The measure from a few millimeters to centimeters The color ranges from pink to tan to dark brown. Lesions can be solitary or multiple. Over time, patients develop anywhere from a few to hundreds of SKs. Many patients request removal of SKs, particularly when multiple or large, because of their unsightly appearance. Pictured here are multiple seborrheic keratoses on back of elderly male.

Seborrheic Keratosis

Seborrheic keratosis: A benign skin disorder due to excessive growth of the top layer of skin cells, usually found in persons over 30 years old. They may appear as just one growth or in clusters. They are most often brown but can differ in color and range anywhere from light tan to black. They come in different sizes, anywhere from a fraction of an inch (or centimeter) to an inch (2.5 cm) in diameter. The telltale feature of seborrheic keratoses is that they look like they have been pasted on the skin or just stuck on it. They may look like a dab of warm brown candle wax that dropped on the skin. Almost everybody eventually develops at least a few seborrheic keratoses since they tend to become more common and more numerous with age. They are sometimes referred to as "barnacles of old age." The development of seborrheic keratoses is sometimes triggered by pregnancy, estrogen therapy or certain medical conditions. Seborrheic keratoses are most often found on the chest or back but can be found on the scalp, face, or neck or almost anywhere on the body. When they first appear, the growths usually begin one at a time as small rough bumps. Eventually they thicken and develop a rough, warty surface. Although seborrheic keratoses may first appear in one spot and seem to spread to another, they are not catching. As people age they may simply develop a few more. These growths may be unsightly, especially if they begin to appear on the face. They can get irritated by clothing rubbing against them. Because they may grow larger over the years, removal is sometimes recommended especially if they get irritated and bleed easily. A seborrheic keratosis may turn black and may be difficult to distinguish from a skin cancer. Sometimes such a growth must be removed and studied under a microscope to determine if it is cancerous or not. Salves, ointments or medication can neither cure nor prevent seborrheic keratoses. Most often seborrheic keratoses are treated by one of three methods: Freezing -- One method is called cryotherapy, or freezing. A very cold liquid called liquid nitrogen is applied to the growth with a cotton swab or spray gun to freeze it. Blisters may form under the growth that dry into a scablike crust. The keratosis usually falls off within a few weeks. No mark is usually left, although occasionally there may be a small dark or light spot. These will fade over time. Scraping -- Another method is called curettage. The growths are removed by "curetting" or scraping them from the surface of the skin. An injection or spray is first used to numb the area before the growth is removed. No stitches are necessary and bleeding is very limited. It can be controlled by applying pressure or by the application of a blood-clotting chemical. Electrosurgery -- Electrosurgery is another form of treatment. The growth is first numbed, then burned using an electric current and then scraped off.

Less Common Skin Cancers

Uncommon types of skin cancer include Kaposi's sarcoma, mainly seen in people with weakened immune systems; Merkel cell carcinoma, which is usually found on sun-exposed areas on the head, neck, arms and legs but often spreads to other parts of the body; and sebaceous gland carcinoma, an aggressive cancer originating in the oil glands in the skin.

Skin Cancer

Excessive exposure to sunlight is the main cause of skin cancer. Sunlight contains ultraviolet (UV) rays that can alter the genetic material in skin cells, causing mutations. Sunlamps, tanning booths, and X-rays also generate UV rays that can damage skin and cause malignant cell mutations. Basal cell carcinoma and squamous cell carcinoma have been linked to chronic sun exposure, typically in fair-skinned people who work outside. Melanoma is associated with infrequent but excessive sunbathing that causes scorching sunburn. One blistering sunburn during childhood appears to double a person's risk for developing melanoma later in life.

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