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Benign skin lesions

Last updated: April 21, 2021

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Benign skin lesions are non-cancerous skin growths that may be pointed out by the patient or discovered during routine skin examinations. Accurately diagnosing a benign skin lesion and distinguishing it from a malignant condition requires consideration of the physical and histological characteristics of the lesion as well as the patient's attributes and overall condition. Biopsy or surgical excision is commonly performed when a potential malignancy cannot be ruled out. Treatment may be considered for cosmetic purposes.

Some of the most common benign skin lesions are covered in this card: hemangiomas, hypertrophic scars, keloid scars, warts, seborrheic keratosis, dermatofibromas, nevi, pyogenic granulomas, and lipomas.

Cherry hemangioma (Campbell de Morgan spots) [1]

  • Epidemiology [2]
    • More common in adults > 30 years
    • Incidence increases with age (most common acquired cutaneous vascular anomaly)
  • Pathophysiology: benign proliferation of dilated mature capillaries
  • Etiology: unknown, genetic predisposition
  • Clinical features
    • Bright cherry red, dome-shaped papules or macules that may appear purple with time (0.5–6 mm in diameter)
    • Usually on the trunk and upper extremities, but may occur all over the body
    • Usually multiple lesions
  • Diagnosis: based on clinical appearance of lesion
  • Treatment
    • Intervention is not necessary unless bleeding occurs or for cosmetic reasons
    • Options: electrocauterization, vascular laser therapy
  • Complications: profuse bleeding after trauma
  • Prognosis
    • No malignant potential
    • No spontaneous regression
    • No prevention possible

Pyogenic granuloma [1][3]

  • Definition: benign vascular tumor characterized by rapid growth and tendency to bleed easily
  • Etiology
    • Cause unknown
    • Associated with trauma and pregnancy
  • Clinical features
    • Soft, round, bright red tumor that bleeds easily
    • Polypoid and lobulated
    • Occasionally ulcerates
    • Localization: usually develops at a site of skin injury on the face or hands
  • Diagnosis: based on clinical appearance of lesion and history of rapid growth and easily injured/bleeding surface
  • Treatment: surgical excision

Other benign skin lesions [1][4][5]

  • Definition: cutaneous condition characterized by high fibroblast proliferation and collagen production that leads to a raised scar that does not grow beyond the boundaries of the original lesion
  • Epidemiology: seen in individuals of all races, and should not be confused with keloid scars, which are more common in dark-skinned individuals
  • Etiology: imbalance in wound healing processes due to various local and genetic factors
  • Pathophysiology: increased synthesis and parallel deposition of collagen type III
  • Clinical features
    • Raised scar that does not grow beyond the boundaries of the original lesion, possibly erythematous (may be firm)
    • Pruritus
  • Diagnosis: : based on clinical appearance of lesion and patient history of trauma or surgery
  • Treatment
  • Prevention: follow surgical principles associated with decreased risk of scar development (e.g., incisions should follow skin creases to reduce tension on the suture)
  • Prognosis
    • Regresses spontaneously
    • Recurrences are infrequent

  • Definition: fibroblast proliferation resulting in small, fibrous benign dermal growth [1][4]
  • Epidemiology: >
  • Etiology: not fully understood (sometimes related to insect bites or trauma)
  • Clinical features
    • Asymptomatic
    • Slowly growing, skin-colored or brownish nodules of ∼ 3–10 mm diameter
    • Localization: most common on lower extremities, but can appear anywhere on the body
  • Diagnosis: dimple sign (Fitzpatrick sign): pinching of lesion produces central dimple (characteristic sign of dermatofibroma)
  • Treatment
    • Usually no treatment required
    • Indications for excision: cosmetic reasons, symptomatic lesion, or suspicion of malignancy

  • Definition: congenital or acquired usually highly pigmented area (benign neoplasm) on the skin that is either flat or raised (a mole)
Overview of different nevi
Type Mongolian spot Becker nevus Spitz nevus Common acquired melanocytic nevus Dysplastic nevus (atypical mole) Giant congenital melanocytic nevus
Patient group
  • Congenital
  • Most common in adult males (late-onset nevus)
  • More common in children
  • Common, regardless of age, gender, or ethnicity
  • Congenital
Clinical features
  • Blue-gray hyperpigmented macula, usually on the sacral-gluteal region
  • Non-tender and non-blanching
  • Rapidly growing solitary, nodular nevus
  • Junctional nevi
  • Compound or intradermal nevi
  • Light to darkly pigmented lesion, often with increased hair growth
Malignant potential
  • None
  • None
  • Possible (Rare)
  • Possible
  • Certain malignant change if associated with dysplastic malignant syndrome
  • Possible
Treatment
  • Not required (usually disappears spontaneously during childhood)
  • Usually not required
  • Excision is recommended for histopathological confirmation.
  • Surgical excision or laser treatment

Becker nevus (melanosis naeviformis) [4][6]

Linear verrucous epidermal nevus

  • Epidemiology: 1–3/1000 live births
  • Etiology: sporadic, may be associated with other developmental abnormalities
  • Clinical features
  • Diagnosis
    • Based on clinical appearance
    • If diagnosis is in doubt, confirm with biopsy
  • Treatment
    • Not required
    • May be excised for cosmetic reasons
  • Prognosis: no malignant potential

Spitz nevus (spindle and epithelioid cell nevus) [4][6]

  • Epidemiology: more common in children
  • Etiology: : unknown (associated with pregnancy and puberty)
  • Histology: irregular and spindle-shaped nevus cells
  • Clinical features
    • Solitary, nodular nevus (may be difficult to distinguish from melanoma)
    • Well-circumscribed
    • Often rapidly growing
  • Diagnosis: histopathology of excised nevus
  • Treatment: Excision with histopathological confirmation is recommended.
  • Prognosis: rarely malignant

Nevus spilus (speckled lentiginous nevus)

  • Epidemiology: prevalence of ∼ 2%
  • Etiology
    • Not fully understood
    • Environmental and genetic influences possible
  • Clinical features
  • Diagnosis
    • Based on clinical appearance
    • If diagnosis is in doubt, confirm with biopsy
  • Treatment: usually not necessary
  • Prognosis: benign, but melanoma may rarely arise in a nevus spilus

Common acquired melanocytic nevi (often referred to as “moles”) [4][6]

Nevus sebaceous

  • Epidemiology: onset commonly during childhood
  • Etiology: unclear, probably due to gene mutations
  • Clinical features:
    • Skin-colored, elevated lesion with surrounding alopecia
    • Localization: usually occurs as single lesion on scalp
  • Diagnosis: based on clinical appearance
  • Treatment: prophylactic excision if sebaceous nevus persists after puberty
  • Prognosis
    • Usually regress after puberty
    • Risk of degeneration if persistent

Dysplastic nevus (atypical mole) [4][6]

  • Epidemiology: 2–10% in white populations
  • Etiology
    • Genetics (parents with many moles)
    • Associated with fair skin
    • Intense sun exposure during childhood
  • Clinical features
    • ABCDE criteria
    • Ugly duckling sign: Differences between nevi in the same patient should be considered suspicious.
  • Diagnosis
    • Clinical diagnosis
    • Dermoscopy can be helpful in clarifying and distinguishing from melanoma.
  • Treatment: excision of suspicious lesions
  • Prognosis: risk of malignant melanoma if associated with dysplastic nevus syndrome

  • Definition: common benign tumor of subcutaneous soft-tissue, made up of mature fat cells [1][4]
  • Etiology: unknown, genetic predisposition
  • Clinical features
    • Slow-growing round, soft “rubberytumor (may be solitary or multiple)
    • Non-tender
    • Localization: typical locations are head, neck, shoulders, and back
  • Special type: Lipomatosis is an autosomal-dominant disorder characterized by multiple lipomas.
  • Diagnosis: clinical diagnosis
  • Treatment
    • Usually not required
    • Surgical excision can be considered in the following cases:
      • If tumor causes pain
      • Cosmetic reasons
      • If tumor grows rapidly or is firm on palpation

  • Definition: rare benign skin appendage tumors (formerly classified as apocrine in origin)
  • Etiology: unknown
  • Clinical features: may occur as a single tumor or as multiple tumors associated with Brooke-Spiegler syndrome (autosomal dominant familial cylindromatosis associated with cylindromas, trichoepitheliomas, and spiradenomas)
    • Solid, skin-colored nodules
    • Involves the head, neck, and face
  • Diagnosis: clinical diagnosis (based on clinical appearance of lesion)
  • Treatment
  • Prognosis: malignant transformation is very rare

  • Definition: flat, brown macules or patches that are induced by sun exposure
  • Epidemiology: usually seen in older fair-skinned people
  • Etiology: exposure to ultraviolet (UV) radiation
  • Pathophysiology: increase in the production of melanin, which is then deposited in basal keratinocytes
  • Clinical features
    • Flat, brown macules or patches
    • Localization: most common on the cheeks and back of the hands
  • Treatment: usually not necessary

  1. Luba MC, Bangs SA, Mohler AM, Stulberg DL. Common Benign Skin Tumors. Am Fam Physician. 2003; 67 (4): p.729-738.
  2. Kim J-H, Park H, Ahn SK. Cherry Angiomas on the Scalp. Case Reports in Dermatology. 2009; 1 (1): p.82-86. doi: 10.1159/000251395 . | Open in Read by QxMD
  3. Pyogenic granuloma. http://www.dermnetnz.org/topics/pyogenic-granuloma/. Updated: January 1, 2003. Accessed: February 18, 2017.
  4. Marks JG Jr, Miller JJ . Lookingbill and Marks' Principles of Dermatology. Saunders Elsevier ; 2013
  5. Sepulveda A, Buchanan E. Vascular Tumors. Semin Plast Surg. 2014; 28 (2): p.49-57. doi: 10.1055/s-0034-1376260 . | Open in Read by QxMD
  6. Lichen simplex chronicus. https://www.pathologyoutlines.com/topic/skinnontumorlichensimplexchronicus.html. Updated: March 18, 2020. Accessed: October 20, 2020.
  7. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
  8. Yoshimi N, Imai Y, Kakuno A, Tsubura A, Yamanishi K, Kurokawa I. Epithelial keratin and filaggrin expression in seborrheic keratosis: evaluation based on histopathological classification. Int J Dermatol. 2013; 53 (6): p.707-713. doi: 10.1111/j.1365-4632.2012.05828.x . | Open in Read by QxMD
  9. Sarkar R, Ailawadi P, Garg S. Melasma in Men: A Review of Clinical, Etiological, and Management Issues.. The Journal of clinical and aesthetic dermatology. 2018; 11 (2): p.53-59.
  10. Brady MF, Rawla P. Acanthosis Nigricans. StatPearls. 2021 .
  11. Chauhan DS, Guruprasad Y. Dermal cylindroma of the scalp. National Journal of Maxillofacial Surgery. 2012; 3 (1): p.59-61. doi: 10.4103/0975-5950.102163 . | Open in Read by QxMD
  12. Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. British Journal of Dermatology . 2014 : p.pp696–712. doi: 10.1111/bjd.13310 . | Open in Read by QxMD
  13. Lumbosacral dermal melanocytosis. http://www.dermnetnz.org/topics/lumbosacral-dermal-melanocytosis/. Updated: January 1, 2003. Accessed: February 20, 2017.
  14. Blaschko lines. http://www.dermnetnz.org/topics/blaschko-lines/. Updated: January 1, 2008. Accessed: February 20, 2017.
  15. WebMD. Atypical Moles. Atypical Moles. New York, NY: WebMD. http://www.webmd.com/melanoma-skin-cancer/atypical-moles. Updated: November 20, 2015. Accessed: February 20, 2017.
  16. The Ugly Duckling Sign. http://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/the-ugly-duckling-sign. Updated: August 29, 2011. Accessed: February 20, 2017.