Benign Skin Tumor

Department of Plastic Surgery

1. Siti Nurul Afiqah binti Johari 10-6-95 BENIGN SKIN TUMOR

2. Anatomy of skin

3. Classification Skin appendages or skin adnexa, such as: Hair follicles, sebaceous and sweat glands Common cyst – sebaceous cyst, dermoid cyst Soft tissue tumor – lipoma , fibroma, neurofibromatosis Epidermal tumor as will be explained in precancerous lesion e) Moles ( naevi )

4. Skin A ppendages Sebaceous hyperplasia Sebaceous adenoma Cylindroma Trichoepithelioma

5. Common Cyst Sebaceous cyst ( epidermoid cyst) It is a retention cyst that is caused by the blockage of sebaceous gland duct. The cyst lined with stratified squamous epithelium contain a grayish white material Often found on scalp, trunk, face, any hairy areas of the body except the palm and the sole

6. Clinical features: S lowly growing cyst and often painless If infected or inflamed, it becomes red, painful and tender to touch Cyst forms a small, well defined cystic swelling usually fixed to overlying skin at one point, freely movable, central punctum may be seen Lesion may be solitary or multiple Sometimes it attains a large size

7. Treatment depends on its clinical state; Incision and drainage Complete excision of the cyst

8. Dermoid cyst Dermoid cyst is lined by stratified squamous epithelium filled with sebaceous material Could occur anywhere in the body. If in the skin, mostly on the face, neck or scalp sc

9. Types Congenital (sequestration) Acquired (implantation) Tubulodermoid

10. Teratomatous dermoid Inclusion dermoid

11. Clinical features: Sequestration dermoid : presents at birth but not appear clinically except after few years when cyst begins to extend (slowly growing), usually occur at fusion lines, painless mass, intense inflammation m ay occur if cyst rupture spontaneously or because of trauma Implantation dermoid : occurs secondary to punctured wounds which displace some epithelial cells into sc tissues. Mainly in the fingers, palm and sole. Cyst usually small and tense and sometimes scarred overlying skin

12. Investigation: 1) Clinical examination By palpation : Dermoid cysts are firm and painless unless ruptured. Dermoid cysts are not attached to the overlying skin 2) Ultrasound (to know the extend of the tissue) CT scan (if suspicion of deep level cyst such as extending to facial cavity or orbit. 4) Sonogram : if there is nearby sinus tract.

13. Treatment : Excision of cyst

14. 1 2 3 4 5 6 7 8 Cheesy content inside the cyst

15. Soft Tissue T umor Lipoma Lipomas are benign aggregates of slowly growing adipocytes most common subcutaneous soft tissue tumor Incidence 1:1000 persons, > in young males

16. Clinical features: Most common as a painless slowly growing solitary swelling M ultiple lipomatosis could occur Present anywhere on the body (subcutaneous, subfascial , intermuscular , submucosa , retroperitoneal) May contain other tissue as fibrolipoma or angiolipoma O/E : well circumscribed mass of variable sizes, soft in consistency, lobulated surface, slippery edges, non tender (unless they grow compressing an underlying nerve)

17. Multiple lipomatosis

18. Dercum’s disease ( adiposis dolorosa) is tender fat deposits especially on trunk Complications are rare include: Degenerative changes lead to liquefaction and calcification Malignant transformation ( liposarcoma ) can occur in retropertoneal lipoma

19. Treatment: Small, asymptomatic lipomas require no treatment Definitive treatment is surgical excision Indication to excise lipomas : Mostly for cosmetic reasons To evaluate their histology when liposarcomas must be ruled out When they cause symptoms Become larger than 5cm, exhibit malignant behavior, located mainly of thigh, shoulder, retroperitoneum

20. Papilloma Benign epithelial  tumor growing exophytically (outwardly projecting) in nipple-like and often finger-like fronds. Consist of central axis of CT, bvs and lymphatics Covered by sq. epi

21. Usually pigmented Commonly in the face, arms and upper trunk May be a familial trait with autosomal dominant inheritance Composed of immature epidermal cells nourished by elongated dermal papillae Malignant transformation is rare Treatment is by excision, cryosurgery or cautery

22. Fibroma Benign tumor composed of fibrous or connective tissue C an grow in all organs, arising from mesenchyme tissue

23. Hard fibroma (fibroma durum) In skin it is called dermatofibroma (mc painful skin tumor) Common cutaneous nodule of unknown etiology, > in females Firm pigmented nodule usually on the lower legs, arms Special form is keloid Soft fibroma (fibroma molle ) Fibroma with a shaft ( acrochordon , skin tag) Represents as hyperplastic dermis either pedunculated or sessile Most common sites are axilla, neck, inguinal region No malignant threat

24. Clinical examination of fibroma durum Inspection: Solitary nodule overlying skin can range from flesh to gray, yellow, orange, pink, red, purple, blue, brown, or black. (commonly pink) Palpation Usually 0.5- to 1-cm nodule, slightly elevated. Firm nodule Fixed to skin surface and is freely movable over the subcutis . May have itching and tenderness Dimple Sign on pinching.

25. Treatment: - No treatment unless for cosmesis or liability to trauma Surgical excision under local anaesthesia or by laser/ radiowave /electrocoagulation/ cryotherapy Elliptical excision of a dermatofibroma on the arm Removal of acrochordon

26. Neurofibroma Neurofibromatosis is a proliferative condition of the endoneurium of nerves associated with tumor formation. These tumors occur under the skin and throughout the nervous system.

27. Solitary neurofibroma – between the age 20-50 yrs. U sually found in sc tissue affecting nerves of upper limb, mobile sideways, forming a small elongated firm tender swelling. Cystic degeneration may occur Rx: tumor should be completely excised

28. Generalized neurofibromatosis (Von Recklinghausen’s disease ) Autosomal dominant disorder with widespread affection of nerves Preceded with multiple c afé -au- lait spots, increase in size and number over time Freckling in the arm pit/groin region during childhood  adolescence S ubcutaneous or cutaneous neurofibromas all over the body surface (small, slowly growing, painless,rubbery skin lesions, movable sideways but not in line of nerve) Rx: E xcision of all tumors is impossible. Complete resection indicated only for very large tumors, painful or tumors producing pressure symptoms.

29. Moles ( Naevi ) Melanocytes migrate from neural crest to the basal epidermis during embryogenesis. W hen this melanocytes layer in epidermis they form a simple mole. M elanocytes that aggregate in the dermis or at dermoepidermal junction are called nevus cells. Classifications : Lentigo Junctional Compound I ntradermal

30. L entigos : small, sharply circumscribed pigmented macules w hich are marker for sun damage and some systemic syndromes. Solar lentigenes >common in fairer skin Junctional naevus : deeply pigmented macule or papule occurs commonly in childhood and adolescence. Represents dermoepidermal proliferation of naevus cells usually progress to form compound or intradermal with advancing age. No malignant potential.

31. Compound naevus : maculopapular pigmented lesion becomes prominent during adolescence. Represent a junctional proliferation of naevus cells with nest and columns in dermis. Intradermal naevus : faintly pigmented papules in adults showing no junctional proliferation but a cluster of dermal melanocytes.

32. Blue naevus : benign skin lesion 4x > common in children typically affecting face and extremities Halo naevus : halo of depigmentation around any benign nevus represents an antibody response to melanocyte. Depigmentation is important as i t may also be a feature of MM. It is assoc. with vitiligo .

33. Treatment of nevi: Nevi are virtually always benign before puberty Indicated for cosmetic reasons , subject to trauma or if there are alerting signs of change