What are Skin Lesions by Steven Namihas, MD

SKIN LESIONS

Our skin is subject to many types of lesions.  Most are benign, but some can be malignant.  It can be difficult at times to tell the difference without removing the lesion and having it examined by a pathologist. 

Skin lesions can be removed at Hilltop Medical Clinic if they are causing discomfort, or if there is a concern for skin cancer.  They can also be removed for cosmetic reasons, though this may not be covered by insurance.  Removal of skin lesions is usually done after injecting a local anesthetic and applying a disinfectant solution.

Benign Skin Lesions

Seborrheic Keratosis

These are scaly, brown lesions, which often appear to be stuck onto the skin surface.  They commonly appear on the trunk of older adult patients.  Treatment may not be necessary unless they become irritated.  Patients may want them removed for cosmetic reasons.   Removal can be accomplished using curettage, which involves scraping the upper skin surface with a sharp instrument called a curette.

Nevus (mole)

These are common benign growths, usually brown in appearance but they can also be blue.  They occur more commonly in fair skinned individuals and increase in number with more sun exposure.  Some nevi may be atypical (dysplastic) and share features of melanoma such as asymmetry, border irregularities, color variation, and diameter >6 mm. Benign appearing nevi do not need to be removed unless they are irritated by clothing or have features suggestive of melanoma or for cosmetic reasons. Remove is usually done by shave excision.  For nevi with features concerning for melanoma, an excision is performed deep and wide enough to assure complete removal.

Epidermal Cysts These appear as a skin-colored nodules, ranging in size from a few millimeters to several centimeters in diameter.  They can grow larger and become red, painful, and infected.  Other cysts may remain stable in size and appearance for years.  An inflamed, uninfected cyst may improve on its own without treatment, though recurrence is common. Excision is best accomplished when the lesion is not inflamed, to assure complete removal.

Infected cysts are typically more red and painful. The infected material can be drained after an incision is made with a scalpel.   Sometimes oral antibiotics are necessary.  Complete removal of the cyst may be needed later after the infection has resolved.

Pilar Cysts

These resemble epidermal cysts, but they occur on the scalp.  They can be removed through a small incision.

Lipoma

These are soft, benign skin nodules found just below the dermis.  They consists of fat cells enclosed in a thin fibrous capsule and range in size from 1 cm to >10 cm.  They can be removed if they cause discomfort or for cosmetic reasons.

Malignant Skin Lesions

Basal Cell Carcinoma

These are the most common type of skin cancer.  Although they are not likely to metastasize to other parts of the body, they can cause local destruction of surrounding structures including bone. They are more likely to occur with lighter skin color and more sun exposure. Tanning beds may also increase the risk. They usually occur on sun exposed surfaces of the head, trunk, and extremities.  They can appear as pearly nodules with small blood vessels; or thin, scaly patches red to pink in color.  In other cases, they can form ulcers, which bleed easily.  If the diagnosis is not clear, a 3 mm biopsy can be performed.  Treatment is accomplished using an excision deep and wide enough to assure complete removal. The pathologist will confirm the diagnosis and verify if the margins are clear.

Squamous Cell Carcinoma

These typically occur in areas of sun damaged skin and can present as a red, scaly patch, or a nodule, or thickened skin, or an ulceration which bleeds easily. They may be painful or itchy. As with basal cell carcinoma, they can eventually cause local destruction of surrounding structures.  If untreated, they can also metastasize. To clarify the diagnosis, a 3 mm biopsy can be performed.  Definitive treatment is accomplished using an excision deep and wide enough to assure complete removal, which is confirmed by pathology.

Malignant Melanoma

Melanoma is the most serious form of skin cancer. These lesions can have multiple shades of red, blue, black, gray, and white. They typically have an irregular border and an uneven, asymmetrical appearance.  They are tend to evolve, increasing in size, shape, color variation, and darkness. They can form ulcers and bleed easily. They can also present as a new, pigmented lesion under a nail. They are more likely to occur in fair skinned individuals, those with increased sun exposure, and in people with family members who have had melanoma. Diagnosis is confirmed by pathology after excising the lesion. After confirmation, wide, local excision is needed to maximize the chances of a favorable outcome.

If you have any skins lesions you are concerned about please contact either of our Clinics for a preliminary evaluation. If removal of your skin lesion is needed then an Appointment we will be arranged with Dr. Steven Namihas.