Skin Growths

Moles, also known as nevi, are growths on the skin that are usually brown or black in color. They can appear anywhere on the body and are typically round or oval-shaped with smooth edges. Moles are composed of melanocytes, the specialized pigment-producing cells in the skin, and can vary in size, shape, and texture. While most moles are harmless, some may be atypical or dysplastic, meaning they have an irregular appearance. These dysplastic moles may have just one (rather than multiple) of the clinical features of melanoma as tracked by the ABCDE’s of melanoma.

The ABCDE’s of melanoma detection can provide helpful clues:

• Asymmetrical Moles: Melanoma lesions are often irregularly shaped, with one half not matching the other half in size, shape, or color.
• Irregular Borders: The borders of melanoma lesions may be uneven, scalloped, or poorly defined.
• Changes in Color: Melanomas may have different colors or shades within the same lesion, including black, brown, tan, red, white, or blue.
• Large Diameter: Melanoma lesions are typically larger in diameter than a pencil eraser (greater than 5 millimeters), although they can be smaller.
• Evolving or Changing Moles: Any changes in the size, shape, color, or elevation of existing moles or the development of new moles should be monitored closely. The ugly duckling sign refers to the one mole that looks different from all the others on patient’s body and should be seen by a dermatologist.

Having a high number of moles or multiple atypical moles can be an overall marker of melanoma risk for a patient. Keep in mind, some lesions don’t follow the ABCDE’s of detection. A suspicious lesion should always be evaluated! It is essential to monitor moles for any changes in size, shape, color, or texture and to seek medical evaluation if any concerning features develop.

Cysts are common benign growths that develop beneath the skin’s surface. These cysts originate from the epidermis, the outermost layer of the skin or the hair follicle, and typically contain a mixture of keratin, sebum, and dead skin cells. Cysts often appear as round or oval-shaped lumps beneath the skin, ranging in size from a pea to a marble or larger. Some may have an opening or punctum. Cysts are usually painless but may become inflamed, infected, or tender if ruptured or irritated.

Two main types exist:

• Epidermal inclusion cyst (infundibular type): Infundibular cyst typically present as small, firm, dome-shaped nodules with a central punctum or opening through which the cyst contents may be expressed. Infundibular cysts are filled with keratin, sebum, and other debris. Infundibular cysts are more prone to rupture, leading to inflammation, pain, and potential infection.
• Pilar cysts (trichilemmal or isthmus catagen type): Trichilemmal cysts tend to be larger, smoother, and rounder in shape, often resembling a marble beneath the skin. Trichilemmal cysts are filled with a more homogenous, soft, and white material called trichilemmal keratin. Trichilemmal cysts are less likely to rupture spontaneously, although trauma or manipulation can cause them to burst.

Cysts can develop anywhere on the body, but they are most commonly found on the scalp, face, neck, back, and trunk. While most cysts do not require treatment, they may be removed for cosmetic reasons, if they become symptomatic, or if they repeatedly enlarge or become infected. Treatment options for cysts may include antibiotics, drainage or corticosteroid injections if they are inflamed or infected. Surgical excision is the most common treatment for skin cysts that are bothersome and fail to resolve and is performed in the outpatient setting under local anesthesia.

Lipomas are benign tumors composed of adipose (fat) tissue that develop beneath the skin’s surface. These growths typically appear as soft, rubbery lumps that are movable and painless to the touch. Lipomas that have active nerves and blood vessels within them, called angiolipomas, may be tender to the touch. Lipomas can vary in size from small pea-sized nodules to larger masses, and they may develop anywhere on the body where fat cells are present. While the exact cause of lipomas is not fully understood, they are thought to result from genetic factors or trauma to the area. Lipomas are generally harmless and do not require treatment unless they cause discomfort, become cosmetically bothersome, or grow rapidly. Surgical excision is the most common treatment for skin lipomas and is performed in the outpatient setting under local anesthesia.

Seborrheic keratoses are benign growths that appear as raised, waxy, wart-like lesions on the skin. They are typically tan, brown, or black in color and may have a rough or scaly texture. Seborrheic keratoses often develop on the face, chest, back, and shoulders, and become more common with age. While seborrheic keratoses are generally harmless, they can be unsightly or cause cosmetic concern. Treatment options for seborrheic keratoses include cryotherapy, curettage (scraping), or laser therapy.

Cherry angiomas are benign vascular growths that appear as small, bright red or purple lesions on the skin. These lesions are composed of clusters of dilated blood vessels and typically develop on the trunk, arms, legs, and face. Most are pinhead to pencil eraser in size. Cherry angiomas are common and tend to increase in number and size with age. While these lesions are harmless and do not require treatment, they can be easily removed for cosmetic reasons or if they bleed or become irritated by electrosurgery or laser therapy.