A number of benign tumors occur in the dermis and subcutaneous tissue. Their behavior may range from completely benign to recurrent and locally aggressive.
Lipomas are fatty tumors of the subcutaneous fat. They are soft, mobile and usually painless. They can range in size from one to tens of centimeters. Larger lipomas are more likely to recur; they are often classified as low-grade liposarcomas. Small lipomas do not need to be biopsied. Patients with very large lipomas should undergo MRI to determine whether local invasion has occurred. Treatment consists of total excision as lipomas may recur if not completely removed.
Dermatofibromas are encapsulated intradermal masses that are painless, firm and mobile. They usually are less than 2 cm and occur on the extremities. Due to their accumulation of hemosiderin, they can display the range of colors seen in an evolving bruise. Treatment consists of excision, mostly for cosmetic purposes. They may recur if incompletely excised.
he dermatofibrosarcoma protuberans is a locally aggressive, indolent, nodular intradermal mass. It occurs on the trunk and thighs. They are often painful and can be complicated by ulceration or superinfection. The overlying epidermis may appear waxy. Dermatofibrosarcoma protuberans tends to grow extensions into the surrounding dermis and fascia, creating a gross "cartwheel" appearance. Treatment consists of wide excision to encompass the extensions of the tumor. Metastasis has been described in neglected or incompletely excised lesions.
Angiofibromas present as small, erythematous, telangiectatic papules, usually located on the cheeks, nose or around the lips. They are benign when solitary. Superficial excision is the standard treatment. When multiple, these papules may be associated with tuberous sclerosis (seizures, mental retardation, renal angiomyolipoma). Dermabrasion can offer some cosmetic improvement for patients with multiple angiofibromas.
Skin tags, also termed cutaneous papillomas, are soft and often pedunculated, arising from a central stalk. They may become infected or may necrose. Treatment consists of amputation at the stalk and electrodissection of the remaining base. They are benign and do not recur.
Glomus tumors present as a painful, firm, blue nodules on the hands and feet, especially subungually. They are benign vascular hamartomas derived from the glomus body. Excision is often required due to the pain caused by pressure from these tumors.
Although most of the lesions described here are benign, many are difficult to clinically distinguish from malignant tumors of the skin. Furthermore, some of the lesions, such as atypical moles, may remain unchanged for years before undergoing dysplastic changes. Even the most experienced surgeon has been fooled on occasion by a lesion he was sure could not be malignant.
These facts emphasize the importance of excisional biopsy of any suspicious skin lesion. Skin incisions should adhere to the principles of relaxed skin tension lines in the neck and face, and should be longitudinal in the extremities. The excision should be as complete as possible; any part of the lesion that appears to have been left behind should also be excised. All excisional biopsies should be sent to a pathologist.
When applicable, specimens should be oriented with a marking stitch. Finally, it is the obligation of the surgeon to follow up on the pathology report and notify the patient of the results.
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Note: This article was sent to us by: Patricia Phillips at 02102011
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