Skin Tumors (Growths)

Here, for those who have a growth and wonder what it is, worry that it might be something bad, or want it removed because they dislike its appearance, we explain the growths commonly seen in dermatology and how they are treated.

Types of Growths

The growths commonly seen in dermatology, listed by their medical names, are as follows. Where a common name exists, it is given alongside.

First, as benign growths:

epidermoid cyst, pilomatricoma, pigmented nevus / nevocellular nevus (mole), soft fibroma (skin tag), dermatofibroma, senile (cherry) angioma, syringoma, lipoma, keratoacanthoma.

As malignant growths:

there are basal cell carcinoma, actinic keratosis, Bowen’s disease, squamous cell carcinoma, malignant melanoma, dermatofibrosarcoma protuberans, and others.

① Epidermoid cyst

A sac with the same structure as the skin’s surface forms beneath the skin, and as the skin turns over, dead skin (keratin) collects inside it and it gradually grows larger. It sometimes develops a bacterial infection. It commonly forms on the back, buttocks, and the like, and some people develop many of them. Sometimes it cannot be told from the surface; other times it shows through as a grayish color with an opening like a pore in the center. When it becomes infected it turns red and swollen, and in severe cases pus collects or bursts out. The cyst itself is not a harmful thing, but if repeated infections make it bothersome, we recommend removing it.

Main treatment: excision with a metal scalpel or trephine (skin punch)

② Pilomatricoma (calcifying epithelioma)

A hard, lumpy growth forms beneath the skin. It often shows through as a bluish gray, but like an epidermoid cyst it can develop a bacterial infection and become red and swollen. It is common in children, and for small children there is no need to force its removal; while taking into account the risk of infection in the meantime, the timing of surgery is decided in consultation with the parents.

Main treatment: excision with a metal scalpel or trephine (skin punch)

③ Pigmented nevus / nevocellular nevus (mole)

This is what we call a mole. At first it is a black or brown spot, but over time it can become raised and wart-like. Almost everyone has them, so removal is not necessarily required, but if one catches and bleeds while shaving, or sits at the edge of the eyelid and interferes with vision, it is better to have it removed. Large ones may be removed in several stages.

Main treatment: excision with a metal scalpel or trephine (skin punch), carbon dioxide laser

④ Soft fibroma (skin tag)

A soft lump the same color as the skin. It is a polyp of the skin. Perhaps because it forms easily from friction, it often appears on the neck, armpits, and the base of the groin. In many cases there are several.

Main treatment: excision with a metal scalpel or scissors, high-frequency electric scalpel, carbon dioxide laser

⑤ Dermatofibroma

A brown, hard, round growth that feels thick to the touch. It forms in various places, such as the arms, legs, and trunk. It also closely resembles the scars left after insect bites or scratching. Because it does no harm it can be left alone, but for those who want it removed because it bothers them, if the post-surgical scar becomes a hypertrophic scar or keloid the appearance may not change much, or may become even more conspicuous than the original growth, so you need to weigh this cosmetic risk in deciding whether to have surgery.

Main treatment: excision with a metal scalpel

⑥ Senile (cherry) angioma

Small red dots can form all over the body with age. Surgical removal is the most reliable, but because it leaves a scar, it is common to use a pulsed dye laser that responds to the red color.

Main treatment: pulsed dye laser (V Beam)

⑦ Syringoma

A condition in which many small, translucent bumps form on the lower eyelids. It is a state in which the cells that make up the sweat ducts proliferate, forming many duct-like structures. Because they are only noticeable to others on close inspection, there is a risk that the post-surgical scar would actually be more conspicuous; various treatments have been tried, and opinions among doctors seem to differ on which is best. It is worth considering based on factors such as what kind of scar you could accept and whether you want it removed reliably in one go.

Main treatment: excision with a trephine (skin punch), Surgitron, carbon dioxide laser, needle RF (Agnes; not available at our clinic), erbium YAG laser (not available at our clinic)

⑧ Lipoma

Because it is a growth beneath the skin, there is usually no change on the skin’s surface. Fat cells proliferate into a mass that may be soft, but it can also be surprisingly firm with a springy resistance. When the risk of bleeding is high, for example when it is large or extends into the muscle layer, we may refer you to an advanced medical institution.

Main treatment: excision after a skin incision with a metal scalpel

⑨ Basal cell carcinoma

A malignant growth, black to red in color, commonly seen on the faces of older people, sometimes partly raised. Dermoscopy is very effective, and when this condition is strongly suspected we may skip a skin biopsy and excise it a size larger from the outset to achieve a complete cure. Because it rarely metastasizes, we aim to reliably remove the existing lesion.

Main treatment: excision with a metal scalpel

⑩ Actinic keratosis

A red, flaky growth commonly seen on the faces of older people, which can be confused with other benign conditions such as eczema or lichen planus-like keratosis. A diagnosis is often made by performing a skin biopsy, removing a portion of skin. Although its name may sound like that of a benign wart, it is a precancerous lesion that progresses to a skin cancer called squamous cell carcinoma.

Main treatment: excision with a metal scalpel, topical medication (imiquimod), liquid nitrogen cryotherapy

⑪ Bowen’s disease

A flat, slightly raised growth, red to black in color, that commonly forms in older people. Like actinic keratosis, it is a precancerous lesion that progresses to the skin cancer squamous cell carcinoma. Some cases are associated with the human papillomavirus (HPV 16/31/33), and it can also arise as a symptom of chronic arsenic poisoning.

Main treatment: excision with a metal scalpel

⑫ Squamous cell carcinoma

In most cases it is a red, rough lump whose surface may become moist and oozing or bleed. Because it can metastasize to lymph nodes and elsewhere, imaging studies may be needed in addition to simply removing it. When we suspect this condition, we refer you to a facility with a specialist in dermatologic surgery or skin tumors.

Main treatment: excision with a metal scalpel, radiation therapy, drug therapy

⑬ Keratoacanthoma

A lump-like growth that commonly forms on the face, with a central depression like a volcanic crater. It is nominally classified as benign, but because it looks just like a malignancy even under the microscope on pathology, and because it can rarely turn malignant in the future, careful handling is needed. Removing a portion in a skin biopsy can sometimes trigger it to disappear, leaving a scar.

Main treatment: excision with a metal scalpel

⑭ Malignant melanoma

This is what is known as mole cancer. It is often dark, but can also be red. It can form anywhere on the body and can also arise on the nails. It can ride the bloodstream or lymph flow and metastasize to other parts of the body. Because removing a portion in a skin biopsy may spread the malignant cells, when we suspect this condition on dermoscopy we may remove the whole lesion for testing rather than taking a partial sample, or refer you directly to a specialist without testing.

Main treatment: excision with a metal scalpel, radiation therapy, drug therapy

⑮ Dermatofibrosarcoma protuberans

A red, rough lump. It is the malignant counterpart of a dermatofibroma, but it extends into the deeper fat layer than a dermatofibroma does. On pathology, the diagnosis is reached by staining the specimen with a special method. When this condition is suspected, we refer you to a facility with a specialist in dermatologic surgery or skin tumors.

Main treatment: excision with a metal scalpel, radiation therapy, drug therapy