Benign Neoplasms/Hyperplasia

Benign Neoplasms/Hyperplasia

Beth Haney



Acrochordons are benign neoplasms. Acrochordons are cosmetic disorders (Figure 14-1).

A. Definition: acrochordons are soft pedunculate, fleshcolored, tan, brown, or pigmented growths, commonly on the neck, shoulders, axillae, groin, inguinal folds, eyelids, upper chest, and trunk. These lesions are asymptomatic but may become irritated or inflamed if exposed to repeated trauma from jewelry, clothing, or opposing skin surfaces.

B. Etiology is not fully understood.

C. Pathophysiology

1. Polyp-type lesion with mildly acanthotic epidermis, a loose, edematous fibrovascular core with mild chronic inflammation and a nerveless dermis

2. Varies in size from 1 to 5 mm although tumors can grow up to 1 cm

3. Single or multiple lesions

D. Incidence

1. Found in approximately 25% of males and females

a. Increases during middle-aged and older adulthood, pregnancy, acromegaly, menopause, and family history

2. Equal in males and females

3. Associated with obesity

4. Frequently higher in diabetics

5. After the fifth decade, there is no further growth


A. History and current health status

B. Diagnosis by clinical presentation: location, color, number, size, irritation, tenderness, and inflammation

C. Biopsy recommended if pigmented or erythematous


A. Electrodesiccation

B. Scalpel or simple scissor excision at the base of the lesion

C. Cryosurgery


A. Wound care (Box 14-1)

B. Control bleeding.

C. Watch for signs of infection.

FIGURE 14-1. A: This soft, pedunculated skin tag, or acrochordon, is typical of a fibroepithelial polyp. Skin tags are most common in skinfolds such as the crural crease and axillae. B: Eyelid acrochordon. (From Edwards, L., & Lynch, P. J. (2010). Genital dermatology atlas. Philadelphia, PA: Wolters Kluwer; Goodheart, H. P. (2003). Goodheart’s photoguide of common skin disorders (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.)



A. Definition: a callus is an elevated superficial, diffusely thickened hyperkeratotic area, usually without a distinct border. Calluses are nontender, but pressure may produce dull pain (Figure 14-2).

B. Etiology

1. Repeated friction or pressure

C. Pathophysiology

1. Normal response to friction or pressure; increased activity of keratinocytes in superficial layer of skin leading to hyperkeratosis

D. Incidence

1. Frequently on palms and weight-bearing surfaces of the foot

2. Increases with age, women affected more often than men


A. Physical examination

B. History of chronic pressure or friction

C. Examination of footwear may assist in assessment.


A. Topical keratolytics (urea, ammonium lactate), 40% salicylic acid plaster, or ointment.

1. Use OTC keratolytic preparations as directed. Forms include a patch, lotions, foam, gel, and cream. Apply keratolytic plaster, sticky medicated side to skin, making sure plaster covers the affected area. Cover the plaster with adhesive tape for 1 to 7 days.

2. Avoid normal skin to prevent irritation and skin damage.

3. Soak the area in warm water after removing the tape. Rub the soft macerated skin with a rough towel or pumice stone. Reapply the plaster and repeat the process until all hyperkeratotic skin is removed.

FIGURE 14-2. Corn in a typical location over a metatarsal head. (From Craft, N., et al. (2010). VisualDx: Essential adult dermatology. Philadelphia, PA: Wolters Kluwer.)

B. Orthopedic shoes, braces, and support devices to redistribute weight.

C. Epsom salt soaks for 5 to 10 minutes several times a day.

D. Geriatric considerations: salicylic acid treatments can cause breakdown and/or ulceration of thin, atrophic skin, people with diabetes, and those with vascular compromise; use these products with caution. Use of protective padding. Avoid activities that contribute to painful lesion formation.

E. Patient education is similar to recommendations for corns in the next section.



Corns are found over bony prominences such as the interphalangeal joints of toes (Figure 14-3).

A. Definition: circumscribed, hyperkeratotic, slightly elevated lesion with a central conical core of keratin resulting in a thickening of the stratum corneum. These lesions cause pain and inflammation. “Hard” corns are frequently over the interphalangeal toe joints, especially the fifth toe, and develop under the pressure site from footwear. “Hard” corns are usually painful: dull constant pain or sharp pain when pressure is applied. “Soft” corns appear as whitish thickening, usually in the interdigital spaces between the fourth and fifth toes.

B. Etiology

1. Repeated external pressure creates localized accumulation of keratin.

FIGURE 14-3. A: Corns and calluses. B: Corn with callus on lateral toe surface. (From Berg, D., & Worzala, K. (2006). Atlas of adult physical diagnosis. Philadelphia, PA: Lippincott Williams & Wilkins; and Craft, N., et al. (2010). VisualDx: Essential adult dermatology. Philadelphia, PA: Wolters Kluwer.)

2. Soft corns result from moisture leading to maceration of the skin and mechanical irritation.

3. Hard corns have a keratin-based core and are usually associated with bony prominences that cause skin to rub on shoe surfaces.

C. Pathophysiology

1. Localized pinpoint accumulation of keratin forms an elongated, hard plug in the horny layer of the epidermis. The plug presses downward on the dermal structure, causing inflammation and irritation of sensory nerves, resulting in marked tenderness.


A. Physical examination

B. History related to footwear, working conditions, foot surgery, previous similar lesions


A. Surgical excision of superficial layer of corn and hard plug in the horny layer

B. Corticosteroids: triamcinolone injection (Kenalog, Aristocort) at base of the corn to relieve pain

C. Topical keratolytics

D. Epsom salt soaks every few hours for 5 to 10 minutes at a time


A. Encourage proper-fitting shoes: extra wide for fifth metatarsal corns.

B. Debridement of corn and use of protective padding.

C. Avoidance of activities that cause pain or create lesions.

FIGURE 14-4. A: Pilar cyst on the scalp. B: Epidermoid cyst. These lesions often occur on the back. They appear as smooth, discrete, freely movable, dome-shaped ballotable masses. C: Epidermal inclusion cyst showing the typical characteristics of yellow color and telangiectasis. (From Stedman’s; Goodheart, H. P. (2003). Goodheart’s photoguide of common skin disorders (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins; and Penne, R. B. (2011). Wills Eye Institute—Oculoplastics. Philadelphia, PA: Wolters Kluwer.)



A cyst is a benign, sac-like growth in the skin layers, which originates from the follicle orifice (Figure 14-4). Types of cysts may include epidermal, epidermal inclusion, epidermoid, keratinous, pilar, infundibular, sebaceous, and acne.

A. Definition: a circumscribed lesion with a wall and a lumen that usually contains fluid or solid matter.

B. Etiology: spontaneous, trauma, or congenital.

1. Cyst wall probably formed from occluded pilosebaceous follicles.

2. Result of cutaneous surface trauma and a portion of the epithelium is forced into the superficial dermis.

C. Pathophysiology: cyst ruptures and keratin is released, causing an inflammatory foreign body response.

D. Incidence.

1. Higher incidence in young and middle-aged males; increases with a family history

2. Multiple lesions (70%)

3. Solitary (30%)


Diagnosis by clinical presentation and examination of expressed material confirmation by biopsy (Table 14-1)

A. Location

B. Number

C. Size

D. Firmness

E. Mobility

F. Globular

G. Tenderness

H. Inflammation

I. Infection


A. Cure by complete excision or punch biopsy for 1- to 2-cm uncomplicated lesions including wall to prevent recurrence

B. Incision and drainage of infected or severely inflamed cysts

TABLE 14-1 Characteristics of Cysts


Common Names


Atheroma Derived from the root sheath of the hair follicle. Globular, elastic, mobile tumor covered with atrophic thin skin, thick wall, filled with keratin, is not connected to the epidermis, and is without external opening. Tender if infected. Baldness over large cyst skin due to follicular pressure damage. No inflammation or proliferation from trauma. No malignant degeneration

Pilar cyst, trichilemmal cyst Archaic names: Wen

>90% Scalp, hair follicle epithelium

Retention cyst Spherical, mobile, firm under tense skin. Ruptures easily by manipulation. Keratinous material can be pressed into the surrounding tissue and then acts as a foreign body and can cause granuloma abscess formation from bacterial infection.

Milia, acne cysts, and traumatic inclusion cysts

Face, trunk, hair follicles areas, scalp, neck, back, and cheeks One millimeter to several centimeters in diameter Cutaneous or subcutaneous—fluctuant, easily movable, tense, swelling Expanded gland duct and foul-smelling rancid lipids and debris will reoccur if wall remains intact.

Sebocystomatosis Central opening exudes a pasty, cheesy odoriferous material composed of keratin and lipid-rich debris

Sebaceous cysts (fat)

Young-middle-aged adults. Scalp, face, neck, upper trunk, scrotum, and vulva

Keratinous cyst Firm, movable, globular, and nontender unless infected. Contents are soft and yellow-white, with a rancid odor

Epidermal and sebaceous

Face, neck, and upper trunk, almost any area of the body

Milium Primary milia arise spontaneously and are keratin filled. Secondary milia arise in pilosebaceous glands or within damaged eccrine sweat gland ducts following subepidermal bulla formation (e.g., epidermolysis bullosa, porphyria cutanea tarda, bullous pemphigoid) or skin radiotherapy. Primary and secondary milia are identical histologically.

Subepidermal cyst

Eyelids, forehead, and cheeks Young to middle-aged men and women and infants Tiny (1-2 mm), superficial, white dome-shaped cysts

Dermoid cyst Present at birth

Deep subcutaneous tissue Walls composed of keratinizing epidermis containing hair follicles, sebaceous glands, and sweat glands

Epidermoid cyst Occurs secondary to traumatic implantation of epidermal cells into the dermis. Contains accumulation of keratin and is encased by a well-formed granular layer of stratified squamous epithelium

Epidermal inclusion cyst

Most common on face, back, chest and base of ears although can occur on almost any skin surface.

Adapted from Goldstein, B. G., & Goldstein, A. O. (2014a). Overview of benign lesions of the skin. Retrieved 27 March, 2014 from; Goldstein, B. G., & Goldstein, A. O. (2014b). Keloids. Retrieved 23 April, 2014 from; Wolff, K., Johnson, R. A., & Saadvedra, A. P. (2013). Fitzpatrick’s color atlas & synopsis of clinical dermatology (5th ed.). New York, NY: McGraw-Hill; Habif, T. P. (2016). Clinical dermatology: A color guide to diagnosis and therapy Philadelphia, PA: Elsevier.

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Mar 9, 2021 | Posted by in NURSING | Comments Off on Benign Neoplasms/Hyperplasia

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