Benign Neoplasms/Hyperplasia



Benign Neoplasms/Hyperplasia


Beth Haney





OBJECTIVES

After studying this chapter, the reader will be able to:



  • List the characteristics of benign neoplasms/hyperplasia.


  • Define benign neoplasms/hyperplasia.


  • Describe the signs and symptoms of benign neoplasms/hyperplasia.


  • Understand the various treatment options available to the patient with benign neoplasms/hyperplasia.



KEY POINTS



  • Benign neoplasms are noncancerous skin lesions or tumors.


  • Benign neoplasms are common skin growths.


  • Benign neoplasms have no malignant potential.


  • Some benign neoplasms require treatment for cosmetic purposes.


  • Some benign neoplasms require treatment to improve comfort.


ACROCHORDONS (SKIN TAGS, PAPILLOMAS, CUTANEOUS TAGS, SOFT FIBROMAS)


I. OVERVIEW

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


II. ASSESSMENT

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


III. COMMON THERAPEUTIC MODALITIES

A. Electrodesiccation

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

C. Cryosurgery


IV. HOME CARE CONSIDERATIONS

A. Wound care (Box 14-1)

B. Control bleeding.

C. Watch for signs of infection.



PATIENT EDUCATION


Acrochordons



  • Acrochordons can become easily irritated or infected.


  • Patients may avoid complications if they:



    • Cover lesion(s) with bandage when clothing or jewelry irritates the lesion(s).


    • Lose weight if appropriate.


    • Keep skin folds clean and dry.


    • Monitor lesion(s) for changes in size, color, or pain.


    • See a health care provider for lesion removal options.







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.)


CALLUSES


I. OVERVIEW

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


II. ASSESSMENT

A. Physical examination



BOX 14-1. Wound Care



  • Keep dressing dry and in place for 24 to 48 hours as ordered.


  • Clean site with soap and water two to three times a day as ordered. Do not apply alcohol or peroxide. Pat site dry.


  • Apply antibiotic ointment to keep site moist, two times a day and cover with appropriate dressing.


  • If bleeding or oozing occurs at the site, gently apply pressure with a clean gauze for 20 minutes. The bleeding/oozing should stop within 25 minutes; if not, call the office.


  • Watch for signs of infection: redness, swelling, pain, heat, pus, and temp greater than 101. Take non-aspirin product for pain and discomfort—Tylenol, if not allergic. Avoid Aleve, Advil, Motrin, ibuprofen, and aspirin products.

Adapted from: Butcher, M. (2013). Assessment, management, and prevention of infected wounds. Journal of Community Nursing, 27(4), 25-34.

B. History of chronic pressure or friction

C. Examination of footwear may assist in assessment.


III. COMMON THERAPEUTIC MODALITIES

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 (CLAVI)


I. OVERVIEW

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.


II. ASSESSMENT

A. Physical examination

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


III. COMMON THERAPEUTIC MODALITIES

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


IV. HOME CARE CONSIDERATIONS

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.




PATIENT EDUCATION


Calluses and Corns



  • Activities with any repetitive friction, including walking, need to be evaluated and modified when corns or calluses are occurring.


  • Proper-fitting shoes are important (e.g., low heeled, wide toe, appropriate length and width).


  • Protection to affected areas is key such as use of gloves, padding, and special bandages to prevent additional formation.


  • Active treatment needs to be modified with excessive breakdown of skin.


  • Activities that cause pain should be avoided.


  • Health care provider should be consulted with any increased pain that occurs or signs of infection that develop, that is, redness, heat, swelling, and discharge.






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.)


CYSTS


I. OVERVIEW

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%)



II. ASSESSMENT

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


III. COMMON THERAPEUTIC MODALITIES

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





































Type

Common Names

Location


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 http://www.uptodate.com/contents/overview-of-benign-lesions-of-the-skin?source=search_result&search=calluses&selectedTitle=2%7E16#H1101420580; Goldstein, B. G., & Goldstein, A. O. (2014b). Keloids. Retrieved 23 April, 2014 from http://www.uptodate.com/contents/keloids?source=search_result&search=keloid+scar&selectedTitle=1%7E150; 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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