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Benign tumours—epidermal and dermal


Skin tumours are common, and their incidence is rising in Western countries (p. 32). The treatment of skin tumours makes up a large part of current dermatological practice (p. 33). Many skin tumours of the epidermis and dermis are benign, and these are described in this section. Benign tumours of dermal structures and appendages are described in Chapter 53 (p. 116). Viral warts, actinic keratoses and naevi are mentioned elsewhere.

Benign epidermal tumours

Seborrhoeic wart (basal cell papilloma)

A seborrhoeic wart (seborrhoeic keratosis) is a common, usually pigmented, benign tumour consisting of a proliferation of basal keratinocytes ( Fig. 52.1 ). The cause is unknown, although they may be ‘naevoid’. Seborrhoea is not a feature.

Fig. 52.1, Histopathology of seborrhoeic wart.

Clinical presentation

Seborrhoeic warts have the following features:

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    often multiple ( Fig. 52.2 ), sometimes solitary

    Fig. 52.2, Seborrhoeic warts on the trunk, with a few small Campbell-de-Morgan spots.

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    affect the elderly or middle-aged

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    mostly found on the trunk and face

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    generally round or oval in shape

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    start as small papules, often lightly pigmented or yellow

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    become darkly pigmented, warty nodules, 1–6 cm in diameter

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    have a ‘stuck-on’ appearance, with keratin plugs and well-defined edges.

Differential diagnosis

The diagnosis is usually obvious from the physical findings and multiplicity of the lesions. Occasionally, a seborrhoeic wart can resemble an actinic keratosis, melanocytic naevus, pigmented basal cell carcinoma or malignant melanoma ( Fig. 52.3 ).

Fig. 52.3, An inflamed seborrhoeic wart, as shown here, may give rise to concern about the presence of malignant change.

Management

Multiple lesions can be adequately dealt with using liquid nitrogen cryotherapy. Thicker seborrhoeic warts are best treated by curettage or shave biopsy, with cautery or hyfrecation. If there is diagnostic doubt, they can be excised. Histological examination is advised in all cases.

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