In the name of god

Benign
cutaneous and
soft-tissue
tumors

S.Shahrokh,MD
 Skin structure
The skin consists of three layers:
The epidermis
The dermis
The hypodermis
There are also some skin appendages such as hair
follicule,sebaceous glands, and also soft tissues that
are associated with skin, such as fat, muscles, and
blood vessels (all of which have a mesenchymal
lineage) and nerves (derived from neural crest
cells).
 Skin lesions variations:
• Epithelial origion

• Mesenchymal origion

• Appendage origion

• Neural cell origion

 Diagnosis
- Inspection and palpation

- Dermoscopy

- Ultrasound and Doppler imaging , X-ray, CT,

MRI, angiography, scintigraphy, and positron
emission tomography (PET)

- pathologic diagnosis
 Benign epithelial-origin tumors
• Epidermal nevus:
composed of skin cells that
normally occur at the affected
site but show hyperkeratosis and
papillomatosis.

Epidermal nevus syndrome:

TX:
- lazer
- crayo
- abrasion
- excision
 Seborrheic keratosis
• a benign skin growth that
originates from the basal and
squamous cells in the epidermis.
• Leser–Trélat sign:

• TX:
Laser therapy
cryotherapy
electrocoagulation
surgical abrasion
excision
 Keratoacanthoma
• Atypical squamous cells that
grows rapidly & resemble to
SCC.

TX:
excisional biopsy should be
considered despite the fact
that this lesion occasionally
self-heals.
If the lesion is on the nose and
face, Mohs micrographic
surgery is particularly suitable.
 Epidermoid cyst
• a smooth, dome-shaped, freely
movable, somewhat fluctuant
subcutaneous swelling.
• TX:
• Epidermoid cysts that exhibit
inflammation or recur should be
removed by simple excision. In
cases where pus and blood are
excreted, the surgeon should
consider incising the cyst and
draining it first, and then excising
it completely 1–2 weeks later.
 Milia
• A smaller version of an
epidermoid cyst (less than 4 mm
in diameter)
• Tx:
by making small holes in the
surface with a needle or CO2 laser
and then extruding the contents.
 Dermoid cyst
• a congenital
subcutaneous cyst that
develops along the
embryonic lines of closure
.
• The most common sites
are the supraorbital
region, brow, upper
eyelid,glabella, and scalp.
• TX:
Surgical excision
 The rare types
• Clear cell acanthoma
• large cell acanthoma
• acantholytic acanthoma
• warty dyskeratoma
• traumatic inclusion cyst
• human papillomavirus-associated cyst
• proliferating epidermal cyst
• cutaneous keratocyst
 Benign appendage-origin tumors
• Nevus sebaceous
 Pilomatricoma
• A cystic nodule that tends to
occur on the head and neck
regions of young patients. A
calcified region can be seen by
ultrasound, X-ray, CT and MRI.

• TX:
complete excision
 Trichilemoma
• A subcutaneous cyst that is
derived from the outer root
sheath of the hair follicle and
arises most frequently on the
hairy region on the head.
• TX:
a small punch biopsy of the cyst &
then pull out the cyst.s wall.
 Syringoma
• intradermal eccrine proliferation
that is malformative rather than
neoplastic, mainly on the eyelids and
presents as a 1–2-mm nodule.

TX:
Electrocoagulation
Dermabrasion
CO2 & Er:YAG lasers
Fractional photothermolysis
 Apocrine cystadenoma
• Dilatation of an apocrine duct
and secondary proliferation of
the ductal epithelium that
appear most commonly as
solitary, soft, dome-shaped, and
translucent papules or nodules &
most frequently on the eyelids,
especially the inner canthus .
• TX:
In solitary forms with excision
In Multiple cystoadenomas with
CO2 laser.
 Chondroid syringoma
• A gland-like epithelial component
that is set in a chondromyxoid
stromal component , Derives
from the sweat gland and is most
frequently seen on the head and
neck
• TX:
complete excision
 The rare forms
• Steatocystoma multiplex
• trichofolliculoma
• Trichoepithelioma
• trichilemmoma
• sebaceous adenoma
• eccrine nevus
• apocrine nevus.
• Moreover, hair follicles, sebaceous glands, and sweat
glands (apocrine and eccrine glands) can undergo
hyperplasia that results in a hamartoma;
• these skin appendages can also develop adenomas, benign
epitheliomas, and primordial epitheliomas.
Benign neural crest-origin tumors
Pigment cell nevus
They are five types:
Lentigo simplex
Aquired pigment cell nevus
Congenital pigmentcell nevus
Dysplastic nevus
Spitz nevus
Spitz nevus
 Blue nevus
• Dermal melanocytosis,that
involves more cells,so it has a
nodular form.
• There are three types: common,
cellular, and combined.

• TX:
surgical excision
Nevus of ota
 Ito nevus
• Ota nevus at the acromiodeltoid
region

• TX:
Alexendrith lazer
 Nevus spilous
• Increased accumulation of
melanin granules .The presence
of six or more nevus spilus lesions
that are greater than 5 mm in
diameter in prepuberty and over
15 mm in diameter in
postpuberty is indicative of
neurofibromatosis type 1.
TX:
Lazer therapy
 Mongolian spot
• A dermal melanocytes, which
presents as bluish-gray spots on
the sacral and coccygeal region.
These spots disappear before the
age of 10 years egion.
• In atypical formthere are multiple
spots or one large patch covering
the lumbosacral area (lower
back), buttocks, flanks, and/or
shoulders.
• TX:
Lazer therapy
 Neurofibroma
• A benign tumor of the peripheral
nerve sheath. It is usually found in
individuals with the genetically
inherited diseases NF1 and NF2.

TX:
Lazer
surgical excision
 Benign mesanchymal origion
• Dermatofibroma
• A common cutaneous nodule that
frequently develops on the
extremities (mostly the lower legs). It
is usually asymptomatic, although
pruritus and tenderness are not
uncommon .
TX:
Excision only in symptomatic forms
 Xanthoma
• The aggregation of foamy
histiocytes that have
phagocytized lipids, most
common on the upper eyelid and
is often associated with
hyperlipidemia.
• Two types:

• TX:
hyperlipidemia control
surgical excision
 Juvenile xanthogranoloma
• A single or multiple dome-like
tumor that occurs on the head
and neck region, the body, or the
limbs of young patients.
• This tumor can be associated
with NF1, Niemann–Pick disease,
urticaria pigmentosa, and juvenile
chronic myelomonocytic
leukemia .
• TX:
surgical Excision
 Soft fibroma
• There are three types of soft
fibroma:
Achrochordon
Fibroma pendulum
Any other types
TX:
Surgical removal
 Keloid & hypertrophic scar
In both keloid and
hypertrophic scar
fibroblasts have an
upregulation of collagen
synthesis,deposition, and
accumulation.
TX:
prevention
silicon, steroid, lazer,etc.
 lipoma
• The most common of the
mesenchymal softtissue tumors .
• Diffuse lipomatosis:

• TX:
Complete surgical excision with
the capsule
 Leiomyoma
• A tumor that is derived from
smooth muscles in the skin,
including the arrector muscle
of hair and vascular smooth
muscle.
• Leiomyomas can be
categorized into four types: (1)
multiple piloleiomyoma; (2)
solitary piloleiomyoma;
(3) Angioleiomyoma;
(4) genital leiomyoma.
TX:
Surgical excision
 Rhabdomyoma
• A benign tumor of striated
muscle.
• Tree types:adult, fetal, and
genital.

• TX:
Local excision
 Accessory auricule
• This congenital nevus arises from
the area between the tragus and
the lateral neck.

• TX:
Surgery
 Granouloma
• Granulomas can be broadly
classified as infectious and
noninfectious.

• TX:
Excision
 Glomus tumor
• Glomus tumors arise from the
arterial portion of the glomus
body, or the Sucquet–Hoyer
canal, which is an arteriovenous
anastomosis in the dermis that
participates in temperature
regulation.

• TX:
Excision
 Treatment modalities
• Lazer
• Cryotherapy
• Direct excision
• Skin abrasion
Thanks for your time