Is It Possible for an Atypical Mole to Grow Back

Summary

Benign skin lesions are non-cancerous skin growths that may be pointed out by the patient or discovered during routine skin examinations. Accurately diagnosing a benign skin lesion and distinguishing it from a malignant condition requires consideration of the physical and histological characteristics of the lesion as well as the patient's attributes and overall condition. Biopsy or surgical excision is commonly performed when a potential malignancy cannot be ruled out. Treatment may be considered for cosmetic purposes.

Some of the most common benign skin lesions are covered in this card: hemangiomas, hypertrophic scars, keloid scars, warts, seborrheic keratosis, dermatofibromas, nevi, pyogenic granulomas, and lipomas.

Vascular skin tumors

Cherry hemangioma (Campbell de Morgan spots) ^[1]

• Epidemiology ^[2]
  • More common in adults > 30 years
  • Incidence increases with age (most common acquired cutaneous vascular anomaly)
• Pathophysiology: benign proliferation of dilated mature capillaries
• Etiology: unknown, genetic predisposition
• Clinical features
  • Bright cherry red, dome-shaped papules or macules that may appear purple with time ( 0.5–6 mm in diameter)
  • Usually on the trunk and upper extremities , but may occur all over the body
  • Usually multiple lesions
• Diagnosis : : based on clinical appearance of lesion
• Treatment
• Complications: profuse bleeding after trauma
• Prognosis
  • No malignant potential
  • No spontaneous regression
  • No prevention possible

Pyogenic granuloma ^{[1] [3]}

• Definition: benign vascular tumor characterized by rapid growth and tendency to bleed easily
• Etiology
  • Cause unknown
  • Associated with trauma and pregnancy
• Clinical features
  • Soft , round, bright red tumor that bleeds easily
  • Polypoid and lobulated
  • Occasionally ulcerates
  • Localization: usually develops at a site of skin injury on the face or hands
• Diagnosis : based on clinical appearance of lesion and history of rapid growth and easily injured/bleeding surface
• Treatment: surgical excision

Hypertrophic scars

• Definition: cutaneous condition characterized by high fibroblast proliferation and collagen production that leads to a raised scar that does not grow beyond the boundaries of the original lesion
• Epidemiology: seen in individuals of all races, and should not be confused with keloid scars, which are more common in dark-skinned individuals
• Etiology: imbalance in wound healing processes due to various local and genetic factors
• Pathophysiology: increased synthesis and parallel deposition of collagen type III
• Clinical features
  • Raised scar that does not grow beyond the boundaries of the original lesion , possibly erythematous (may be firm)
  • Pruritus
• Diagnosis : : based on clinical appearance of lesion and patient history of trauma or surgery
• Treatment
• Prevention: follow surgical principles associated with decreased risk of scar development (e.g., incisions should follow skin creases to reduce tension on the suture)
• Prognosis
  • Regresses spontaneously
  • Recurrences are infrequent

Keloid scars

• Definition: skin lesions caused by high fibroblast proliferation and collagen production as excessive tissue response to, typically small, skin injuries
• Epidemiology: increased incidence in patients with a family history of keloids and in dark-skinned individuals
• Etiology: imbalance in wound healing processes due to local factors and genetics
• Pathophysiology: increased synthesis and unorganized deposition of collagen types I and III and fibroblast proliferation
• Clinical features
  • Brownish-red scar tissue of varying consistency (soft or hard) with claw-like appearance that grows beyond the boundaries of the original lesion
  • Pruritus
  • Pain
  • Localization: earlobes , face (especially cheeks), upper extremities , chest, and neck
• Diagnosis : : based on clinical appearance of lesion and patient history of trauma or surgery
• Treatment: same as for hypertrophic scars (see above)
• Prognosis
  • Does not regress spontaneously
  • Frequent recurrences after resection

Warts

• Definition: hyperkeratosis and hyperplasia of epidermis commonly caused by human papillomavirus ( HPV )
• Epidemiology : : more frequent in children and young adults
• Etiology
  • Common clinical manifestation of HPV
  • Transmitted by direct skin contact
• Clinical features
  • Common warts ( verruca vulgaris )
    • Localization: elbows , knees , fingers, palms
    • Appearance: skin -colored or whitish, soft, rough-surfaced , scaly papules or plaques (sometimes with a cauliflower-like appearance)
  • Flat warts (verruca plana)
  • Plantar wart (verruca plantaris )
    • Localization: soles of the feet
    • Appearance: flesh-colored , hyperkeratotic surface
  • Anogenital warts: see "Anogenital warts."
• Histology
• Diagnosis: based on clinical appearance of lesion
• Treatment
• Prognosis

Seborrheic keratosis

• Definition: benign growths of immature keratinocytes ^{[4] [6]}
• Epidemiology: most commo n benign skin tumor in the elderly population
• Etiology: incompletely understood
  • Genetic predisposition
  • Paraneoplastic seborrheic keratosis ( Leser-Trélat sign ) most commonly results from gastrointestinal cancer.
• Clinical features
  • Multiple darkly pigmented papules / plaques , sharply demarcated , and soft
  • Grea sy , wax-like , and " stuck-on " appearance
  • May become irritated by external trauma or spontaneously
  • May be pruritic or bleed easily
  • Usually single lesion but can also appear as multiple seborrheic keratosis ( Leser-Trélat sign )
  • Localization: trunk, back of the hands, forearms, head, face, and neck
• Diagnosis
• Histopathology ^[7]
  • Papillomatosis
  • Proliferation of squamous epithelium
  • Immature keratinocytes with small keratin -filled cysts ( horn cysts )
• Treatment

Dermatofibroma

• Definition: fibroblast proliferation resulting in small, fibrous benign dermal growth ^{[1] [4]}
• Epidemiology: ♀ > ♂
• Etiology: not fully understood (sometimes related to insect bites or trauma)
• Clinical features
• Diagnosis: dimple sign (Fitzpatrick sign): pinching of lesion produces central dimple (characteristic sign of dermatofibroma )
• Treatment

Nevus

Spitz nevus (spindle and epithelioid cell nevus) ^{[4] [6]}

• Epidemiology: more common in children
• Etiology : : unknown (associated with pregnancy and puberty)
• Histology: irregular and spindle-shaped nevus cells
• Clinical features
  • Solitary, nodular nevus (may be difficult to distinguish from melanoma)
  • Well-circumscribed
  • Often rapidly growing
• Diagnosis: histopathology of excised nevus
• Treatment: Excision with histopathological confirmation is recommended.
• Prognosis: rarely malignant

Common acquired melanocytic nevi (often referred to as "moles") ^{[4] [6]}

• Epidemiology: common, regardless of age, gender, or ethnicity
• Etiology
• Clinical features: In general, all types have a uniform color, border, and surface.
  • Junctional nevi: flat, well-demarcated brownish macules growing at the dermal-epidermal junction
  • Compound nevi: arising from a junctional nevus, forming an elevated lesion
  • Intradermal nev i : elevated papular lesion that may be hard (fibrotic) and grow hair
• Diagnosis: Dermoscopy shows well-nested melanocytic proliferations at the dermal-epidermal junction.
• Treatment
  • Usually not required
  • Biopsy or excision if nevi appear atypical
• Prognosis: dysplastic nevi ( atypical moles) and congenital moles can undergo dysplastic changes → melanoma formation

Dysplastic nevus (atypical mole) ^{[4] [6]}

• Epidemiology: 2–10% in white populations
• Etiology
• Clinical features
  • ABCDE criteria
  • Ugly duckling sign : Differences between nevi in the same patient should be considered suspicious.
• Diagnosis
  • Clinical diagnosis
  • Dermoscopy can be helpful in clarifying and distinguishing from melanoma.
• Treatment: excision of suspicious lesions
• Prognosis: risk of malignant melanoma if associated with dysplastic nevus syndrome

Lipoma

• Definition: common benign tumor of subcutaneous soft-tissue , made up of mature fat cells ^{[1] [4]}
• Etiology: unknown, genetic predisposition
• Clinical features
• Special type: Lipomatosis is an autosomal-dominant disorder characterized by multiple lipomas.
• Diagnosis: clinical diagnosis
• Treatment
  • Usually not required
  • Surgical excision can be considered in the following cases:

Dermal cylindroma

Melasma

• Definition: a benign disorder characterized by hyperpigmentation of the skin that is associated with pregnancy and oral contraceptive use
• Epidemiology
• Etiology
  • Pregnancy: referred to as "mask of pregnancy "
  • Hormonal contraceptives
  • Neoplastic diseases that produce hormones
• Clinical features
  • Hyperpigmented lesions on the face
  • Exacerbated by exposure to sunlight ( UV radiation )
• Diagnosis: clinical diagnosis
• Treatment
  • Sunscreen
  • Topical depigmenting agents (e.g., hydroquinone)

Benign acanthosis nigricans

• Definition: a condition characterized by velvety, hyperpigmented plaques on the skin that most frequently involve intertriginous sites such as the axillae and neck
• Etiology
  • Endocrinal
    • Diabetes mellitus type 2
    • PCOS
    • Cushing syndrome
  • Obesity: pseudoacanthosis nigricans
  • Familial causes: autosomal dominant inheritance
  • Drug-related causes (e.g., glucocorticoids, oral contraceptives)
• Pathogenesis: insulin, IGF, and/or other growth factors (e.g., fibroblast growth factor) → epidermal hyperplasia and fibroblast proliferation ^[9]
• Clinical findings
  • Brown to black, intertriginous and/or nuchal hyperpigmentation that can develop into itching, papillomatous, poorly defined eruption
  • Symmetrical thickening of skin
  • Localization: axilla, groin, neck
• Differential diagnosis: malignant acanthosis nigricans
• Treatment
  • No specific treatment available; primary aim is to treat the underlying condition
  • Cosmetic treatment involves laser therapy, dermabrasion, and topical retinoids.

Solar lentigo (liver spots)

• Definition: flat, brown macules or patches that are induced by sun exposure
• Epidemiology: usually seen in older fair-skinned people
• Etiology: exposure to ultraviolet (UV) radiation
• Pathophysiology: increase in the production of melanin, which is then deposited in basal keratinocytes
• Clinical features
  • Flat, brown macules or patches
  • Localization: most common on the cheeks and back of the hands
• Treatment: usually not necessary

Lichen simplex chronicus

• Definition: secondary skin lesions as a result of chronic scratching
• Clinical features
  • Lichenified plaques and excoriations
  • Lesions occur on any part of the body that is scratchable, including anogenital areas (e.g., vulva, scrotum, anus)
• Histopathology: hyperplasia and hyperkeratosis of squamous epithelium ^[10]
• Treatment
  • Treat the underlying cause of pruritus to avoid scratching
  • Topical corticosteroids
• Prognosis: benign condition (risk of squamous cell carcinoma not increased)

Acrochordon (skin tag)

• Definition: small, sometimes slightly discolored, papillomatous skin lesions that most commonly arise in skin creases
• Epidemiology: prevalence is between 50% and 60% in individuals > 50 years of age and increases with age ^[11]
• Etiology
  • Not fully understood; thought to be caused by frequent irritation, e.g., skin rubbing on skin
  • Associated with HPV and endocrine changes ; (e.g., during pregnancy, or in obesity, type 2 diabetes mellitus, and acromegaly )
  • Perianal acrochordons are associated with Crohn disease.
• Clinical features ^{[11] [12]}
  • Typically arise in locations exposed to friction ; (e.g., lower neck, axilla , inframammary fold, inguinal region )
  • Usually small, soft, sometimes slightly discolored, pedunculated outgrowths with a smooth surface
• Diagnostics: clinical diagnosis
• Histopathology: composed of hyperplastic epithelium and accumulations of collagen; usually well-vascularized
• Differential diagnoses: warts, seborrheic keratosis, neurofibromas, nevi, basal/squamous cell carcinoma
• Treatment

References

1. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
2. Marks JG Jr, Miller JJ . Lookingbill and Marks' Principles of Dermatology. Saunders Elsevier ; 2013
3. Yoshimi N, Imai Y, Kakuno A, Tsubura A, Yamanishi K, Kurokawa I. Epithelial keratin and filaggrin expression in seborrheic keratosis: evaluation based on histopathological classification. Int J Dermatol. 2013; 53 (6): p.707-713. doi: 10.1111/j.1365-4632.2012.05828.x . | Open in Read by QxMD
4. Luba MC, Bangs SA, Mohler AM, Stulberg DL. Common Benign Skin Tumors. Am Fam Physician. 2003; 67 (4): p.729-738.
5. Brady MF, Rawla P. Acanthosis Nigricans. StatPearls. 2021 .
6. Kim J-H, Park H, Ahn SK. Cherry Angiomas on the Scalp. Case Reports in Dermatology. 2009; 1 (1): p.82-86. doi: 10.1159/000251395 . | Open in Read by QxMD
7. Pyogenic granuloma. http://www.dermnetnz.org/topics/pyogenic-granuloma/. Updated: January 1, 2003. Accessed: February 18, 2017.
8. Sepulveda A, Buchanan E. Vascular Tumors. Semin Plast Surg. 2014; 28 (2): p.49-57. doi: 10.1055/s-0034-1376260 . | Open in Read by QxMD
9. Sarkar R, Ailawadi P, Garg S. Melasma in Men: A Review of Clinical, Etiological, and Management Issues.. The Journal of clinical and aesthetic dermatology. 2018; 11 (2): p.53-59.
10. Lichen simplex chronicus. https://www.pathologyoutlines.com/topic/skinnontumorlichensimplexchronicus.html. Updated: March 18, 2020. Accessed: October 20, 2020.
11. Marks JG, Miller JJ. Epidermal Growths. Elsevier ; 2018 : p. 41-61
12. Skin tag. https://dermnetnz.org/topics/skin-tag/. . Accessed: June 1, 2021.
13. Chauhan DS, Guruprasad Y. Dermal cylindroma of the scalp. National Journal of Maxillofacial Surgery. 2012; 3 (1): p.59-61. doi: 10.4103/0975-5950.102163 . | Open in Read by QxMD
14. Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. British Journal of Dermatology . 2014 : p.pp696–712. doi: 10.1111/bjd.13310 . | Open in Read by QxMD
15. Lumbosacral dermal melanocytosis. http://www.dermnetnz.org/topics/lumbosacral-dermal-melanocytosis/. Updated: January 1, 2003. Accessed: February 20, 2017.
16. Blaschko lines. http://www.dermnetnz.org/topics/blaschko-lines/. Updated: January 1, 2008. Accessed: February 20, 2017.
17. WebMD. Atypical Moles. Atypical Moles. New York, NY: WebMD. http://www.webmd.com/melanoma-skin-cancer/atypical-moles. Updated: November 20, 2015. Accessed: February 20, 2017.
18. The Ugly Duckling Sign. http://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/the-ugly-duckling-sign. Updated: August 29, 2011. Accessed: February 20, 2017.

Is It Possible for an Atypical Mole to Grow Back

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