Common benign skin lesions | DermNet (2024)

What is a benign skin lesion?

A benign skin lesion is a non-cancerous skin growth.

Who gets benign skin lesions?

Any individual from any age group can present with a benign skin lesion.

What are the features of benign skin lesions?

The features in common for benign skin lesions include:

• Symmetry in shape, colour and structure
• Stable or slowly evolving
• Absence of spontaneous bleeding (bleeding or ulceration may be due to recent injury).

Benign lesions can be classified by their cellular origin: melanocytic, keratinocytic, vascular, fibrous, fat, and so on,

Which are the common melanocytic lesions?

Common benign skin lesions of melanocytic origin include the ephilis, lentigo simplex, and melanocytic naevus(mole).

Ephilides are genetically determined well-defined small brown macules with the following characteristics:

• 1–4 mm in diameter
• Tan or brown colour
• Located in areas exposed to the sun such as the face and forearms.
• Increased melanin deposition in the basal keratinocyte on biopsy [1,2].

Lentigo simplex is not sun-induced. It has the following characteristics:

• Well-circ*mscribed, uniform brown to black macule
• Located on mucous membrane or skin, including palms and soles
• Develops during childhood or young adult life [1,2].

A melanocytic naevus can be histologically classified as a junctional, compound, or dermal naevus depending on the location of nests of naevus cells.

A junctional naevus has naevus cells at the base of the epidermis.

• A junctional naevus is well-circ*mscribed pigmented macule with regular but fading borders.
• The number and appearance of junctional naevi depend on sun exposure, fluctuating hormonal levels, and immunosuppression [1,3].

A compound naevus has papular and flat components due to junctional and dermal naevus cells.

• The compound naevus is usually a pink or brown, dome-shaped papule surrounded by macular pigmentation [3].
• Most lesions arise during childhood.

A dermal naevus is characterised by naevus cells in the dermis.

• The dermal naevus is an elevated papule.
• It can be brown, blue, black or skin coloured.
• Dermal naevi arise in childhood but mature during early adult life.

Which are the common keratinocytic lesions?

Benign keratoses include solar lentigo and seborrhoeic keratosis.

A solar lentigo is a sun-induced pigmented macule.

• Solar lentigines vary from small to large size and are usually tan to brown-black.
• The lesions are mostly uniformly pigmented with a sharp border.
• They arise in adult life and are prevalent in older people [1,2].

Seborrhoeic keratosis presents as a variable warty plaque.

• Seborrhoeic keratosis has a dull, verrucous, or waxy surface with a classical stuck-on appearance.
• The shape and structure are often irregular and varies over time.
• They can be yellow to brown to black in colour or made up of several colours.
• Skin biopsy reveals a papillomatous epidermis with a thick basal layer and presence of keratin-filled cysts [1,4].

Stucco keratoses are flat-toppedkeratoticpapules.

• Usually rough, dry, and occasionally itchy.
• 'Stuck on’ appearance on the skin (like sprayed chalk or stucco cement)
• Round, oval, or irregular borders; diameter of 1–4mm.
• White/creamor grey colour, or sometimes pink or brown

Epidermoid cyst is a follicular nodule with a central punctum.

• This type of cyst can be skin-coloured to off-white and is a dome-shaped papule or nodule.
• Cheesy or yellowish keratin can be expressed through the punctum or removed by incising the cyst.
• The epidermal cyst is lined with flat epidermal cells and has a granular layer surrounding laminated keratin [1,2].

Corns and calluses are localised areas of thickened skin induced by pressure

• A corn (small tender papule) or callus (thickened non-tender plaque) is most often located on a pressure area of the hand or foot.
• A soft corn is a scaly plaque while hard corn is a firm papule with a translucent central core [1,2].

Sebaceous hyperplasia occurs on the forehead and cheeks of adults.

• It presents as one or more dome-shaped papules with central umbilication.
• Uniform yellow lobules are seen on dermoscopy [1,2].

Which are the common lesions of vascular origin?

An angioma is due to the proliferation of the endothelial cells.

• A superficial angioma is a bright red colour and a deeper angioma is purple or blue.
• Angiomas are commonly nodular or macular lesions of varying sizes.

A pyogenic granuloma is a vascular response to trauma and bacterial infection.

• It presents as a rapidly growing friable nodule on fingers, toes, or facial sites.
• They have a yellow to violaceous colour.
• The pyogenic granuloma is surrounded by a scaly collarette.

Which are the common fibrous lesions?

Dermatofibroma is a reactive lesion that presents as one or more firm dermal papules.

• The dermatofibroma is pink, tan or brown.
• It forms a dimple when pinched.
• A skin biopsy shows fibrohistiocytic cell proliferation with entrapment of collagen at the periphery [1,2].

Which are the common subcutaneous lesions?

The lipoma is the most common benign soft-tissue tumour.

• A lipoma presents as a soft, rubbery, freely mobile mass that is usually found on the back, neck, or trunk.
• Skin biopsy shows white adipose tissue in the subcutaneous layer [1,2].

What is a skin tag?

The most common type of skin tag is also called acrochordon.

• An acrochordon is a soft, fleshy papule that is almost always pedunculated.
• They vary in diameter from 1 to 6 mm.
• On biopsy, there is a fibrovascular core covered by normal squamous epithelium [2].