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Skin lumps are a common occurrence and may arise as a result of pathology arising from the cells in the skin or beneath it. Most skin lesions are benign and respond well to simple treatment.
Skin lesions manifest as lumps protruding from the skin surface. Lesions may enlarge, cause pain, become infected, catch onto clothing and cause aesthetic concerns when occurring in visible areas such as the face, neck and hands.
Viral warts. Viral warts are small flesh coloured lesions that are verrucous in appearance. They arise from human papillomavirus infection of the skin and commonly occur on the face, neck, palms and soles.
Skin tags. Skin tags are small flesh-coloured lesions arising from overgrowth of skin in the skin creases, such as the eyelids, neck, underarms (axilla) and groins. These lesions are often connected by narrow stalks (pedunculated) to the underlying skin. They may catch onto clothing are unsightly.
Seborrheic keratoses. Seborrheic keratoses are among the most common benign skin lesions. They present as round or oval lesions and may be slightly raised. The colour may range from light tan to black. These are benign lesions arising from the epidermis and frequently occur in older persons. The cause is unknown.
Syringomas. Syringomas are small, round, skin-coloured and raised lesions usually measuring 1 to 4 mm in diameter. They often grow around the eyelids and are aesthetically displeasing. Syringomas may also present in the scalp, underarms and genitals. They arise from the sweat ducts.
Moles. Moles, or melanocytic nevi, are pigmented lesions visible on the skin surface. Melanocytes (pigment forming cells) residing deeper in the skin appear lighter in color, whereas those in the superficial skin layers appear darker. The color of moles may range from light tan to black. Individuals may be born with moles, or more commonly acquire them throughout life. They may present as flat or raised lesions. Individuals often seek removal of moles due to aesthetic concerns.
Epidermal (sebaceous) cysts. Epidermal cysts may occur in any part of the face, trunk or extremities. They present as firm, raised lesions in the skin and may occasionally discharge clear, whitish material. Epidermal cysts may become infected and present as red, painful, warm lesions that are tender to touch and may discharge pus.
Cholesterol spots. Xanthelasmas (cholesterol spots) present as deep yellow lesions occurring in the inner portion of the upper and lower eyelids. They may eventually increase in size and affect the outer eyelids as well. The colour of the lesions form distinct contrast with the surrounding skin and create highly visible deformities.
Xanthelasmas are caused by the deposition of cholesterol within the skin. Many individuals with xanthelasma are affected by the aesthetic appearance and seek their removal.
Lipomas. Lipomas are soft, mobile lesions lying below the skin surface and may arise in the scalp, trunk and extremities. They are slow-growing and vary in size. They rarely cause symptoms. Lipomas arise from the adipocytes (fat storage cells) and are benign.
Neurofibromas. Neurofibromas are benign lesions that present as skin-coloured, soft lumps that have a rubbery consistency. They may catch onto clothing and may present as aesthetic concerns in visible areas. Neurofibromas arise from the nerve sheaths and may present in the skin or as growths within deeper tissues. There are genetic syndromes that predispose to neurofibroma formation.
Viral warts. Individuals may seek treatment of viral warts due to pain (especially if occurring on the sole of the foot) or for cosmesis. The options for treatment include topical salicylic acid application, cryotherapy (freezing), laser ablation and excision. Topical salicylic application is useful for small, flat warts that do not occur on contact surfaces. Cryotherapy (freezing) is a simple ambulatory treatment administered using liquid nitrogen. It is useful for warts in non-visible areas. Laser ablation may be performed for small warts occurring in the face, neck and hands with a carbon dioxide laser. Laser wounds typically heal within a week. Surgical excision is normally reserved for larger or deeper warts and is a simple ambulatory treatment performed within the clinic under local anesthesia.
Skin tags. Individuals often seek treatment for skin tags as they catch onto clothing and may be unsightly. The treatment options include ligation, laser excision and surgical excision. Ligation is a simple home remedy and involves tying a fine string or suture at the base of the skin tag and leaving it for a few days until the skin tag drops off. This is appropriate for small skin tags. Excision may be performed in the clinic using the laser or by surgery. Laser excision is performed under local anesthesia and leaves a very small wound at the base of the skin tag that is self-healing within a week. Surgical excision is a simple procedure and is also performed under local anesthesia and is appropriate for larger skin tags.
Seborrheic keratoses. Seborrheic keratoses are benign lesions and may be managed conservatively. Individuals may seek treatment in cases where the appearance is bothersome or in cases that resemble skin cancers. The treatment options are laser ablation and surgical excision. Laser ablation is performed in the clinic under local anaesthesia and removes the seborrheic keratosis and part of the underlying epidermis.
The resulting wound heals in about 1 week and is aided by the application of a proprietary serum derived from umbilical cord lining stem cell conditioned media for the first 5 days. Surgical excision is usually done for cases that resemble skin cancers as the excised lesion will be sent for histopathological reporting.
Syringomas. Syringomas often arise in visible areas and individuals seek removal for aesthetic reasons. Syringomas are usually treated with laser ablation. This is performed in the clinic under local anesthesia. The resulting wound heals in about 1 week and is accelerated by application of a proprietary serum derived from umbilical cord lining stem cell conditioned media for the first 5 days.
Moles. Moles are benign lesions and individuals seek treatment for aesthetic reasons or if there is a concern of skin cancer. Flat moles are treated by laser ablation, whereas raised moles, or moles in which skin cancer is a concern, require surgical excision and histopathological testing. Depending on the location and size of the mole excised, minor reconstructive surgery may be required for coverage of the defect.
Epidermal cysts. Epidermal cysts may present with infection and abscess formation. In such cases, drainage of pus may be performed in the clinic under local anaesthesia. Picasso Plastic Surgery uses a proprietary method of drainage that incorporates a small 3 to 4 mm skin incision (even for large abscesses) that effectively evacuates pus and minimizes the resultant scar. In uninfected cases, early surgical excision permits the removal of the cyst with shorter and better quality scars. This may be performed as an ambulatory procedure under local anaesthesia.
Xanthelasmas. A detailed description of xanthelasma and its treatment .
Lipomas. Small lipomas with no clinical features suspicious of malignancy may be excised as an ambulatory procedure under local anaesthesia. Lipomas that are large, rapidly growing, painful or deep (within the muscle or deep fat layer) require MRI scan assessment prior to surgery. Large lipomatous lesions are occasionally cancerous and may require wide excision surgery, which is a different procedure from simple excision biopsy.
Neurofibromas. Individuals with neurofibromas often seek treatment as the lesion(s) may be unsightly or cause functional impairment due to their location and/or size. Superficial neurofibromas may be excised as ambulatory procedures under local anesthesia. Deeper plexiform neurofibromas may grow quite extensively beneath the skin surface and require MRI scan assessment and planning prior to surgery.
Excision of plexiform neurofibromas is a specialized skill; Dr Yeo has previously undergone fellowship training and attained experience in excision of such tumors. Plexiform neurofibroma excision is a fine art that requires precise technical execution and striking an optimal balance between maximal lesional clearance, preservation nerve and muscle function and achieving cosmetically pleasing outcomes.
Surgery for benign skin lesions is often minor and Picasso Plastic Surgery offers the convenience of same-day consultation and excision in the vast majority of cases. The clinic has an en suite operating facility that assures your maximal privacy and convenience and keeps facility and equipment costs attractive. Dr Yeo is also editor of various professional dermatologic surgery journals and actively publishes peer-reviewed papers aimed at educating other fellow specialists.