BENIGN SKIN TUMOURS (FIBROMAS, KELOIDS, SEBORRHEIC KERATOSES)
Description of the procedure and method of treatment:
- Seborrheic wart (verruca seborrhoica), senile wart (keratosis senilis), seborrheic keratosis
A wide-spread condition linked with the impairment of basal cell maturation and their accumulation in the epidermis.
Seborrheic keratoses occur primarily in older adults in the form of flat superficial plaques or nodules appearing to be stuck onto the skin surface, often with greasy, waxy surface and colour ranging from yellowish to light and dark brown to black. Small cavities corresponding to horn cysts (pseudocysts) are visible on the surface. Lesions are often numerous, which may be determined by family predilection. The early seborrheic keratoses are light-coloured flat nodules, which in time become darker, more elevated and papillomatous. They may be accompanied by inflammation and itching.
Location: Seborrheic warts occur most frequently on the trunk, face (especially on the hairline) and the proximal parts of the limbs.
Differentiation: Papillomatous nevi, viral warts, pigmented basal cell carcinoma, melanoma. Differential diagnosis is facilitated by dermatoscopic examination, which determines the presence of horn pseudocysts.
Treatment: Various forms of superficial ablations are used with good effects, including curettage, tangential shaving, electrocoagulation, cryotherapy, peels, laser vaporization and dermabrasion. Removal of the intact dermis is unnecessary.
Benign hyperplasia derived from fibrous connective tissue
- Keloids
These lesions are frequent, especially in black population. Keloids are overgrowths of increased density and smooth surface, developing in a scar that forms at the site of cutaneous injury and extending beyond its borders. Their characteristic feature is the growth of tumour projections. The development of keloid may be accompanied by itching or pain. Overgrowth of lesions can result in the motor impairment of the affected area and the occurrence of contractures.
Lokalizacja: In areas prone to damage, as well as within post-surgical, post-burning, post-inflammatory (e.g. juvenile acne- or vaccine-related) scars. Keloids often develop in places of increased skin tension, e.g. the shoulder girdle area, the upper trunk.
Treatment: Intralesional injections (by traditional injections, mesotherapy or optimally - needleless dermo-jet applicator) applied every 3-6 weeks combined with compression therapy and topical application of silicone gels or dressings. A total surgical excision is burdened with a high risk of recurrence, therefore it is not recommended as the sole treatment. Tangential shaving or excising only the central part of the tumour with subsequent drug injections into the remaining parts is more commonly recommended. There are also guidelines indicating gradual freezing or freezing supplemented by drug injections. In extremely advanced and treatment-resistant cases, using low doses of radiation may be considered. With a highly-vascularised tumours (reddened) it is advisable to use a pulsed dye laser.
- Soft fibroma (fibroma molle), senile fibroma, acrochordon (skin tags), pofibroepithelial polyp
These lesions are widespread. Usually occur as multiple, soft, pedunculated nodules, hyperpigmented or flesh-coloured, ranging in size from a few millimetres to a few centimetres. They occur more frequently in the course of obesity, diabetes, endocrine disorders, acanthosis nigricans and during pregnancy.
Location: On the neck, armpits, submammary region and groins.
Treatment: The lesions can be successfully removed by electroresection, CO2 laser vaporisation or surgical shave (e.g. scissor shave).
- Hard fibroma (fibroma durum), dermatofibroma (DF), histiocytoma, benign fibrous histiocytoma, sclerotic/sclerosing fibroma
Frequently occurring, hard, flat-topped (sometimes below the surface of the skin), reddish, brown or bluish discs or nodules up to 1 cm in size, usually single, less frequently multiple. The lesion may occur at any age but usually in the third or fourth decade of life. Sometimes fibroma develops as a result of a local trauma, insect bite or inflammation of the hair follicle. In some rare cases, immunodeficiency (AIDS, pharmacological immunosuppression) in particular, there may occur massive lesions, either consisting of a few or more coalescing nodules (hardened plaques of up to 20 cm in diameter) or deeply infiltrating, requiring differentiation from dermatofibrosarcoma protuberans.
Location: Lower limbs, trunk, rarely other regions.
Treatment: Surgical excision.
- Angiofibroma, fibrous papule of the nose
Frequently occurring, small, dome-shaped, hard and smooth nodules, ranging in colour from skin-colour (or slightly darker) to pink. They may occur independently or accompany a variety of conditions, e.g. tuberous sclerosis.
Location: Anywhere on the body, most typically on the nose or in the middle part of the face.
Treatment: Tangential shave followed by laser ablation of the wound bed.
Postoperative recommendations:
Provide proper wound care with mild cleansing agents and protect against wound infection.
The period of incapacity for work:
The procedure usually does not require absence from work.
Important information:
| Procedure duration: | 30-60 minutes |
| Type of anaesthesia: | local |
| Required tests and preparation: | none |
| Contraindications: | purulent infections and inflammations of the skin |
