Benign Lesion - Lipoma, Cyst, Haemangiona, Xanthelasma, Comedones, Granuloma

Lipoma

• Asymptomatic. Slow growing
• Dome or egg-shaped, soft, mobile sub-cutaneous nodule

Epidermoid (sebaceous) cyst

• Smooth mobile flesh coloured nodule within and fixed to overlying skin
• Presence of punctum helps confirm diagnosis

Spider haemangioma

• Compressible central feeding blood vessel of variable size
• May be associated with high levels of oestrogen e.g pregnancy, liver cirrhosis

Xanthelasma

• Yellowish plaques nodules above and below the eyes

Giant comedones

• Like a small cyst with punctum

Pyogenic granuloma

• Rapidly growing vascular lesion often trauma site

Lipoma

• Symptomatic lesions may be removed in primary care, but treatment usually not indicated

Epidermal (sebaceous) cyst

• Treatment not usually indicated. Symptomatic cysts may be removed in primary care

Spider haemangioma

• No treatment as they may resolve spontaneously, especially in children

Xanthelasma

• May be a sign of underlying hyperlipidaemia
• Reassure patient, no treatment required

Giant comedones

• Reassure patient, content often easily expressed

Pyogenic granuloma

• Due to frequent bleeding, excision or curettage/cautery required (specimen to pathology)

Dermatology Referral Criteria

Referral of patients with benign tumours may be appropriate if there is:

• Diagnostic doubt (particularly pyogenic granuloma, consider possibility of malignancy)
• Lesion causing functional problems or significant disfiguration
• Lesion prone to recurrent infection
• Recurrent bleeding (pyogenic granuloma)

If benign skin lesion is diagnosed, it will not be removed in secondary care for cosmetic reasons alone