Dermatology Patient Pathways

Benign Lesion- Skin Tags, Warts, Moles, Dermatofibroma

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Presentation

Skin Tags

  • Soft flesh coloured or pigmented pedunculated tags in body folds (neck, armpit, groin)
  • Especially in obese patients and in those with type 2 diabetes

 

Seborrhoeic Keratoses (warts)

  • Yellow / brown greasy papules or rough grey / black hyperkeratotic papules with ‘stuck-on’ appearance
  • Keratin plugs or inclusion cysts may help differentiate from melanoma
  • Often multiple
SK.jpg

 

 

Benign Melanocytic Naevi (moles)

  • Flat or raised, symmetrical, uniform border, uniform pigment, pale, dark or reddish brown
  • May darken/enlarge during pregnancy. If hairy may become inflamed (folliculitis)

 

Dermatofibroma

  • Firm reddish brown nodules often on the limbs. May be tender on pressure
  • If the skin over a dermatofibroma is squeezed a dimple forms, indicating tethering of the skin to the underlying fibrous tissue
dermatofibroma.jpg
Management

Skin tags

  • If symptomatic, consider treatment in Primary Care by cryotherapy or snip/shave + cautery, if available.

Seborrhoeic  Keratoses

  • If diagnosis certain, reassure that no treatment is needed
  • Treatment in Primary Care, if available, can be considered for symptomatic lesions:
  • Cryotherapy
  • Curettage for large lesions (specimen to be sent to pathology)

Benign Melanocytic Naevi (moles)

  • Do not refer patients with moles for cosmetic removal
  • Excision of benign naevi only if they meet the criteria as outlined in the exceptional referral pathway (hotlink)

Dermatofibroma

  • If diagnosis is certain, reassure that no treatment is needed
  • Excision, if indicated e.g. significant pain or discomfort, is the treatment of choice
  • Warn patient about resulting scar
  • Send specimen to pathology
Referral

Dermatology Referral Criteria

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

  • Diagnostic doubt
  • Significant risk of neoplasm
  • Lesion causing functional problems or significant disfigurement
  • Lesion prone to recurrent infection

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

Patient Information