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Benign skin lesions are a common sighting for doctors in primary care. Many patients develop at least one of these changes during their lifetime. They are usually easy to spot. Consequently, benign skin lesions can cause great concern and even affect the psychological well-being of some patients.

That is why it is not uncommon for patients to urgently require a confirmation of the lesion’s nature from their doctor. Luckily, it is usually possible to identify benign skin growths in a primary care setting.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology.

Benign skin lesions may develop in patients of all age groups. Their most important characteristic is that they are non-cancerous. However, they have some other common traits. These include:

• Their shape and size may remain stable or change slowly
• They are symmetrical in structure, colour, and shape
• Spontaneous bleeding is absent in such lesions

Diagnosing benign skin lesions in primary care

With adequate training in general dermatology, a general practitioner can diagnose benign skin lesions. Usually, observing the patient’s medical history and the lesion’s clinical appearance (distribution and morphology) is enough for a correct diagnosis.

Dermoscopy is the most common diagnostic method for identifying benign skin lesions. It allows the doctor to see the skin structures beneath the surface using a handheld instrument called a dermatoscope.

The technique enables the recognition of both non-pigmented and pigmented changes with great accuracy.

A more invasive diagnostic technique is a biopsy. It involves making an incision in the skin to gather a small sample for microscopic observation. A biopsy is necessary when the clinical appearance of the lesion and dermoscopy is not enough for an accurate diagnosis.

These are usually cases in which rapid changes in symptoms and the appearance of the lesion exist.

Which are the most common benign skin lesions?

Benign skin lesions may differ by cellular origin. The common types are:

• Melanocytic,
• Keratinocytic,
• Vascular,
• Fibrous, and
• Fat skin lesions.

Common melanocytic benign skin lesions include:

• Melanocytic naevi (moles)
• Ephelides
• Lentigo simplex (not sun-induced)

Histologically, naevi can be junctional, compound, or dermal.

Junctional naevi have well-defined but fading borders. They usually appear as flat and pigmented macules.

Compound naevi are dome-shaped, and pink or brown.

Dermal naevi form as papules. They can be brown, bluish, black, or the same colour as the skin.

Frequently encountered keratinocytic lesions of benign nature are:

• Solar lentigo, and
• Seborrhoeic keratosis

Corns, calluses, and epidermoid cysts also fall into this group.

Angiomas and pyogenic granulomas are the most common benign vascular skin lesions.

A pink, tan, or brown, firm dermal papules that form dimples when pinched are dermatofibroma. These are the most common fibrous skin lesion.

Skin tags or acrochordon are also common benign skin changes with a fibrovascular core.

Treatment of benign skin lesions

Removal is sometimes the best treatment approach to benign skin lesions. These changes score low on the aesthetic appeal scale, and they can negatively affect the patient’s physical and mental well-being.

There are many techniques in use for this. The three common ones include:

• Cryosurgery
• Curettage, and
• Excision

Cryosurgery uses liquid nitrogen to freeze and destroy unwanted skin changes.

Curettage requires local anaesthesia. It involves scraping out the lesion using a spoon-shaped instrument. The technique often goes together with electrocautery.

Excision is another high-quality treatment option, but it is usually the last option for non-cancerous lesions.

– Dr Rosmy De Barros

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References

• Higgins JC, Maher MH, Douglas MS. Diagnosing Common Benign Skin Tumors. Am Fam Physician. 2015 Oct 1;92(7):601-7. PMID: 26447443.
• Marghoob NG, Liopyris K, Jaimes N. Dermoscopy: A Review of the Structures That Facilitate Melanoma Detection. J Am Osteopath Assoc. 2019 Jun 1;119(6):380-390. doi: 10.7556/jaoa.2019.067. PMID: 31135866.
• Köse O. Carbon dioxide ablative laser treatment of acquired junctional melanocytic nevi. J Cosmet Dermatol. 2021 Feb;20(2):491-496. doi: 10.1111/jocd.13579. Epub 2020 Jul 12. PMID: 32593221.
• Thai KE, Sinclair RD. Cryosurgery of benign skin lesions. Australas J Dermatol. 1999 Nov;40(4):175-84; quiz 185-6. doi: 10.1046/j.1440-0960.1999.00356.x. PMID: 10570551.