***This page is under review***
The skin is a common site for benign and malignant lesions to occur. These can be related to any of the structural components of the skin including the dermis, the hair follicles, sebaceous and sweat glands as well as nerve and vascular elements – all of which may present with benign or malignant forms. The skin may also be involved with metastases from tumours of other organs including breast, bowel and lung.
Longstanding, asymptomatic lesions tend to be benign whereas a short history of recent change in size, shape or symptoms such as the presence of deepening pigmentation, ulceration, bleeding and itch are more concerning features.
Subcutaneous lesions are more likely to be malignant if they are rapidly enlarging, are over 5cm in diameter and located deep to the deep fascia.
Some lesions that are superficial or are considered to be pre-cancerous may be amenable to topical treatment with various agents such as 5-Fluorouracil, Imiquimod or Diclofenac cream or LASER treatment. Other benign or malignant lesions that need to be removed generally require surgical excision and reconstruction of the defect by direct closure, skin grafting or local flaps.
Who to refer:
- Any patient with a potentially malignant lesion – urgent referral required.
- Any patient with a likely benign lesion that is nonetheless symptomatic or causes functional difficulties.
Who not to refer:
- Patients with longstanding, asymptomatic or mildly symptomatic benign lesions.
- Xanthelasma
How to refer:
Via SCI gateway to the Hand Service at St John’s hospital with relevant details and background information.
