{"id":3730,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/benign-lesion-lipoma-cyst-haemangiona-xanthelasma-comedones-granuloma\/"},"modified":"2025-07-28T13:18:19","modified_gmt":"2025-07-28T12:18:19","slug":"benign-lesion-lipoma-cyst-haemangiona-xanthelasma-comedones-granuloma","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/benign-lesion-lipoma-cyst-haemangiona-xanthelasma-comedones-granuloma\/","title":{"rendered":"Benign Lesion (Lipoma, Cyst, Haemangiona, Xanthelasma, Comedones, Granuloma)"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"263\" height=\"197\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lipoma.png\" alt=\"Lipoma\" class=\"wp-image-19102\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">DermNet (dermnetnz.org)<\/span> <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=lipoma\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p><strong>Lipoma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Asymptomatic. Slow growing<\/li>\n\n\n\n<li>Dome or egg-shaped, soft, mobile sub-cutaneous nodule<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"641\" height=\"483\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Benign-Lesion-Pillar-Cyst-01-04-20.gif\" alt=\"Dermatology Benign Lesion Pillar Cyst\" class=\"wp-image-1052\" style=\"aspect-ratio:1.3333333333333333;width:299px;height:auto\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=epidermoid&amp;gsc.page=3\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p><strong>Epidermoid cyst<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Smooth mobile flesh coloured nodule within and fixed to overlying skin<\/li>\n\n\n\n<li>Presence of punctum helps confirm diagnosis<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img decoding=\"async\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Spider-haemangioma.png\" alt=\"Spider haemangioma\" class=\"wp-image-15275\" style=\"aspect-ratio:1.5096774193548388;width:307px;height:auto\" \/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=spider%20haemangioma\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p><strong>Spider haemangioma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Compressible central feeding blood vessel of variable size<\/li>\n\n\n\n<li>May be associated with high levels of oestrogen e.g pregnancy, liver cirrhosis<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"481\" height=\"481\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Benign-Lesion1-Xantehlasma.png\" alt=\"Dermatology Benign Lesion 1 Xantehlasma\" class=\"wp-image-1049\" style=\"width:305px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Benign-Lesion1-Xantehlasma.png 481w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Benign-Lesion1-Xantehlasma-300x300.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Benign-Lesion1-Xantehlasma-150x150.png 150w\" sizes=\"auto, (max-width: 481px) 100vw, 481px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=xanthelasma\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p><strong>Xanthelasma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li> Yellowish plaques nodules above and below the eyes<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"787\" height=\"592\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Giant-comedones.png\" alt=\"Giant comedones\" class=\"wp-image-19053\" style=\"width:300px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Giant-comedones.png 787w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Giant-comedones-300x226.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Giant-comedones-768x578.png 768w\" sizes=\"auto, (max-width: 787px) 100vw, 787px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\"><a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&#038;gsc.q=giant%20comedones&#038;gsc.page=1\">DermNet<\/a><\/span> <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=giant%20comedones&amp;gsc.page=1\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p><strong>Giant comedones<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Like a small cyst with punctum<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"257\" height=\"194\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Benign-Lesion-2-Pyogenic-Granuloma.png\" alt=\"Dermatology Benign Lesion 2 Pyogenic Granuloma\" class=\"wp-image-1051\" style=\"aspect-ratio:1.3277777777777777;width:299px;height:auto\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=pyogenic%20granuloma\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p><strong>Pyogenic granuloma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rapidly growing vascular lesion&nbsp;often trauma site<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<p><strong>R.C 18-05-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Dermatology Referral Criteria<\/h3>\n\n\n\n<p>Referral of patients with benign tumours may be appropriate under the following circumstances:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diagnostic doubt or concerns over possible malignancy&nbsp;<\/li>\n\n\n\n<li>If there is no diagnostic doubt and the lesion is causing significant functional disability or recurrent trauma\/infection, then please refer to your locality minor surgery service (see Refhelp page on Minor Surgery). Benign lesions in cosmetically sensitive sites where aesthetic outcome is very important to the patient (e.g. face) should be referred to the Plastic Surgeons if removal is justified.<\/li>\n\n\n\n<li>Benign lesions which are disfiguring or are cosmetically sensitive should be referred to plastics through the EARP (see\u00a0<a href=\"\/refhelp\/guidelines\/AestheticSurgery\" target=\"_blank\" rel=\"noreferrer noopener\">AestheticSurgery.aspx<\/a>).<\/li>\n\n\n\n<li>Please use the <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CCA4Poster.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Consultant Connect app<\/a> to take photos of the lesion(s) and then attach these to your Sci Gateway referral.<\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/attaching-photos-to-referrals\/\" target=\"_blank\" rel=\"noreferrer noopener\">Attaching photos to referrals \u2013 RefHelp<\/a><\/li>\n<\/ul>\n\n\n\n<p><em>Kindly inform patients prior to referral that if a skin lesion is diagnosed as benign, it is highly unlikely to be removed in secondary care for cosmetic reasons alone<\/em><\/p>\n\n\n\n<p>Please do not refer lesions that are known to be benign to the dermatology department for cryotherapy.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Lipoma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Symptomatic lesions&nbsp; may be removed in primary care, but treatment in usually not indicated and risk of infection scarring and bleeding with minor surgery should be stressed.<\/li>\n\n\n\n<li>Lesions &gt;5cm increasing in size warrant onward referral to relevant specialty as higher risk of liposarcoma.<\/li>\n<\/ul>\n\n\n\n<p><strong>Epidermal (sebaceous) cyst<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Treatment not usually indicated. Symptomatic cysts may be removed in primary care.<\/li>\n<\/ul>\n\n\n\n<p><strong>Spider haemangioma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>No treatment as they may resolve spontaneously, especially in children.<\/li>\n<\/ul>\n\n\n\n<p><strong>Xanthelasma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>May be a sign of underlying hyperlipidaemia \u2013 consider checking fasting lipids.<\/li>\n\n\n\n<li>Reassure patient, no treatment required.<\/li>\n<\/ul>\n\n\n\n<p><strong>Giant comedones<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Reassure patient no treatment required.<\/li>\n<\/ul>\n\n\n\n<p><strong>Pyogenic granuloma<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Due to frequent bleeding, excision or curettage\/cautery required (specimen to pathology)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">For Patients<\/h4>\n\n\n\n<p>Relevant patient information leaflets can be found at:<\/p>\n\n\n\n<p><a href=\"http:\/\/www.bad.org.uk\/for-the-public\/patient-information-leaflets\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.bad.org.uk\/for-the-public\/patient-information-leaflets<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">For Health Professionals<\/h4>\n\n\n\n<p><a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/lipoma\" target=\"_blank\" rel=\"noreferrer noopener\">Link to PCDS Lipoma clinical guidance<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/epidermoid-cyst\" target=\"_blank\" rel=\"noreferrer noopener\">Link to PCDS Epidermoid Cyst clinical guidance<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/Haemangioma-and-other-vascular-tumours-malformations\" target=\"_blank\" rel=\"noreferrer noopener\">Link to PCDS&nbsp; Haemangioma and other vascular tumour malformations clinical guidance<\/a><\/p>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/xanthomata\" target=\"_blank\">Link to PCDS Xanthomata clinical guidance<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Lipoma Epidermoid cyst Spider haemangioma Xanthelasma Giant comedones Pyogenic granuloma R.C 18-05-24<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[98],"class_list":["post-3730","page","type-page","status-publish","hentry","category-benignlesionlipomacysthaemangionaxanthelasmacomedonesgranuloma"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/benignlesionlipomacysthaemangionaxanthelasmacomedonesgranuloma\/\" rel=\"tag\">Benign Lesion (Lipoma, Cyst, Haemangiona, Xanthelasma, Comedones, Granuloma)<\/a>","rttpg_excerpt":"Lipoma Epidermoid cyst Spider haemangioma Xanthelasma Giant comedones Pyogenic granuloma R.C 18-05-24","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3730","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3730"}],"version-history":[{"count":24,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3730\/revisions"}],"predecessor-version":[{"id":24922,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3730\/revisions\/24922"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3730"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}