Department of Plastic Surgery

1. Siti Nurul Afiqah binti Johari 10-6-95

2. Anatomy of skin

3. Classification
a) Skin appendages or skin adnexa, such as:
• Hair follicles, sebaceous and sweat glands
b) Common cyst – sebaceous cyst, dermoid cyst
c) Soft tissue tumor – lipoma, fibroma, neurofibromatosis
a) Epidermal tumor as will be explained in precancerous lesion
e) Moles (naevi)

4. Sebaceous hyperplasia
Sebaceous adenoma
Cylindroma
Trichoepithelioma

5. Sebaceous cyst (epidermoid cyst)
It is a retention cyst that is caused by the
blockage of sebaceous gland duct.
• The cyst lined with stratified squamous
epithelium contain a grayish white material
• Often found on scalp, trunk, face, any hairy
areas of the body except the palm and the
sole

7. Clinical features:
• Slowly growing cyst and often painless
• If infected or inflamed, it becomes red, painful
and tender to touch
• Cyst forms a small, well defined cystic swelling
usually fixed to overlying skin at one point,
freely movable, central punctum may be seen
• Lesion may be solitary or multiple
• Sometimes it attains a large size

9. Treatment depends on its clinical state;
• Incision and drainage
• Complete excision of the cyst

10. Dermoid cyst
• Dermoid cyst is lined by stratified squamous
epithelium filled with sebaceous material
• Could occur anywhere in the body. If in the
skin, mostly on the face, neck or scalp
sc

11. Types
Congenital (sequestration)
Acquired (implantation)
Tubulodermoid

12. Teratomatous dermoid
Inclusion dermoid

13. Clinical features:
Sequestration dermoid: presents at birth but not
appear clinically except after few years when cyst
begins to extend (slowly growing), usually occur at
fusion lines, painless mass, intense inflammation
may occur if cyst rupture spontaneously or because
of trauma
Implantation dermoid: occurs secondary to
punctured wounds which displace some epithelial
cells into sc tissues. Mainly in the fingers, palm and
sole. Cyst usually small and tense and sometimes
scarred overlying skin

15. Treatment : Excision of cyst

16. 1
2
3
4
5
6
7
8
Cheesy content
inside the cyst

17. Lipoma
Lipomas are benign aggregates of slowly
growing adipocytes
• most common subcutaneous soft tissue tumor
• Incidence 1:1000 persons, > in young males

18. Clinical features:
• Most common as a painless slowly growing
solitary swelling
• Multiple lipomatosis could occur
• Present anywhere on the body (subcutaneous,
subfascial, intermuscular, submucosa,
retroperitoneal)
• May contain other tissue as fibrolipoma or
angiolipoma
• O/E : well circumscribed mass of variable sizes,
soft in consistency, lobulated surface, slippery
edges, non tender (unless they grow compressing
an underlying nerve)

19. Multiple lipomatosis

20. Dercum’s disease (adiposis dolorosa) is
tender fat deposits especially on trunk
Complications are rare include:
1. Degenerative changes lead to
liquefaction and calcification
2. Malignant transformation (liposarcoma)
can occur in retropertoneal lipoma

21. Treatment:
• Small, asymptomatic lipomas
require no treatment
• Definitive treatment is surgical
excision
Indication to excise lipomas:
1. Mostly for cosmetic reasons
2. To evaluate their histology
when liposarcomas must be
ruled out
3. When they cause symptoms
4. Become larger than 5cm,
exhibit malignant behavior,
located mainly of thigh,
shoulder, retroperitoneum

22. Fibroma
Benign tumor composed of fibrous or
connective tissue
• Can grow in all organs, arising from
mesenchyme tissue

23. Hard fibroma (fibroma durum)
• In skin it is called dermatofibroma
(mc painful skin tumor)
• Common cutaneous nodule of
unknown etiology, > in females
• Firm pigmented nodule usually
on the lower legs, arms
• Special form is keloid
Soft fibroma (fibroma molle)
• Fibroma with a shaft
(acrochordon, skin tag)
• Represents as hyperplastic dermis
either pedunculated or sessile
• Most common sites are axilla,
neck, inguinal region
• No malignant threat

24. Treatment:
- No treatment unless for cosmesis or liability to
trauma
- Surgical excision under local anaesthesia or by
laser/radiowave/electrocoagulation/cryothera
py
Elliptical excision of a
dermatofibroma on the arm
Removal of acrochordon

25. Neurofibroma
Neurofibromatosis is a proliferative condition of
the endoneurium of nerves associated with
tumor formation. These tumors occur under the
skin and throughout the nervous system.

26. a) Solitary neurofibroma – between the age 20-
50 yrs. Usually found in sc tissue affecting
nerves of upper limb, mobile sideways,
forming a small elongated firm tender
swelling. Cystic degeneration may occur
Rx: tumor should be completely excised

27. b) Generalized neurofibromatosis (Von Recklinghausen’s
disease)
• Autosomal dominant disorder with widespread
affection of nerves
• Preceded with multiple café-au-lait spots, increase in
size and number over time
• Freckling in the arm pit/groin region during childhood
 adolescence
• Subcutaneous or cutaneous neurofibromas all over the
body surface (small, slowly growing, painless,rubbery
skin lesions, movable sideways but not in line of nerve)
Rx: Excision of all tumors is impossible. Complete
resection indicated only for very large tumors, painful or
tumors producing pressure symptoms.

28. Melanocytes migrate from neural crest to the basal epidermis
during embryogenesis.
When this melanocytes layer in epidermis they form a simple
mole. Melanocytes that aggregate in the dermis or at
dermoepidermal junction are called nevus cells.
Classifications :
- Lentigo
- Junctional
- Compound
- Intradermal

30. • Lentigos: small, sharply
circumscribed pigmented
macules which are marker for
sun damage and some systemic
syndromes. Solar lentigenes
>common in fairer skin
• Junctional naevus: deeply
pigmented macule or papule
occurs commonly in childhood
and adolescence. Represents
dermoepidermal proliferation of
naevus cells usually progress to
form compound or intradermal
with advancing age. No
malignant potential.

31. • Compound naevus:
maculopapular pigmented
lesion becomes prominent
during adolescence.
Represent a junctional
proliferation of naevus cells
with nest and columns in
dermis.
• Intradermal naevus: faintly
pigmented papules in adults
showing no junctional
proliferation but a cluster of
dermal melanocytes.

32. • Blue naevus: benign skin lesion
4x > common in children
typically affecting face and
extremities
• Halo naevus: halo of
depigmentation around any
benign nevus represents an
antibody response to
melanocyte. Depigmentation is
important as it may also be a
feature of MM. It is assoc. with
vitiligo.

33. Treatment of nevi:
- Nevi are virtually always benign before
puberty
- Indicated for cosmetic reasons, subject to
trauma or if there are alerting signs of change