Nevus, Keratosis, Skin Spots, Warts, Benign Growths and Moles

BENIGN GROWTHS & MOLES

Everyone has skin growths. The dermatologist is the expert on determining which are harmless and which should receive attention.
This article is not a substitute for a medical exam. If you have any serious skin issues or concerns, you need to consult your physician.

Moles

nevus on an arm

Everyone has moles, from a few to several dozen. Most people think of a mole as being a dark brown spot, but moles have a much wider range of appearance. They can be raised from the skin and very noticeable, or they may contain dark hairs. Having hairs in a mole doesn’t make it more dangerous.

Moles can appear anywhere on the skin, alone or grouped. They usually are brown in color and can be various sizes and shapes.  Special cells that contain the pigment melanin cause the brown color.  Facial moles are probably are determined before a person is born. Many of those that form in childhood and early adult life are now thought to be due to sun damage. Some may not appear until later in life, but moles that appear after age 50 should be regarded with suspicion. Moles may darken, which can happen after exposure to the sun, pregnancy and sometimes during therapy with certain steroid drugs. Moles can be safely removed for cosmetic or medical reasons.

Blood Moles

These are benign growths that consists of small blood vessels. These tumors can be located anywhere on the body. Some of the different types include spider angiomas, cherry angiomas, and angiokeratomas. We do not know the cause of most types of angiomas.

Age Spots

Multiple small brown spots that may appear on wrists, backs of the hands, forearms, and face could be solar lentigos. These are also called “liver spots” or “age spots” and occur later in life. The are flat and evenly colored.

Keratosis

After a person reaches middle age, he or she may acquire other dark areas that are not moles. The brown, wart-like growths that appear on the face or trunk and look as if they have been stuck to the skin may be seborrheic keratoses. Seborrheic keratoses are non-cancerous thickenings of the outer layer of skin. They may be just one growth or clusters. They are usually brown but can vary in color from light tan all the way to black. They’re different sizes as well –anywhere from a fraction of an inch in diameter to larger than a half dollar. A main feature of seborrheic keratoses is their waxy, pasted-on, or stuck-on look. They sometimes look like a dab of warm brown candle wax that has dropped onto the skin. Others have a rough surface.

Actinic Keratoses, also called solar keratoses, are caused by sun damage. They occur on body areas that have been heavily exposed to sunlight or exposed a little bit often for a lot of years. The face, hands, forearms and the V of the neck are the most common areas for actinic keratoses. They may get sore a times. These growths are more common among pale-skinned, fair-haired, light-eyed individuals. They are flatter, redder and rougher than seborrheic keratosis. Actinic keratoses are pre-cancerous, which means they may become skin cancers. The risk has been estimated at 1% per spot, per year,

WARTS
Warts are caused by a viral infection of the cells found in the top layer of the skin. The name of this virus is the human papillomavirus HPV). Warts are skin-colored and feel rough to the touch. Hand warts are usually found around the nails, on the fingers and on the back of the hand. They are more common where skin has been broken and in the areas where fingernails are bitten or hangnails picked. Foot warts are usually on the soles of the feet. These warts are called plantar warts (this has nothing to do with farming-the bottom of the foot is called the plantar side by doctors). Flat warts are much smaller and are less rough than hand or foot warts. They tend to grow in great numbers — 20 to 100 at any one time. They can occur anywhere, but in children they are most common on the face. In adults they are most often found in the beard area in men and on the legs in women. Skin irritation from shaving probably accounts for this.

Watch out for…

Melanoma is a serious form of skin cancer. Melanomas are often, but not always, very dark brown to bluish-black growths. Melanomas may be confused with seborrheic keratoses or moles because both can become very dark. It is wise to have any growth that turns dark or becomes irritated checked by a dermatologist. Early detection of skin cancer is the best way to assure successful treatment.

Information by : Dermatologist, Robert M Rosen, D. O.

Wart Treatment by Type of Drug and Procedure

The new advance in treatment of genital warts has been imiquimod (Aldara). This encourages the patient’s autoimmune system to attack the wart. This is particularly helpful in the moist areas of the skin or mucosal surfaces.

Salicylic acid
Salicylic acid can be applied either in the form of plasters or as liquid on to the warts. This will break down the thickened skin on the surface. It is more effective if the area is covered. These are useful for warts on the hands, knees and feet. They do turn the skin white. They can be used in combination with paring of the warts. Treatment with these at nighttime and covering with duct tape can be effective although slow.

Podophyllin

Podophyllin has a long history of use. It is useful mostly in genital warts. It should be applied very carefully on the warts, trying to prevent spread on to normal skin. It should be washed off after a few hours. There is irritation usually for a few days. Repeat treatments are usually required. A more purified form of podophyllin called podophyllotoxin is available for patient use. It can be used once or twice daily for a few days in succession. This produces some irritation. It has the advantage of not being as irritating as podophyllin and can be applied by the patients themselves.

Vitamin Acid

Vitamin acid (Tretinoin) is a vitamin A preparation. It is used in the treatment of acne and photo damage. Vitamin A products tend to regulate the surface of the skin, generally trying to keep the epidermis behaving normally. It may also cause some inflammation. In some individuals it can help reduce or even eliminate warts.

Cantharone

Cantharone (cantharidin) is derived from an insect. It can be very helpful in children but the application is painful. Inflammation and
blistering usually occurs later in the day, after application. Multiple treatments may be required. There are two concentrations. The
stronger version combines Cantharone with podophyllin and salicylic acid. Very occasionally the blistering reaction can be quite severe
and associated with swelling and pain. It is often very effective even in resistant warts.

Cryotherapy

Cryotherapy is the use of liquid nitrogen. This can be applied either with a Q-Tip or it can be sprayed on to the skin. It causes destruction by freezing water inside the cells. This damages the cell causing death. It is painful to apply and there is blistering associated with this. Multiple treatments may be required. Thawing and freezing again makes this therapy more effective. It can be a problem in dark skin in that it can either increase or decrease pigmentation, which can be permanent. This treatment can be used in combination with other therapies.

Electrodesiccation

Electrodesiccation is the use of an electric needle to burn warts. It usually requires a local anesthetic. It does have a potential risk of scarring. Very large warts can sometimes be scraped off before they are cauterized.

CO2 Laser

The CO2 laser has been used for many years. It essentially vaporizes water in the skin and causes destruction. It leaves a hole in the skin which will heal. There is often scarring with this technique. Other lasers such as the pulse dye laser are easier to use. The yellow light is absorbed by blood in the vessels that feed the warts. This is a similar laser used in the treatment of red birthmarks. The pulse dye laser at a high power setting can be effective particularly if multiple pulses are used in succession.

Aldara

Aldara is an immune response modulator. It boosts the patient’s immune response to viruses. It can also encourage the production of a lasting immune memory. It has been available in Canada since 1999. It works best in the genital area as penetration into the skin is easier. When it is used elsewhere it often has to be covered to help with penetration into the skin. It has been shown to work well particularly in women. It is applied three times weekly. There will be some inflammation associated with this. The results may be enhanced by combining this with liquid nitrogen. This drug has added a very significant tool in treating genital warts.

Identifying Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

Milia and Seborrheic Keratosis

Milia, also known as milk spots or oil seeds, are benign, keratin-filled cysts that can appear just under the epidermis or on the roof of the mouth. They are commonly associated with newborn babies but can appear on people of all ages. They are usually found around the nose and eyes, and sometimes on the genitalia, often mistaken by those infected as warts or other STDs.

In children milia often disappears within two to four weeks. In adults it may require removal by a physician or an esthetician. Milia can sometimes be a result of harsh face washes or from repeated heat stress from hot showering on people with sensitive skins. Milia can be confused with stubborn whiteheads.

A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart”) is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age. In fact they are sometimes humorously referred to as the “barnacles of old age”.

They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across. They can resemble warts, though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well. Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.

Classification

Seborrheic keratoses may be divided into the following types:

* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)

Reticulated seborrheic keratosis (also known as “Adenoid seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with keratin cysts seen histologically.

* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic

keratosis) Stucco keratosis (also known as “Digitate seborrheic keratosis,” “Hyperkeratotic seborrheic keratosis,” “Serrated seborrheic keratosis,” and “Verrucous seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with church-spire-like projections of epidermal cells around collagen seen histologically.

* Clonal seborrheic keratosis
Clonal seborrheic keratosis is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.

* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)

* Seborrheic keratosis with squamous atypia

Seborrheic keratosis with squamous atypia is a less common cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.

* Melanoacanthoma (Pigmented seborrheic keratosis)

Melanoacanthoma (also known as “Pigmented seborrheic keratosis”) is a common, benign, darkly pigmented cutaneous condition characterized by a skin lesion with a dull or lackluster surface.

* Dermatosis papulosa nigra

Dermatosis papulosa nigra (DPN) is a condition of many small, benign skin lesions on that face that closely simulate seborrheic keratoses, a condition generally presenting on dark-skinned individuals.

They should not be confused for Leser-Trélat sign, a sudden explosion of lesions due to a growing tumor.

* The sign of Leser-Trélat

The Leser-Trélat sign is the explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome. In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic. It is named for Edmund Leser and Ulysse Trélat.

Although most associated neoplasms are gastrointestinal adenocarcinomas (stomach, liver, colorectal and pancreas), breast, lung, and urinary tract cancers, as well as lymphoid malignancies are associated with this impressive rash. It is likely that various cytokines and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses. In some cases, paraneoplastic acanthosis nigricans accompanies the sign of Leser-Trélat.

Variances of Seborrheic Keratosis:

Dermatosis Papulosis Nigra: Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.

Stucco Keratosis: Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.

Diagnosis: Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy.

Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.

Treatment
When correctly diagnosed, no treatment is necessary. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.

Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.

Cause
The cause of seborrheic keratosis is unclear. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light

may play a role, as may genetics.[8] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.

Etymology
The term “seborrheic keratosis” combines the adjective form of seborrhea, keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.