Red flag symptoms: Skin nodules

Patients presenting with nodules are often worried about the cosmetic appearance or the potential for malignancy.

The abcde of melanoma

A - Asymmetry
B - Border irregularity
C - Colour variation
D - Diameter over 6mm
E - Evolving (enlarging, changing)

Nodular melanoma is an aggressive tumour that usually occurs in a younger age group. Dark pigmentation or an irregular shape may indicate malignant melanoma.

Excision biopsy should be carried out to determine any malignancy. A nodule in a mole is undeniably a red flag.

Squamous cell carcinoma may appear as a reddish brown or skin-coloured nodule. Nodular basal cell carcinoma is a common type of basal cell carcinoma. It is typically found in sun-exposed areas such as the face or the back of the hands, is usually slow growing and tends to only spread locally.

Many nodules over a widespread area may be a cutaneous manifestation of an underlying malignancy, especially in a middle-aged patient or where weight loss is also experienced.

Benign nodules
Warts usually appear as rough, skin-coloured growths with a hard, uneven surface but can also be smooth. They are frequently found on the hands around the nails or fingers. Treatment is not usually required and warts often resolve spontaneously.

Seborrhoeic warts are a benign build up of ordinary skin cells, often found in the elderly. Despite their name they are not related to viral warts. Most need no treatment but thorough examination is required to rule out malignancy.

Lipoma or dermatofibroma are common causes of nodules on the skin. A lipoma tends to be larger and very soft. Both are harmless and can be left untreated. There is low risk of any malignant change occurring. They can be removed, however, for cosmetic reasons.

Sebaceous cysts are very common. They are firm mobile cysts, usually skin coloured or yellow/white with a central punctum. They are usually found as a painless lump.

The appearance of many nodules under the skin could indicate neurofibromatosis. This condition is heralded by the presence of cafe au lait spots. Treatment is not required for this disease unless complications arise. The majority of these tumours are benign.

Possible causes

  • Malignancy
  • Wart
  • Lipoma
  • Dermatofibroma
  • Sebaceous cyst
  • Neurofibromatosis
  • Nodulocystic acne
  • Keloid scar

Resource

British Association of Dermatologists clinical guidelines www.bad.org.uk/healthcare/guidelines/

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