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INTRODUCTION

Patients present commonly to the dermatologist for new skin growths noticed in order to determine their etiologic and biologic nature. In Singapore, the population is multi-racial and multi-ethnic with a myriad of natural skin colors ranging from the lighter-skinned Chinese and Eurasians to the darker-skinned Malays and Indians. The appearance of skin tumors between these groups may vary, making an accurate diagnosis challenging at times.

CLASSIFICATION

A skin tumor is defined as an abnormal mass of tissue derived from the epidermis, dermis, or subcutis. Based on their biologic behavior, they are classified as benign, pre-malignant, or malignant. A histopathology, aided by the appropriate stains, will provide further clues to the tissue or cell of origin and help confirm the final diagnosis.

CLINICAL APPROACH

Skin tumors may be defined based on their layer of origin. Epidermal lesions are often accompanied by surface changes of crusting, scaling, and verrucous thickening. Dermal and subcutaneous tumors usually have no discernible surface change. The rate and pattern of growth contribute to the clinical appearance. A skin tumor may present as a slowly expanding patch or plaque or a rapidly growing nodule. Characteristics such as age of the patient, distribution/site, borders, color, pigmentary network, and tumor consistency allow clinical differentiation of skin tumors. Other important considerations include background racial pigmentation, amount of sun damage, and associated signs (e.g., bleeding) that may indicate a more sinister etiology. For some tumors, e.g., pigmented lesions, dermoscopy is an invaluable tool that may help the clinician further determine the nature of the lesions he is dealing with. The clinical approach to skin tumors based on their key characteristics is highlighted in Table 11.1.

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