Benign Lesions

Lipoma

• Asymptomatic. Slow growing 
• Dome or egg-shaped, soft, mobile sub-cutaneous nodule 

Epidermoid (sebaceous) cyst 

• Smooth mobile flesh coloured nodule within and fixed to overlying skin 
• Presence of punctum helps confirm diagnosis 

Spider haemangioma 

• Compressible central feeding blood vessel of variable size 
• May be associated with high levels of oestrogen e.g pregnancy, liver cirrhosis 

Xanthelasma

• Yellowish plaques nodules above and below the eyes 

Giant comedones 

• Like a small cyst with punctum 

Pyogenic granuloma 

• Rapidly growing vascular lesion often trauma site 

Skin Tags 

• Soft flesh coloured or pigmented pedunculated tags in body folds (neck, armpit, groin) 
• Especially in obese patients and in those with type 2 diabetes 

Seborrhoeic Warts

• Yellow / brown greasy palpules or rough grey / black hyperkeratotic papules with ‘stuck-on’ appearance 
• Keratin plugs or inclusion cysts may help differentiate from melanoma 
• Often multiple 

Benign Naevi (moles)

• Flat or raised, symmetrical, uniform border, uniform pigment, pale, dark or reddish brown 
• May darken/enlarge during pregnancy.  If hairy may become inflamed (folliculitis) 

Dermatofibroma 

• Firm reddish brown nodules often on the limbs. May be tender on pressure 
• If the skin over a dermotofibroma is squeezed a dimple forms, indicating tethering of the skin to the underlying fibrous tissue 

Referral of patients with benign tumours may be appropriate if there is: 

• Diagnostic doubt 
• Significant risk of neoplasm 
• Lesion causing functional problems or significant disfiguration 
• Lesion prone to recurrent infection 

If benign skin lesion is diagnosed, it will not be removed in secondary care for cosmetic reasons alone. 

National guidance on exceptional referral protocol is available here: 

https://www.publications.scot.nhs.uk/files/cmo-2019-05.pdf 

Lipoma

• Symptomatic lesions may be removed in primary care (where this service is offered), but treatment usually not indicated 

Epidermal (sebaceous) cyst 

• Treatment not usually indicated. Symptomatic cysts may be removed in primary care (where this service is offered). 

Spider haemangioma

• No treatment as they may resolve spontaneously, especially in children 

Xanthelasma

• Reassure patient, no treatment required 

Giant comedones

• Reassure patient, content often easily expressed 

Pyogenic granuloma

• Due to frequent bleeding, excision or curettage/cautery required 
• Caution with lesions with an atypical history or appearance as could be a malignancy 

Skin tags 

• If symptomatic, consider treatment in Primary Care by cryotherapy (if available) or snip/shave + cautery (where this service is offered).  

Seborrhoeic Warts

• If diagnosis certain, reassure that no treatment is needed 
• Treatment in Primary Care (where this service is offered), can be considered for symptomatic lesions: 

• • Cryotherapy administrated by trained nurse 
  • Curettage for large lesions  

• Specimen to pathology 

Benign Naevi (moles)

• Do not refer patients with moles for cosmetic removal 
• Excise or shave benign naevi only if they meet the criteria as outlined in the exceptional referral pathway: 

https://www.publications.scot.nhs.uk/files/cmo-2019-05.pdf   

Dermatofibroma 

• If diagnosis is certain, reassure that no treatment is needed 
• Excision, if indicated e.g. significant pain or discomfort, is the treatment of choice 
• Warn patient about resulting scar 
• Send specimen to pathology 

Criteria for referral

Lipoma

• Lipoma only if there is diagnostic doubt 

Epidermal (sebaceous) cyst

• If  diagnostic doubt 

Spider haemangioma

• Referral not generally required 
• Cautery, hyfrecation or laser only in exceptional circumstances 

Xanthelasma

• Exceptionally consider referral 

Giant comedones

• Referral not generally required 

Pyogenic granuloma

• Diagnostic doubt, or for excision 

Skin Tags

• Rarely any indication for referral to secondary care 

Seborrhoeic Warts

• Referral only if there is diagnostic doubt. Follow pathway for suspicious pigmented lesion 

Benign Naevi (moles)

• Referral only if there is diagnostic doubt. Follow pathway for suspicious pigmented lesion. 

Dermatofibroma

• Referral only if there is diagnostic doubt 

• NHS Inform Tel: 0800 224 488 www.nhsinform.co.uk 
• NHS24 Tel: 08454 242424 
• Primary Care Dermatology Service: http://www.pcds.org.uk/ 
• Dermnet nz: http://www.dermnetnz.org/ 
• BAD patient information sheets: https://cdn.bad.org.uk/uploads/2023/11/19173954/QR-Code-PILs_UPDATED-8_11_23.pdf 

Images for the ‘Skin Tags’, ‘Seborrhoeic Warts’, ‘Benign Naevi (moles)’, and ‘Dermatofibroma’ reproduced with permission from http://www.dermnetnz.org/