Common Diagnoses - Help with Your Pathology Report

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When you look at a biopsy report, it can be overwhelming. Here is a list of very common diagnoses that are seen on pathology reports from skin biopsies. This is not meant to be medical advice, but it is meant to help explain what certain terms mean. The ultimate decision on the most appropriate treatment of your skin lesion must be made at the recommendation of your board-certified dermatologist.

• Actinic Keratosis: An actinic keratosis is a scaly spot found on sun-damaged skin. It is known to be a "pre-cancerous” lesion in that a percentage of these can go on to develop into squamous cell carcinoma if left untreated. If your biopsy shows actinic keratosis, the dermatologist will follow up by freezing it with liquid nitrogen. If you have many of these, we may consider a topical chemotherapy cream. Variants of these seen on a biopsy report include hypertrophic actinic keratoses (slightly thicker and more scaly) and pigmented actinic keratoses (small amount of color seen, which sometimes only visible to the dermatologist via dermoscopy).

• Acral nevus: An acral nevus is a nevus, or “mole,” on the palms or soles. These appear as small, usually flat, pigmented lesions, and they sometimes have linear striations that are visible either with the naked eye or via dermoscopy. Acral nevi are benign, but as with all moles, there is a chance of developing melanoma. If an acral nevus has severe “atypia” or atypical cells, an excision is usually recommended. It’s a good idea to keep an eye on the hands and feet as these are areas that are at risk for developing acral lentiginous melanoma, a particularly aggressive type of melanoma.

• Acrochordon: An acrochordon is also known as a skin tag. It is a small, soft, benign lesion that appears to hang off of the skin. They can be pedunculated (appear to hang from a stalk) at times, and they can sometimes become irritated or inflamed. Acrochordons are more common in skin folds, such as the armpits, the neck, and the groin area. They are sometimes also found underneath the breasts. No one knows exactly what causes skin tags, but chafing and rubbing of the skin appears to be a factor. They can also be seen when high levels of growth factor are present in the body, such as with acromegaly or with pregnancy, and sometimes they may be associated with insulin resistance. While occasionally a single tag may be removed via biopsy if it is irritated or inflamed, removal of numerous skin tags is considered a cosmetic procedure that is not covered by insurance.

• Angiofibroma: An angiofibroma is a benign growth, often on the face, that is composed of blood vessels and fibrous tissue. Most commonly they are solitary and acquired (show up later in life) on the face or nose, and are known as fibrous papules. They can also show up in the penis area, and in this case they are known as pearly penile papules. Occasionally patients can have numerous angiofibromas seen in a variety of genetic conditions. Angiofibromas are benign; however, if there are many similar lesions on the face, genetic evaluation may be warranted.