As we age, our skin undergoes many changes. One of the most noticeable is the increasing appearance of various growths. While the sight of new spots or bumps can be alarming, many are non-cancerous and a normal part of the aging process. The key is to know which are common and benign, and which require a closer look by a dermatologist.
Seborrheic Keratoses: The "Stuck-On" Growths
Seborrheic keratoses (SKs) are the most common benign skin tumors in older adults. They are so prevalent that some people refer to them as the "barnacles of aging." These growths are a natural and often genetic part of the aging process, not contagious, and are not caused by sun exposure, though they often appear on sun-exposed areas.
Appearance and Location
SKs vary widely in appearance but share some common features:
- Color: Tan, brown, or black.
- Texture: Often waxy, scaly, or rough, sometimes with a velvety or verrucous (wart-like) surface.
- Shape: Usually round or oval.
- "Stuck-On" Look: They often look as though they have been pasted or stuck onto the skin, and can sometimes be easily picked off with a fingernail.
- Location: Found most often on the chest, back, face, and scalp. They do not appear on the palms or soles of the feet.
Variants and Removal
A common variant is stucco keratosis, which appears as small, white, scaly papules, typically on the lower legs and ankles. While most SKs don't require treatment, removal is an option for cosmetic reasons or if they become irritated by clothing. Common removal methods include cryotherapy (freezing), electrocautery (burning), or shave excision.
Acrochordons: Soft Skin Tags
Skin tags are small, soft, and painless skin growths that are extremely common with age. They are often attached to the skin by a tiny stalk, or peduncle.
What They Look Like and Where They Appear
- Appearance: Flesh-colored to brownish, soft, and pendulous.
- Size: Usually very small, but can grow up to several millimeters.
- Location: Typically form in areas where skin rubs against itself or clothing, such as the neck, armpits, groin, and under the breasts.
Associated Conditions and Treatment
Skin tags are often associated with obesity, diabetes, and insulin resistance. While harmless, they can become irritated or twisted, cutting off their blood supply. Removal is simple and can be done with cryotherapy, cauterization, or snip excision, but should be performed by a medical professional.
Cherry Angiomas: Bright Red Spots
These are common vascular lesions that appear as small, bright red, or purplish bumps. Also known as Campbell de Morgan spots or senile angiomas, they increase in number with age.
Characteristics and Treatment
- Appearance: Small, round, bright red papules composed of tiny blood vessels. They can be flat or raised.
- Location: Most commonly appear on the trunk and extremities.
- Concern: While completely benign, they can bleed profusely if traumatized. They are usually removed for cosmetic reasons, often using laser therapy or electrocautery.
Dermatofibromas: Firm, Embedded Bumps
Often mistaken for moles, dermatofibromas are benign nodules that most often appear on the legs and arms. They are firm to the touch and can be reddish-brown or purple.
The "Dimple Sign"
A key distinguishing feature of a dermatofibroma is the "dimple sign." When lateral pressure is applied to the lesion, it dimples or retracts inward. This is because the growth is embedded in the dermis layer of the skin.
Causes and Management
These growths are believed to form in response to minor skin trauma, such as an insect bite. They are harmless and usually require no treatment. If removal is desired for cosmetic reasons or if the lesion is painful, surgical excision is necessary.
Comparison of Common Benign Growths in Older Adults
| Feature | Seborrheic Keratosis (SK) | Skin Tags (Acrochordons) | Cherry Angiomas | Dermatofibromas |
|---|---|---|---|---|
| Appearance | Waxy, scaly, "stuck-on" | Small, soft, fleshy, often with a stalk | Small, bright red/purple bumps | Firm, reddish-brown nodules |
| Texture | Rough, velvety, or warty | Soft, smooth | Smooth or slightly raised | Firm, embedded in skin |
| Location | Face, back, chest, scalp | Neck, armpits, groin, eyelids | Trunk, arms, legs | Lower legs, arms, upper back |
| Cause | Aging, genetics | Friction, obesity, aging | Aging, genetics, chemical exposure | Minor trauma (e.g., insect bite) |
| Diagnosis | Visual exam, dermoscopy | Visual exam | Visual exam, dermoscopy | Visual exam (dimple sign) |
| Treatment | Cryotherapy, electrocautery | Snip excision, cryotherapy | Laser, electrocautery | Excision if symptomatic |
| Malignant Risk | None | None | None | None |
Benign vs. Malignant: When to be Concerned
While most growths are harmless, it's critical to know the warning signs of skin cancer, especially melanoma. Regularly check your skin using the ABCDEs of melanoma:
- Asymmetry: One half of the spot is unlike the other half.
- Border: The lesion has an irregular, scalloped, or poorly defined border.
- Color: The spot has varying shades of brown, tan, black, or even red, white, or blue.
- Diameter: Melanomas are typically larger than 6 millimeters (the size of a pencil eraser) but can be smaller.
- Evolving: The mole or spot changes in size, shape, color, or elevation, or begins to bleed, itch, or crust.
Monitoring and Prevention
Annual skin exams by a dermatologist are a crucial part of senior health care. It's also wise to perform monthly self-checks to notice any changes in existing growths or the appearance of new ones. While genetic and age-related growths are not entirely preventable, reducing sun exposure can minimize the risk of developing sun-related growths and skin cancers.
For more information on monitoring skin growths and the differences between benign and malignant lesions, visit the American Academy of Dermatology <https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-what-to-look-for>_.
Conclusion
Many benign skin growths are an expected part of the aging process. Seborrheic keratoses, skin tags, cherry angiomas, and dermatofibromas are all very common and generally harmless. By becoming familiar with their characteristics, you can gain peace of mind and better understand your body's changes. The most important step for any suspicious or changing growth is a professional evaluation to ensure accurate diagnosis and appropriate care.
