Image Gallery - Common Skin Masses - Clinician's Brief

26/8/2019 Image Gallery: Common Skin Masses | Clinician's Brief
Image Gallery: Common Skin

Masses
Elizabeth R. May, DVM, DACVD, University of Tennessee
DERMATOLOGY | JANUARY 2018 | PEER REVIEWED | WEB-EXCLUSIVE
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Although most skin tumors encountered in veterinary patients are benign, malignant tumor
types do occur. Because many are erythematous and pruritic, they can be easily confused
with commonly diagnosed pruritic conditions (eg, scabies, allergic disease). e following
tumors are commonly misdiagnosed based on their gross appearance.
FIGURE 1 Nodular sebaceous hyperplasia
Benign sebaceous gland tumor on the lateral thorax of a dog.

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26/8/2019
Sebaceous gland tumors develop anywhere sebaceous glands
Image Gallery: Common Skin Masses | Clinician's Brief
are present, but occur primarily on the limbs and trunk; they
can cause discomfort if they become secondarily infected.
Sebaceous gland tumors are o en observed on canine skin
and infrequently on feline skin. These tumors have a
recognizable wart-like appearance, but unlike papillomatous
skin lesions, do not have a known viral cause. Although most
sebaceous gland tumors are classified as the nodular
sebaceous hyperplasia type, other types of sebaceous gland
tumors—including sebaceous epithelioma, sebaceous
adenoma, and sebaceous adenocarcinoma—are
di erentiated by distinctive histologic features.
FIGURE 2 Cutaneous papilloma, ventral surface of tail
Solitary, raised, keratinized mass on the tail of a dog. This

papilloma has an irregular fronded appearance and a whitish
gray-to-yellowish color. Its location (the underside of the tail
of a long-haired dog) is considered unusual for development
of a cutaneous papilloma, which are more frequently
encountered on the head or limbs of dogs. Because of its
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similarity in clinical appearance to other neoplastic skin
lesions, particularly squamous cell carcinoma (SCC), this

lesion was surgically removed and submitted for
histopathology for definitive diagnosis.
FIGURE 3 Canine oral papilloma
Grayish, shiny, solitary pedunculated mass originating from

the lip margin of a young dog. Note the classic cauliflower
appearance of this mass caused by a papillomavirus as
compared with the appearance of the tail mass shown in
Figure 2. This benign skin tumor occurs frequently in young
(ie, <2 years of age) dogs and usually spontaneously regresses
within a few months. Surgical excision may be necessary if
multiple masses are present. If lesions become ulcerated,
surgical removal and histopathology should be considered to
prevent transformation into SCCs. While considered
uncommon, progression of papilloma to SCC can occur and
has been previously reported.1
FIGURE 4 Interdigital cyst
Dorsal (A) and plantar (B) appearance of a large keratinized

interdigital cyst on the foot of a boxer. Especially important
for successful treatment is recognizing that the problematic
cyst is located interdigitally on the plantar surface of the foot,
whereas the connecting draining tract and much of the
observable inflammation and subsequent discomfort is
present on the dorsal aspect. Treating the draining tract
without addressing the primary problem by completely
removing the cyst from the plantar aspect of the foot could
result in recurrence of clinical signs.
FIGURE 4 Interdigital cyst
Dorsal (A) and plantar (B) appearance of a large keratinized

interdigital cyst on the foot of a boxer. Especially important
for successful treatment is recognizing that the problematic
cyst is located interdigitally on the plantar surface of the foot,
whereas the connecting draining tract and much of the
observable inflammation and subsequent discomfort is
present on the dorsal aspect. Treating the draining tract
without addressing the primary problem by completely
removing the cyst from the plantar aspect of the foot could
result in recurrence of clinical signs.
FIGURE 5 Feline squamous cell carcinoma in situ, Bowen

disease
SCC in situ in a cat. SCCs are malignant cutaneous neoplasms

routinely diagnosed in dogs and cats. Lightly pigmented dogs
and cats can develop neoplastic skin lesions resulting from
ultraviolet light exposure. However, SCCs in situ (ie, Bowen
disease) are less common in cats and develop regardless of
ultraviolet light exposure. Note that this lesion, located above
the le eye, is plaque-like and pigmented, which is atypical of
SCC neoplasms. Lesions consistent with those of Bowen
disease are multiple in number and frequently located on the
head but can also be located on the skin of the neck, dorsal
trunk, and limbs. As lesions progress, they can bleed easily
with minimal manipulation.
FIGURE 6 Fibrovascular papillomas, multiple (skin tags)
Benign tumors in a dog. In this patient, multiple skin tags

(fibrovascular papillomas) are located on the skin of the
sternum and ventral thorax. The tags are more numerous on
the sternum and thus are likely associated with chronic
friction or pressure. The pedunculated and pigmented
appearance may resemble papilloma-induced viral
pigmented plaques, which have been reported in pugs and
miniature schnauzers. In contrast, fibrovascular papillomas
are not associated with papillomavirus infection, despite the
nomenclature, and do not cause clinical problems beyond
altered cosmetic appearance.
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FIGURE 7 Fibrovascular papilloma, single (skin tag)
Unusual fibrovascular papilloma in a dog. This skin tag is focal

and not located in an area of known friction or trauma. The
narrow stalk and solitary nature of the lesion made it easy to
remove via CO2 laser excision. There was no evidence of
regrowth or development of new lesions 2 years later.
FIGURE 8 Milia
Groups of milium cysts (ie, milia) in a dog. These cysts

develop when keratin is trapped beneath the skin surface and
accumulates into thin-walled cystic structures. Development
of milia in dogs is consistent with steroid excess, similar to
that associated with spontaneous or iatrogenic
hypercortisolemia, and is particularly common a er
application of topical corticosteroids. In this dog, multiple
very large milia are present in a locally extensive area because
of repeated application of a potent topical steroid spray. The
well demarcated a ected area of skin suggests previous
application of a product to this location. In addition, note the
large dilated comedones and evidence of cutaneous atrophy,
as demonstrated by prominent blood vessels and a crepe-
paper appearance of the skin.
FIGURE 9 Epitheliotropic lymphoma, feline
Cutaneous lymphoma located along the medial aspect of the

le thoracic limb in a cat. These lesions are pruritic and
improve with corticosteroid therapy, making them easily
mistaken for eosinophilic plaques, which are steroid-
responsive pruritic lesions common in cats. Surface cytology
of cutaneous lymphoma neoplasms is not predominantly
eosinophilic in nature and, therefore, is not consistent with
cytology of an eosinophilic plaque. Findings should prompt
the clinician to consider other diagnostic di erentials and
pursue skin biopsy.
26/8/2019
FIGURE 10 Epitheliotropic lymphoma, canine
Cutaneous lymphoma lesions located in the inguinal region of

a dog. Patients with this type of lesion are intensely pruritic,
and lesions can be very similar in clinical appearance to
lesions caused by staphylococcal pyoderma, demodicosis, or
dermatophytosis. Note the erythematous borders of these
lesions along with the circular rims of scale along the
periphery and varying degrees of hyperpigmentation. These
features are similar to a bacterial skin infection secondary to
allergic dermatitis. Epitheliotropic lymphoma is more
common in dogs more than 10 years of age; however, the
pruritus associated with this disease may be steroid-
responsive, and progression of the disease is slow, which may
complicate diagnosis.
FIGURE 11 Mast cell tumor, feline
Cutaneous mast cell tumor (MCT) in a cat. Note the discrete

raised masses above both eyes, one of which has surface crust
formation. MCTs in cats occur much more commonly on the
skin of the head and neck; although discrete masses are more
obvious, some patients present with areas of indistinct
swelling or lesions that appear more like sebaceous gland
tumors when near the eye itself.
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FIGURE 12 Mast cell tumor, canine
Cutaneous MCT in a dog. On initial examination, the MCT on

the lateral aspect of the head has a very similar clinical
appearance to that of pyotraumatic dermatitis. However,
cytology findings were not primarily neutrophilic with
intracellular and extracellular cocci, as would be expected
with a diagnosis of pyotraumatic dermatitis. Instead, the mast
cells were poorly di erentiated without granules, making
cytologic diagnosis challenging when compared with findings
for most canine cutaneous MCTs.
REFERENCES
1. Watrach AM, Small E, Case MT. Canine papilloma: progression of oral papilloma
to carcinoma. J Natl Cancer Inst. 1970;45(5):915-20.
SUGGESTED READING
Cli ord CA. Neoplastic and non-neoplastic tumors. In: Miller WH, Gri n CE,
Campbell KL, eds. Muller and Kirk’s Small Animal Dermatology. 7th ed.
26/8/2019 Image 2012:774-843.
Philadelphia, PA: WB Saunders; Gallery: Common Skin Masses | Clinician's Brief
Duclos DD, Hargis AM, Hanley PW. Pathogenesis of canine interdigital palmar
and plantar comedones and follicular cysts, and their response to laser surgery.
Vet Dermatol. 2008;19(3):134-141.
Teifke JP, Löhr CV, Shirasawa H. Detection of canine oral papillomavirus-DNA in

canine oral squamous cell carcinomas and p53 overexpressing skin papillomas of
the dog using the polymerase chain reaction and non-radioactive in situ
hybridization. Vet Microbiol. 1998;60:119-130.
AUTHOR
Elizabeth R. May
DVM, DACVD
University of Tennessee
Elizabeth R. May, DVM, DACVD, is an associate professor of small animal dermatology

at University of Tennessee. She earned her DVM from Texas A&M University and
completed a dermatology residency at University of Tennessee. Dr. May’s main area of
concentration is treatment of otitis in companion animals.
For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units
can be found here.
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26/8/2019 Image Gallery: Common Skin Masses | Clinician's Brief

Image Gallery: Common Skin

DERMATOLOGY | JANUARY 2018 | PEER REVIEWED | WEB-EXCLUSIVE

FIGURE 1 Nodular sebaceous hyperplasia

Benign sebaceous gland tumor on the lateral thorax of a dog.

FIGURE 2 Cutaneous papilloma, ventral surface of tail

Solitary, raised, keratinized mass on the tail of a dog. This

lesions, particularly squamous cell carcinoma (SCC), this

FIGURE 3 Canine oral papilloma

Grayish, shiny, solitary pedunculated mass originating from

FIGURE 4 Interdigital cyst

Dorsal (A) and plantar (B) appearance of a large keratinized

FIGURE 4 Interdigital cyst

Dorsal (A) and plantar (B) appearance of a large keratinized

FIGURE 5 Feline squamous cell carcinoma in situ, Bowen

SCC in situ in a cat. SCCs are malignant cutaneous neoplasms

FIGURE 6 Fibrovascular papillomas, multiple (skin tags)

Benign tumors in a dog. In this patient, multiple skin tags

Unusual fibrovascular papilloma in a dog. This skin tag is focal

Groups of milium cysts (ie, milia) in a dog. These cysts

FIGURE 9 Epitheliotropic lymphoma, feline

Cutaneous lymphoma located along the medial aspect of the

Cutaneous lymphoma lesions located in the inguinal region of

FIGURE 11 Mast cell tumor, feline

Cutaneous mast cell tumor (MCT) in a cat. Note the discrete

FIGURE 12 Mast cell tumor, canine

Cutaneous MCT in a dog. On initial examination, the MCT on

Teifke JP, Löhr CV, Shirasawa H. Detection of canine oral papillomavirus-DNA in

Elizabeth R. May, DVM, DACVD, is an associate professor of small animal dermatology

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