Skip to content
Back to all posts

Estrogen-Related Skin Tumors – Connection to Gender transition?

- In: Clinical Practice

I recently had a male-to-female transitioning (MTF) patient present with a 2cm painless, protruding, red, friable tumor on the chest. This appeared roughly two months after initiating estrogen therapy. The lesion was surrounded by a strikingly erythematous, 10cm painless plaque. The central mass was saucerized and sent for pathologic evaluation. After extensive path testing, the final diagnosis was pyogenic granuloma. The lesion began resolving spontaneously after biopsy and was significantly improved at a 3-week follow-up. Topical steroids were prescribed for the remainder of the healing process to reduce the chance of recurrence. While I was relieved that this lesion was benign, it increased my awareness of estrogen-related skin tumors (ERST).


As dermatology professionals, it is imperative to stay informed about the various factors influencing skin health, including hormone therapies. Estrogen therapy, widely used for menopausal symptoms, hormone replacement, and gender transition MTF, has notable implications for the development of ERST.


Estrogen plays a crucial role in skin physiology, affecting thickness, elasticity, and moisture levels. However, exogenous estrogen can induce cellular changes with potential oncogenic effects. Understanding these dynamics is essential for effective patient management.


Estrogen receptors are prevalent in the skin, and their activation through estrogen therapy can alter cell proliferation and differentiation. Prolonged exposure to estrogen has been associated with an increased risk of both benign and malignant skin tumors. Benign conditions include seborrheic keratoses or pyogenic granuloma(1 ), while malignant tumors like melanoma2 and squamous cell carcinoma3 pose more severe health risks.


For MTF patients, the use of estrogen therapy introduces unique considerations. Transgender individuals may require long-term, high-dose estrogen therapy to achieve desired physical changes, potentially heightening their risk for ERST. This population necessitates diligent dermatological surveillance due to the extended and intensive nature of their hormone treatment.


Due to an increased potential for melanoma(2), it is important to educate MTF patients about the importance of regular skin checks and prompt reporting of any new or changing lesions. Similarly, SCC can become invasive and should be closely monitored in patients on estrogen therapy.


Dermatology professionals should conduct thorough skin examinations and maintain a high index of suspicion for atypical growths in patients undergoing estrogen therapy. Implementing a proactive approach, including patient education on self-examination and routine dermatologic assessments, is vital.




References:

  1. Walker JL, Wang AR, Kroumpouzos G, Weinstock MA. Cutaneous tumors in pregnancy. Clin Dermatol. 2016 May-Jun;34(3):359-67. doi: 10.1016/j.clindermatol.2016.02.008. Epub 2016 Feb 9. PMID: 27265074.
  2. Dika E, Patrizi A, Lambertini M, Manuelpillai N, Fiorentino M, Altimari A, Ferracin M, Lauriola M, Fabbri E, Campione E, Veronesi G, Scarfì F. Estrogen Receptors and Melanoma: A Review. Cells. 2019 Nov 19;8(11):1463. doi: 10.3390/cells8111463. PMID: 31752344; PMCID: PMC6912660.
  3. Tang JY, Spaunhurst KM, Chlebowski RT, Wactawski-Wende J, Keiser E, Thomas F, Anderson ML, Zeitouni NC, Larson JC, Stefanick ML. Menopausal hormone therapy and risks of melanoma and nonmelanoma skin cancers: women's health initiative randomized trials. J Natl Cancer Inst. 2011 Oct 5;103(19):1469-75. doi: 10.1093/jnci/djr333. Epub 2011 Aug 30. PMID: 21878677; PMCID: PMC3186783.


Mark Hyde is a dermatology PA at the University of Utah. He has extensive training and experience in skin cancer/melanoma risk, diagnosis and treatment. Outside of work, Mark enjoys spending time with his family, watching University of Utah sports, and doing anything outdoors.