Where do hyperplasia lesions typically begin and how do they progress?

• A. Lesions start at the MCJ and move out on exposed, irritated skin
• B. Begin at the stoma site center
• C. Spread inward toward the stoma
• D. Appear only at the peristomal margin

Answer: (A)

Hyperplasia around a stoma starts as a reactive overgrowth of skin at the mucocutaneous junction, the area where the stoma meets the skin. Irritation from stool, moisture, friction, or an ill-fitting appliance drives this response most strongly at that junction. Because that interface is where the skin first contacts the stoma and its output, the lesion typically begins there and then progresses outward onto the surrounding exposed peristomal skin as irritation persists. It’s not expected to originate in the center of the stoma, and it doesn’t usually spread inward toward the stoma, nor is it limited only to the peristomal margin. Recognizing this outward progression from the MCJ helps guide skin-care approaches—addressing appliance fit, managing moisture and friction, and protecting the peristomal skin to prevent further growth and skin damage.