29- SubQ, Sweat G,Hair, Epith Tumors

Question 1

Sharply circumscribed yellow orange hamartoma

Solitary, congenital, linear
Scalp-most common location
Lesions persist through life

Answer 1

Nevus sebaceous

Question 2

Neoplasms that have been described as arising from nevus sebaceous

Answer 2

Trichoblastoma

Syringocystadenoma papilliferum

Question 3

Treatment for nevus sebaceous

Answer 3

Surgical removal

Question 4

Small cream colored/yellowish umbilicated papules

Occurs after age 40
Favors forehead, infraorbital and temples

Answer 4

Sebaceous hyperplasia

Question 5

Prominent sebaceous hyperplasia occurs in 15% of patients taking this drug

Answer 5

Cyclosporine

Question 6

Treatment for sebaceous hyperplasia

Answer 6

Purely for cosmetic reasons
Electrosurgery
Laser
PDT

Question 7

Sebaceous carcinoma is a rare tumor that usually occur on

Answer 7

Eyelid or around the eye

Question 8

This syndrome is now recognized as a subset of the Lynch syndrome/ hereditary nonpolyposis colorectal CA syndrome (HNCCS)

Sebaceous tumor + internal malignancy

Answer 8

Muir-Torre Syndrome (MTS)

Question 9

Most common malignancy associated with MTS and Lynch syndrome

Answer 9

Colonic adenocarcinoma

Question 10

Small papules, yellow, brown or pink
Demonstrates sweat duct differentiation

Frequently occurs on eyelids and upper cheeks

Answer 10

Syringoma

Question 11

Treatment for syringoma

Answer 11

Very light electrodessication
Shave removal
CO2 laser

Question 12

Translucent cystic papules that may have a bluish tint

Eccrine or apocrine differentiation

Solitary, more common in women
Most often periocularly (face or scalp area)

Answer 12

Hidrocystoma

Question 13

Benign slow growing slightly protruding soft sessile reddish tumor that usually occurs on the sole or side of the foot

Bleed on slight trauma
Cup shaped shallow depression from which the tumor grows

Answer 13

Poroma

Question 14

Most common form of sweat duct carcinoma

Answer 14

Malignant acrospiroma

Question 15

Solitary deep seated nodule covered with normal appearing skin

Usually occurs in ventral surface of the body (esp upper half)
15-35 years old
May mets to regional lymph nodes or hema

Answer 15

Spiradenoma

Question 16

This condition may occur with spiradenoma together in the same patient

Answer 16

Cylindroma

Question 17

Firm, rubberlike pink-blue tumor that usually occurs on the face and scalp as a solitary lesion

Answer 17

Cylindroma

Question 18

Very slow growing plaque or nodule

Head and neck- favor midface and periorbital area, predilection for left side
Upper lip more often than lower

Long term sun exposure msy play a role
Perineural invasion common

Answer 18

Microcystic adnexal carcinoma

Sclerosing sweat duct carcinoma

Question 19

Derived from hair matrix cells, bimodal age distribution (1st and 6th decades)

Single lesion on face neck or proximal upper extremity
Asymptomatic, deeply seated firm nodule covered by normal or pink skin
Overlying epidermal atrophy common

Answer 19

Pilomatricoma

Question 20

Small dome shaped nodule with a small wisp of fine vellus hairs that protrude through a central pore

Highly structured tumor of the pilosebaceous unit

Answer 20

Trichofolliculoma

Question 21

Autosomal dominant
Familial cylindroma or multiple familial trichoepithelioma

Multiple cystic and solid papules on the face
Often symmetrical
Small round smooth shiny slightly translucent firm papules or nodules

Answer 21

Brooke-Spiegler syndrome

Question 22

Firm slightly indented (central dell sign) with a raised annular border
skin colored dermal tumor

Affects young women

Focal calcifications, horn cysts and central dell favor this dx

Answer 22

Desmoplastic trichoepithelioma

Question 23

Benign neoplasm of follicular germinative cells

Asymptomatic nodules in the deep dermis or subcutaneous tissue, may be pigmented
Scalp most common site, occur in adult

Arise in organoid nevi and represent majority of basaloid neoplasms described as BCC in nevus sebaceus

Answer 23

Trichoblastoma

Question 24

Benign neoplasm that differentiates towards cells of outer root sheath

Small solitary papule on the face (nose and cheeks)

Answer 24

Trichilemmoma

Question 25

Multiple trichilemmoma may be a marker for this autosomal dominant condition

Answer 25

Cowden syndrome

Question 26

Mucocutaneous diagnostic criteria for Cowden syndrome include

TAP the Cow

Answer 26

Trichilemmoma
Acral keratoses
Papillomatous papules
Mucosal lesions

Question 27

Mucosal lesions in Cowden Syndrome occur in 80% of patients and usually involve

Answer 27

Buccal

Gingival

Question 28

Malignancies associated with Cowden Syndrome

Answer 28

Breast
Endometrial
Thyroid

Question 29

Cowden Syndrome is caused by a mutation in this tumor suppressor gene

Answer 29

PTEN

Question 30

Smooth compressible cystic mass
Shiny, freely movable
Usually from plugging of follicular orifice, pasty contents cheesy consistency and with pungent odor, may rupture

Usually on face neck and trunk

Answer 30

Epidermal inclusion cyst

Question 31

Treatment for epidermal inclusion cyst

Answer 31

Surgical excision
“Daughter cysts” must be removed- enucleation and scraping with curette

Remove cyst lining- 20%TCA

Question 32

Similar to an epidermoid cyst clinically except that about 90% occur on the scalp

Women over age 60 are predominantly affected and it’s more mobile and firmer than epidermoid cysts

Answer 32

Pilar cyst (trichilemmal cyst)

Question 33

This is a large and exophytic neoplasm confined almost exclusively to the scalp and back of the neck.

Up to 25cm in size, more common in women age 65

Answer 33

proliferating pilar cyst

Question 34

This occurs in the midline sacral region at the upper end of the cleft of the buttocks

becomes symptomatic during adolescence due to inflammation

Often occurs with nodulocystic acne, dissecting cellulitis and hidradenitis suppurativa

Answer 34

Pilonidal cyst

Question 35

Keratinous cysts 1-4mm
White, can occur congenitally (resolve in weeks)

Can also occur due to trauma (chemical peels, dermabrasion, laser), long term use of occlusive moisturizer or topical steroids

Answer 35

Milia

Question 36

Treatment for milia

Answer 36

Incision and expression of contents :
Blade 11
Cutting tip hypodermic needle
Comedo extractor