3/10 Benign Skin Lesions Flashcards
What is a Nevus? What are the various types? (3)
- benign, circumscribed overgrowth of cells composed of tissue elements; aka “birthmarks”
- can be acquired (usually before 30yo) or congenital (present at birth)
3 Types
• junctional – at the DEJ (but in the epidermis)
• compound - in both epidermis and dermis
• intradermal – in the dermis
What is a Seborrheic keratosis?
How is it treated?
- benign epidermal growth that can arise anywhere body surfaces except palms and soles; often multiple and can be extensive
- lesions do not go away on its own
- waxy character with a “stuck on” appearance - glob of wax smushed onto the skin (scratching the lesion reveals its waxy character)
Treatment
- curette (picked off)
- electrodessication
- liquid N2
What are the 2 variants of Seborrheic keratosis?
Dermatosis papulosa nigra
- Common with darker skin
- Strong familial tendency
Stucco Keratoses
- small white-gray SK’s that pepper the dorsal feet and ankles of older, fair skinned individuals
What are Acrochordons?
What are the risk factors for these lesions?
If a patient who is obese comes in with these skin tags, what should you do?
How are these treated?
“skin tags”
- fleshy papules that arise in areas where there is friction (axillae, neck, groin, and eyelids)
- often pendunculated
- risk factors: obesity, friction, genetics
- Can be a marker for insulin resistance/DM (like acanthosis nigricans), so get a fasting blood glucose, esp if the patient is overweight
Treatment
- snipping
- Liquid N2 (may result in hypopigmentation)
- electrodessication
- occasionally skin tags will outgrow their blood supply or become torsed such that they necrose and fall off on their own
What are Cherry Angiomas?
What can cherry angiomas be confused with?
- benign lesions that develop in areas of high friction, usually in the trunk (chest/back
- common around age 30; likely to develop more with age
- Occasionally cherry angiomas may bleed or thrombose, thereby mimicking melanoma – “When in doubt, cut (or refer) it out”
What are Dermatofibroma? What are some maneuvers that you can do to confirm?
- spindle cell dermal proliferation; looks and feels like a wad of scar tissue
- Peripheral rim of darkening pigment is common
- tends to occur in the legs, possibly due to minor skin insults (esp. women who shave)
Dimple Sign = lesion tends to dimple down due to that scar-like tethering of the dermis
What are Solar lentigines? What should worry about if you see them? How do you treat them?
“sun spots”
“liver spots”
“age spots”
- blemishes on the skin associated with aging and exposure to ultraviolet radiation from the sun
- NOT cancerous or precancerous, BUT extensive solar lentigines indicate a history of UV exposure, and therefore can identify patients at risk for skin cancer
- if you see an “ugly duckling”, differentiate from melanoma using ABCDEs
Treatment: - none required, but there are cosmetic treatments available (bleaching creams, liquid nitrogen, chemical peels, lasers…) - first step: sun protection
What is Sebaceous hyperplasia?
What should you worry about if you see these?
How do you tell the difference?
How is it treated?
sebaceous gland overgrowth
- lesions are skin-colored or slightly yellow, umbilicated smooth papules on forehead and central face (umbilication is due to gland growth around a central hair follicle)
- patients tend to accumulate more with age
- hard to differentiate with basal cell carcinoma!
(BCC tends to be solitary, more friable (bleeds, scabs) and often pearly translucent, often with telangiectasia)
when in doubt, get a - not medically required and is cosmetic
What is a keloid?
How is it treated?
- overgrowth of scar tissue beyond the original scar site
- common on upper trunk and earlobes
- genetic influence (most common in African-Americans)
Treatment - inject it with steroid - DO NOT excise it because it will come back bigger than it was before
What is an Epidermal inclusion cyst?
How is it treated?
- arise from hair follicles (not sebaceous glands) to form mobile subcutaneous nodules, often with an overlying punctum
- debris (dead skin cells, oil, etc.) collects within a sack, and may result in a foul smelling cheesy white material
- Ruptured EIC tends to be sterile, but it may induce an inflammatory reaction that lead to abscess formation; requires drainage
Treatment: surgical excision
What is a miia?
How is it treated?
- tiny epidermoid cyst - often forms on the face
Treatment - extraction (does not scar)
What is a pilar cyst?
How is it treated?
- Firm, mobile subcutaneous nodules, lacking punctum that does not discharge any material (compared to an EIC, less likely to rupture or get inflamed b/c there’s no punctus)
- Nearly always on the scalp and can cause hair follicle loss due to pressure buildup
- Slowly enlarges over months to years
Treatment - excision
What is a Lipoma?
How do you treat it?
How do you differentiate it from a pilar cyst?
- soft, mobile subcutaneous nodule without any overlying skin change
- Often solitary, frequently on the trunk and proximal extremities
- If familial (AD inheritance), lipomas tend to be multiple and begin in early adulthood
Treatment: excision
What is this?
What are the various types? (3)
NEVUS
- benign, circumscribed overgrowth of cells composed of tissue elements; aka “birthmarks”
- can be acquired (usually before 30yo) or congenital (present at birth)
3 Types
• junctional – at the DEJ (but in the epidermis)
• compound - in both epidermis and dermis
• intradermal – in the dermis
What is this?
How is it treated?
Seborrheic keratosis
- benign epidermal growth that can arise anywhere body surfaces except palms and soles; often multiple and can be extensive
- lesions do not go away on its own
- waxy character with a “stuck on” appearance - glob of wax smushed onto the skin (scratching the lesion reveals its waxy character)
Treatment
- curette (picked off)
- electrodessication
- liquid N2
What is this?
2 variants of Seborrheic keratosis
Dermatosis papulosa nigra
- Common with darker skin
- Strong familial tendency
Stucco Keratoses
- small white-gray SK’s that pepper the dorsal feet and ankles of older, fair skinned individuals
What is this?
What are the risk factors for these lesions?
If a patient who is obese comes in with these skin tags, what should you do?
How are these treated?
Acrochordons “skin tags”
- fleshy papules that arise in areas where there is friction (axillae, neck, groin, and eyelids)
- often pendunculated
- risk factors: obesity, friction, genetics
- Can be a marker for insulin resistance/DM (like acanthosis nigricans), so get a fasting blood glucose, esp if the patient is overweight
Treatment
- snipping
- Liquid N2 (may result in hypopigmentation)
- electrodessication
- occasionally skin tags will outgrow their blood supply or become torsed such that they necrose and fall off on their own
What are these things?
What can they be confused with?
Cherry Angiomas
- benign lesions that develop in areas of high friction, usually in the trunk (chest/back
- common around age 30; likely to develop more with age
- Occasionally cherry angiomas may bleed or thrombose, thereby mimicking melanoma – “When in doubt, cut (or refer) it out”
What is this?
What are some maneuvers that you can do to confirm?
Dermatofibroma
- spindle cell dermal proliferation; looks and feels like a wad of scar tissue
- Peripheral rim of darkening pigment is common
- tends to occur in the legs, possibly due to minor skin insults (esp. women who shave)
Dimple Sign = lesion tends to dimple down due to that scar-like tethering of the dermis
What are these lesions called?
What should worry about if you see them?
How do you treat them?
Solar lentigines
“sun spots”
“liver spots”
“age spots”
- blemishes on the skin associated with aging and exposure to ultraviolet radiation from the sun
- NOT cancerous or precancerous, BUT extensive solar lentigines indicate a history of UV exposure, and therefore can identify patients at risk for skin cancer
- if you see an “ugly duckling”, differentiate from melanoma using ABCDEs
Treatment: - none required, but there are cosmetic treatments available (bleaching creams, liquid nitrogen, chemical peels, lasers…) - first step: sun protection
What is this?
What should you worry about if you see these?
How do you tell the difference?
How is it treated?
Sebaceous hyperplasia
sebaceous gland overgrowth
- lesions are skin-colored or slightly yellow, umbilicated smooth papules on forehead and central face (umbilication is due to gland growth around a central hair follicle)
- patients tend to accumulate more with age
- hard to differentiate with basal cell carcinoma!
(BCC tends to be solitary, more friable (bleeds, scabs) and often pearly translucent, often with telangiectasia)
when in doubt, get a - not medically required and is cosmetic
What is this?
How is it treated?
Keloid
- overgrowth of scar tissue beyond the original scar site
- common on upper trunk and earlobes
- genetic influence (most common in African-Americans)
Treatment - inject it with steroid - DO NOT excise it because it will come back bigger than it was before
What is this?
How is it treated?
Epidermal Inclusion Cyst
- arise from hair follicles (not sebaceous glands) to form mobile subcutaneous nodules, often with an overlying punctum
- debris (dead skin cells, oil, etc.) collects within a sack, and may result in a foul smelling cheesy white material
- Ruptured EIC tends to be sterile, but it may induce an inflammatory reaction that lead to abscess formation; requires drainage
Treatment: surgical excision
What is this?
How is it treated?
miia
- tiny epidermoid cyst - often forms on the face
Treatment - extraction (does not scar)
What is this?
How is it treated?
What is it easily confused with? How do you tell the difference??
Pilar cyst
- Firm, mobile subcutaneous nodules, lacking punctum that does not discharge any material (compared to an EIC, less likely to rupture or get inflamed b/c there’s no punctus)
- Nearly always on the scalp and can cause hair follicle loss due to pressure buildup
- Slowly enlarges over months to years
Treatment - excision
Often confused with a lipoma cyst, which is soft
What is a this?
How do you treat it?
What is it easily confused with? How do you tell the difference??
Lipoma
- soft, mobile subcutaneous nodule without any overlying skin change
- Often solitary, frequently on the trunk and proximal extremities
- If familial (AD inheritance), lipomas tend to be multiple and begin in early adulthood
Treatment: excision
Often confused with Pilar cyst, which is hard
