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Senior - Derm 2 > 7 - Benign Tumors > Flashcards

7 - Benign Tumors Flashcards

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Dermatology Board Prep flashcards
1
Q

In this section, we’ll be discussing:

A
  1. Seborrheic keratosis (SK)
  2. Dermatosis papulosis nigra
  3. Stucco keratosis
  4. Acrochordon
  5. Dermatofibromas
  6. Sebaceous hyperplasia
  7. Lipoma
  8. Neurofibroma
  9. Keloid
  10. Keratoacanthoma (KA)
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2
Q

What is the MC benign cutaneous neoplasm?

A

Seborrheic keratosis (SK)

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3
Q

What is the etiology of seborrheic keratosis?

A

Proliferation of immature keratinocytes

Usually pigmented as melanin transferred into keratinocytes

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4
Q

Clinical presentation, morphology, location of SK

A

Middle age-elderly, often hereditary

Could be a few or many, skin colored or brown/black

Discrete, raised, rough or hyperkeratotic papules to plaques

Often verrucous-appearing

Stuck-on appearance

Greasy

On sebaceous areas (face, back, chest, groin - any hair-growing area)

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5
Q

Management of SK

A

No txt required

Liquid N2 or curettage, if desired

They may recur after txt

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6
Q

Prognosis for SK?

A

Excellent

Must r/o malignant melanoma in darker lesions

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7
Q

What is Leser-Trelat Sign?

A

Sudden appearance of multiple SK’s

Sign of internal malignancy

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8
Q

What dermatosis papulosis nigra?

A

Essentially the same thing as SK - think “morgan freeman freckles”

More common in blacks and hispanics

Hereditary

Teens to middle age

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9
Q

Morphology and location of DPN?

A

2-3mm dome-shaped papules

Brown-black

Hyperkeratoticm pedunculated, or verrucous papules

Female predominance

Found on cheeks, around the eyes, in a photodistribution

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10
Q

Management of DPN?

A

No txt req’d

Be careful with freezing (hypopigmentation)

Small lesion - electrocautery and curette

Large lesion - anesthetize, remove (shave or scissor excision)

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11
Q

What is Stucco Keratosis?

A

AKA “barnacles”

We don’t know the cause - maybe vascular insufficiency, xerosis

It’s benign proliferation of keratinocytes (same etiology as SK but these appear differently)

More common in elderly white people with peripheral edema

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12
Q

Morphology and location of stucco keratosis?

A

1-10mm round, dry, white or skin-colored hyperkeratotic papules, warty lesions, “stuck-on” appearance

Ankles, feet (dorsal), forearms, hands

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13
Q

Management of stucco keratosis?

A

No txt req’d or desired due to poor healing

Pt’s may pick at them, leaving themselves open to secondary infection

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14
Q

Fancy word for skin tags?

A

Acrochordon

Affects 1/4 of people over age 25

MC in obese

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15
Q

Morphology and location of acrochordon?

A

Skin colored to brown

Soft, pedunculated, 1mm-1cm

Areas of rubbing - eyelids, neck, groin, axilla, waist, buttocks

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16
Q

Management and prognosis of acrochordon

A

Larger lesion - anesthesia with excision

Smaller lesion - scissor excision, electrodessication, cryosurgery

Won’t recur, technically, but they get new lesions

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17
Q

What are dermatofibromas? What causes them?

A

It’s a collection of fibroblasts, endothelial cells, and histocytes

A fibrous reactive process to trauma (i.e. bug bite, viral infection, shaving, etc.)

They are pruritic or tender early on, then become asymptomatic

18
Q

Morphology and location of dermatofibromas?

A

3-10mm, slightly raised, pink-brown, sometimes scaly, hard growths

Retract beneath skin surface with compression (dimpling)

Could be found anywhere on trunk or extremities (anterior lower legs - think shaving, shoulders, upper back)

19
Q

How do we manage dermatofibromas?

A

They don’t resolve on their own - we need to actually do stuff

Remove with punch bx or regular excision

Bx darker lesions to r/o malignant melanoma

Conservative cryosurgery to decrease color

20
Q

If a dermatofibroma is growing rapidly, consider:

A

Dermatofibrosarcoma ptouberans (DFSP) - locally invasive tumor

21
Q

What is sebaceous hyperplasia?

A

Small tumors of enlarged sebaceous glands on the face, due to sun-damaged, oily skin in adults over 30yrs

22
Q

Describe sebaceous hyperplasia to your preceptor:

A

They begin as small yellow papules

Then become dome-shaped with a central puncta (i.e. umbilicated)

23
Q

What do we do with sebaceous hyperplasia?

A

No txt required

If desired, curette, shave bx, electrosurgery

If there’s a LOT of lesions, we can consider isotrentinoin (refer)

24
Q

What if your patient has what appears to be sebaceous hyperplasia (SH) with telangiectasia?

A

MUST differentiate from BCC

On dermoscopy, BCC will have haphazard arrangement of the vessels, while with SH the vessels occur only within the valleys between small yellow lobules

25
Q

What is the MC benign soft tissue tumor?

A

Lipoma

26
Q

Describe lipoma

A

Soft, pillowy, mobile subcutaneous lesion

Normal overlying skin

Anywhere from 1 to 10cm (or larger)

Found on trunk and extremities

Asxs

27
Q

What do we do with lipomas?

A

Dealer’s choice - leave em alone or cut em out

Once removed, usually won’t recur

28
Q

What is a syringoma?

A 
A medical syringe stuck inside your skin...
.
.
.
.
.
.
.
.
.
....ok, ok - it’s a sweat duct tumor
29
Q

Presentation, morphology, location of syringoma?

A

Usually young women in their 20’s or 30’s, but could be any age

Asxs

1-3mm small, firm, flesh-colored dermal papules

Found under the eyes / lower lids

Less commonly on the forehead, chest, abdomen, and vulva

30
Q

Management for syringoma?

A

Nothing - we don’t wanna risk scarring young women if we don’t have to

But if cosmetic removal is desired: electrodessication and curettage, or elevation and excision with curved scissors, or shave with a #11 blade

31
Q

Prognosis for syringoma?

A

After appearance, remain stable in number

Totally benign

32
Q

What is a neurofibroma? Morphology?

A

A nerve sheath tumor

Grows anywhere

Flesh to pinkish-white, soft, pedunculated 2-20cm

Occasionally firm and waxy-nevus looking

Button-hole sign = invaginated through skin with pressure

33
Q

Management and prognosis of neurofibroma?

A

Nothing

Excise is bothersome

They don’t recur

34
Q

If you’ve got two or more neurofibromas, or axillary freckling and cafe-au-lait spots, suspect:

A

Von Recklinghousen (NF1) - can become cancerous

35
Q

What is a hypertrophic scar?

A

An abnormally large scar, CONFINED to the wound site

Starts early, in time regresses

May soften with time

May become painful / pruritic / sensitive

36
Q

What is a keloid?

A

Abnormally large scar that EXTENDS BEYOND the borders of the wound site

Starts later, usually constant and stable (rarely subsides)

May become painful / pruritic / sensitive

37
Q

Where are keloids most commonly found?

A

Shoulder and chest

But can technically appear anywhere

38
Q

Management and prognosis of hypertrophic scar / keloid?

A

No universal, routinely effective therapy

Intralesional steroids are effective but painful

Surgery, cryotherapy, silicone gel sheeting, intralesional 5-FU, sharks with freakin “lasers” attached to their heads

These may recur if txt stops 2/2 continued collagen production

39
Q

What is a keratoacanthoma?

A

Relatively common, benign epithelial tumor

Solitary, discreet, smooth, dome-shaped red papule

Rapid expansion to 1-2cm, then growth stops around 6 weeks, regresses in 2-12 mos, leaving a scar

Distinctive central hyperkeratotic core

MC’ly on the limbs, especially sun-exposed hands/arms

40
Q

Management and prognosis of keratoacanthoma?

A

It will resolve on its own, but we went to PA school, so we might as well treat it - excise that shit and send it to the pathologist to r/o SCC

41
Q

Why did the coffee get a police report?

A

Because it got mugged

Senior - Derm 2 (7 decks)

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