7 - Benign Tumors Flashcards by Samuel Halajian

In this section, we’ll be discussing:

Seborrheic keratosis (SK)
Dermatosis papulosis nigra
Stucco keratosis
Acrochordon
Dermatofibromas
Sebaceous hyperplasia
Lipoma
Neurofibroma
Keloid
Keratoacanthoma (KA)

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What is the MC benign cutaneous neoplasm?

Seborrheic keratosis (SK)

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What is the etiology of seborrheic keratosis?

Proliferation of immature keratinocytes

Usually pigmented as melanin transferred into keratinocytes

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Clinical presentation, morphology, location of SK

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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Management of SK

No txt required

Liquid N2 or curettage, if desired

They may recur after txt

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Prognosis for SK?

Excellent

Must r/o malignant melanoma in darker lesions

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What is Leser-Trelat Sign?

Sudden appearance of multiple SK’s

Sign of internal malignancy

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What dermatosis papulosis nigra?

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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Morphology and location of DPN?

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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Management of DPN?

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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What is Stucco Keratosis?

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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Morphology and location of stucco keratosis?

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

Ankles, feet (dorsal), forearms, hands

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Management of stucco keratosis?

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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Fancy word for skin tags?

Acrochordon

Affects 1/4 of people over age 25

MC in obese

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Morphology and location of acrochordon?

Skin colored to brown

Soft, pedunculated, 1mm-1cm

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

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Management and prognosis of acrochordon

Larger lesion - anesthesia with excision

Smaller lesion - scissor excision, electrodessication, cryosurgery

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

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What are dermatofibromas? What causes them?

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

Morphology and location of dermatofibromas?

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)

How do we manage dermatofibromas?

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

If a dermatofibroma is growing rapidly, consider:

Dermatofibrosarcoma ptouberans (DFSP) - locally invasive tumor

What is sebaceous hyperplasia?

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

Describe sebaceous hyperplasia to your preceptor:

They begin as small yellow papules

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

What do we do with sebaceous hyperplasia?

No txt required

If desired, curette, shave bx, electrosurgery

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

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

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

What is the MC benign soft tissue tumor?

Lipoma

Describe lipoma

Soft, pillowy, mobile subcutaneous lesion Normal overlying skin Anywhere from 1 to 10cm (or larger) Found on trunk and extremities Asxs

What do we do with lipomas?

Dealer’s choice - leave em alone or cut em out Once removed, usually won’t recur

What is a syringoma?

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

Presentation, morphology, location of syringoma?

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

Management for syringoma?

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

Prognosis for syringoma?

After appearance, remain stable in number Totally benign

What is a neurofibroma? Morphology?

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

Management and prognosis of neurofibroma?

Nothing Excise is bothersome They don’t recur

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

Von Recklinghousen (NF1) - can become cancerous

What is a hypertrophic scar?

An abnormally large scar, CONFINED to the wound site Starts early, in time regresses May soften with time May become painful / pruritic / sensitive

What is a keloid?

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

Where are keloids most commonly found?

Shoulder and chest But can technically appear anywhere

Management and prognosis of hypertrophic scar / keloid?

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

What is a keratoacanthoma?

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

Management and prognosis of keratoacanthoma?

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

Why did the coffee get a police report?

Because it got mugged