Approach to Skin Lumps

Question 1

What is molluscum contagiosum and what is the associated skin presentation?

Answer 1

DNA poxvirus skin infection
- smooth, firm pink papules with central umbilication in clusters

• spread by direct skin contact, fomites, sexual transmission, autoinnoculation
• asymptomatic but ± surrounding irritation and pruritus

Question 2

What is the main causative agent of viral warts?

Answer 2

HPV

Question 3

What are the typical skin presentations of HPV warts?

Answer 3

Benign skin proliferation
- tiny black or red dots (thrombosed capillaries) within lesion are characteristic
- ±pruritic
- scratching → linear array via autoinoculation

Question 4

What is Furunculosis and what is the associated skin presentation?

Answer 4

Cutaneous abscesses, tender to palpation
- a/w hair follicles
- #1 Staph Aureus
- common in adolescent and young adults, rare in children
- continuous → carbuncles

Question 5

What is a pyogenic granuloma and what is the associated skin presentation

Answer 5

Rapidly growing, benign vascular proliferations of skin and mucous membranes
- red papule with meaty erosive surface
- common in children and young adults
- many etiologies (eg. infection, eczema, injury, hormonal fluctuations, retinoid therapy)

Question 6

What is a fibroepithelial polyp and what is the associated skin presentation?

Answer 6

Common benign cutaneous growths
- small, skin-coloured/brown soft papules
- areas of frequent friction (eg. eyelids, inguinal, neck, axilla)
- pedicle twisting → frank necrosis

Question 7

What is a seborrheic keratosis and what is the associated skin presentation?

Answer 7

Common benign neoplasm of epidermis
- “stuck-on” appearance papules and plaques with well-defined borders
- ↑age → ↑incidence
- rapid onset of numerous SKs may be a sign of malignancy

Question 8

What is a epidermal cyst and what is the associated skin presentation?

Answer 8

Semi-solid cyst
- contains: macerated keratin and lipid-rich debris
- etiology (eg. trauama, iatogenic, eccrine duct/pilosebaceous unit occlussion, HPV, Gardner’s syndrome)

Question 9

What is a lipoma and what is the associated skin presentation?

Answer 9

Slow-growing, mature fat cells
- soft, rubbery, freely-mobile SQ masses without overlying skin change
- often solitary but can be multiple
- usually asymptomatic

Question 10

What is the 1st and 2nd most common skin cancer?

Answer 10

1) Basal cell carcinoma
2) Squamous cell carcinoma

Question 11

What is a Basal Cell Carcinoma and what is the associated skin presentation?

Answer 11

Neoplasm of basal keratinocytes
- dark brown to dark blue, rolled edges, slight central induration
- greatest risk factor: sun exposure (intermittent sun > cumulative UV)

Question 12

What is a Squamous Cell Carcinoma and what is the associated skin presentation?

Answer 12

Neoplasm of squamous epithelial cells
- papulonodule lesion, erosion and ulceration, scaling
- #1 sun-exposed areas of skin
- risk factors: UV, immunosuppression, HIV/AIDS, radiation exposure, smoking, HPV, etc.

Question 13

What is a Kerathoacanthoma and what is the associated skin presentation?

Answer 13

Rapidly growing, well-differentiated neoplasm of squamous epithelium
- papule → nodule, central crust, painless
- low grade SCC
- appear within few weeks and spontaneously resolve within 6mths → atrophic scar

Question 14

What is Leukemia cutis and what is the associated skin presentation?

Answer 14

Skin infiltration by malignant proliferation of leukocytes
- polymorphic, haemorrhagic ulcers, pink/red-brown/purple papules/nodules, large tumours, ulcerate and bullous
- 2° to eg. ALL, AML, CML, CLL

Question 15

What is Dermatofibrosarcoma protuberans and what is the associated skin presentation?

Answer 15

Fibroblast-derived intermediate-grade soft tissue sarcoma (uncommon with low-metastatic potential but locally aggressive)
- slow-growing, red-brown, indurated plaque with irregular nodularity
- #1 trunk, proximal extremities, head and beck
- common in African descents

Question 16

What is Cherry angioma and what is the associated skin presentation?

Answer 16

Campbell de Morgan spots, senile haemangiomas, acquired benign vascular proliferation
- thin-walled, dilated capillaries
- solitary, well-circumscribed, red papules

Question 17

What is Xanthelasma and what is the associated skin presentation?

Answer 17

Type of localised plane xanthoma
- yellowish macules/slightly elevated papules/plaques on eyelids
- 3x > in F, 1/2 lipid disorder
- is an independent risk factor for atherosclerosis → IHD

Question 18

What is a Keloid and what is the associated skin presentation?

Answer 18

Hypertrophic scar tissue
- Dense fibrous tissue nodules that can be painful, pruritic and grow to become very large → chronic discomfort, disfiguring and restrictive
- typically on previously traumatised skin

Question 19

What is Kaposi sarcoma and what is the associated skin presentation?

Answer 19

Malignant neoplasm of lymphatic endothelial cell origin
- deep red/maroon/purple patches, papules, plaques, tumours, and nodules
- can be AIDS-associated or non-AIDS-associated
- all a/w HHV-8

Question 20

What is Sarcoidosis and what is the associated skin presentation?

Answer 20

Immune-mediated systemic disorder → granuloma formation
- asymptomatic red-brown dermal papule/plaques
- favor face, neck, upper extremities and upper trunk

Question 21

What is a Melanoma and what is the associated skin presentation?

Answer 21

Fibroblast-derived intermediate-grade soft tissue sarcoma (uncommon with low-metastatic potential but locally aggressive)
- slow-growing, red-brown, indurated plaque with irregular nodularity
- #1 trunk, proximal extremities, head and beck
- common in African descents

Question 22

What is a Sebaceous hyperplasia and what is the associated skin presentation?

Answer 22

Localised hypertrophy of the sebaceous glands that occurs on central face (#1 forehead)
- solitary/multiple skin-colour/yellow papules, central dell
- peripheral “crown” of telangiectatic vessels on dermoscopy

Question 23

What is a Stucco keratosis and what is the associated skin presentation?

Answer 23

Keratosis/Keratoelastoidosis verrucose (benign and asymptomatic)
- white/gray scaly papule on dorsal feet and lower legs
- >40, north europe, 4x > M

Question 24

What is Tendinous xanthomas and what is the associated skin presentation?

Answer 24

Lipid deposits within tendons
- smooth firm nodules over extensor tendons of elbows, knees, hands or #1 achilles
- #1 cause: familial hypercholesterolemia

Question 25

What is a Actinic keratosis and what is the associated skin presentation?

Answer 25

Precancerous lesions on chronically sun-exposed skin
- rough, scaly macules/patches
- common in lighter skin individuals
- usually asymptomatic but may be tender