Benign Lesions

Question 1

Includes:

Answer 1

Seborrhoeic Keratoses
Viral warts
# Cysts
Dermatofibromas
Lipomas
Angiomas
Pyogenic Granulomas

Question 2

Patient presents with an encapsulated lesion on the skin, it contains fluid and is firm but mobile on the skin. What is it? [2]

Answer 2

A cyst. Most likely an epidermoid cyst

Question 3

How would you treat a sebaceous cyst in the skin? [4]

Answer 3

Excision with complete removal of cyst wall to prevent recurrence

If they’re infected you’ll need:

• Antibiotics
• Intralesional steroids
• Incision & Drainage

Question 4

Patient presents with rough hyperkeratotic surfaces containing black spots of blood vessels. Mainly around the fingers. Whats the most likely diagnosis? [2]

Answer 4

Viral Wart. Brought on by the HPV virus

Question 5

How do we treat viral warts? [2]

Answer 5

• Chemical paints and cryotherapy to stimulate immune system

- Currete if severe or painful ones.

Question 6

Patient comes in with multiple “warty” growths with a stuck on appearance. They have nearby cherry angiomas?

Answer 6

Seborrhoeic Keratoses are dark brown and appear to be stuck on. Can be greasy (look like rough moles)

Question 7

How would you treat seborrhoeic keratoses? [2]

Answer 7

Mostly you leave them, they may even fall off themselves.

If they’re troublesome you can currette them or use cryotherapy

Question 8

What do you think if seborrhoeic keratoses appear suddenly? (multiple warty “stuck on” growths)? [2]

Answer 8

Leser-Trelat Syndrome

Its a paraneoplasic syndrome resulting from GI adenocarcinomas

Question 9

Most people have firm fibrous nodules that are pale pink/brown and may be itchy/tender. What are they? [2]

Answer 9

Proliferations of fibroblasts at the site of minor trauma e.g. insect bites known as dermatofibromas

They dimple when you pinch them

Question 10

Dermatofibromas
Define [2]
Appearance [4]
Management [2]

Answer 10

Benign neoplasm of dermal fibroblasts containing histiocytes, blood vessels and fibrotic changes

App: brown pigmented nodule, firm and woody, intradermal ie can be moved over subcutaneous tissue, dimples when pinched

Leave it unless its causing itching or tenderness, or if its potentially developing malignancy. Then you must excise it

Question 11

Patient presents with a smooth rubbery subcutaneous mass thats quite mobile. its completely asymptomatic. Give 2 differentials

Answer 11

Probably a lipoma (benign adipose tumour)

If its tender that might indicate an angiolipoma

Question 12

A patient comes in with a number of red nodules with spider naevi, upon dermatoscopy you see venous lakes in the nodule. What is it? [1]

Answer 12

An angioma.
Due to proliferation of blood vessels

Often found during pregnancy or liver disease

Question 13

How do treat an angioma [2]

Answer 13

Excision or laser ablation

Question 14

Patient with a red raw growth on hand that bleeds?
RF [2]
Appearance [3]
Mx

Answer 14

Pyogenic Granuloma
RF: previous trauma, pregnancy
Sy/Si:
- bright red hemi-spherical nodule on hands, face, gums and lips
- that may have purulent discharge
- soft and bleed very easily (may mimic amelanotic melanoma)
Mx: cutterage and diathermy at base

Question 15

What is a complication of lipoma

Answer 15

Sarcomatous transformation

Question 16

Lipomas: when to intervene

Answer 16

Surgical excision if causing pressure symptoms or features indicative of sarcomatous change

Question 17

Sebaceous cyst

Types - differentiate between the 2

Answer 17

Epithelial lined cyst containing keratin

1. Epidermoid cyst: proliferation of epidermal cells in dermis
2. Pilar cyst: arise from outer root sheath of hair follicle

Question 18

Sebaceous cyst

Presentation [2]

Answer 18

Sites: hair growth areas eg scalp, face, neck, chest, back, never on soles, palms
App: typically have punctum and are firm, smooth, intradermal

Question 19

Neurofibroma [2]
Appearance [3]
Mx [1]

Answer 19

Benign nerve sheath tumour arising from Schwann cells, can be associated with neurofibromatosis type I

Appearance:

• Solitary/multiple pedunculate nodules
• Fleshy consistency
• Pressure can cause paresthesia

Mx: surgical excision if malignant growth suspected

Question 20

Papilloma [1]
Associated with [2]
Appearance [2]
Mx [2]

Answer 20

Overgrowth of all skin layers with a central vascular core; assoc. w/ HPV 6 and 11

Appearance: skin tag or fibre-epithelial polyp, pedunculate, flesh colored

Mx: excision, diathermy if trauma to control bleeding

Question 21

Pyogenic granuloma [1]
Risk factors [2]
Presentation [3]
Mx [1]

Answer 21

Rapidly growing capillary haemangioma (neither actually pyogenic or a granuloma)
RF: previous trauma, pregnancy
Sxs: bright red hemi-spherical nodule on hands, face, gums and lips that may have purulent discharge; soft and bleed very easily (may mimic amelanotic melanoma)
Mx: cutterage and diathermy at base

Question 22

Dermoid cyst
2 types [4] (causal)
Appearance [3]
Ix [1]
Mx [1]

Answer 22

• Congenital (inclusion): inclusion of epidermis along sides of skin fusion; usually occur in midline of neck or nose and at medial and lateral ends of eyebrows
• Acquired (implantation): implantation of epidermis into dermis, often secondary to trauma e.g. piercing
• Smooth spherical swelling at sites of embryological fusion,
• may scar at recurrence
• soft, tender and subcutaneous

Ix: CT if congenital
Mx: surgical excision

Question 23

Keratocanthoma
Define 
Appearance [3]
Prognosis 
Mx [2]

Answer 23

Define: benign overgrowth of hair follicle cells
App: fast growing intradermal dome shaped lesion with a keratin plug
Prog: usually regress in 6w
Mx: excision and histology to reduce scarring and excl. well differentiated SCC

Question 24

Granuloma Annulare
Epidemiology
Aetiology 
Appearance [4]
Mx

Answer 24

Ep: skin of teenagers and young adults
Ax: delayed hypersensitivity to part of dermis
Sy/Si: papular lesions that are often slightly hyper pigmented and depressed centrally, typically occur on dorsal surfaces of hands and feet and extensor aspects of arms and legs
Mx: not rqd