Benign Skin Growths Flashcards
Definition and Incidence of
Acrochordon
•Common, fleshy lesions along skin folds
–neck, eyes, axilla, intertriginous areas
•Incidence:
–females > males
–uncommon before age 30
–more common with familial tendency, obesity
Characteristics of
Acrochordon
•skin-toned to medium brown color
•flat, fleshy, mobile
•attached via stalk (pedunculated)
•most persist lifelong
•symptomatic due to
–clothing
–jewelry
trauma (torsion - becomes black/hemorrhagic
D/dx and Tx of
Ddx:
- wart
- nevus
Tx:
- reassurance
- snip excision
- electrodessication
- cryotherapy
- pathology not required *
*SEND IF UNCERTAIN
Definition and Incidence of
Cafe au lait spot
•Uniformly pigmented light brown macule/patch
•Usually present at birth
–Almost always present by 1 yo
–Tendency to be inherited
- •6+ café-au-lait macules
> 1.5 cm diameter may indicate neurofibromatosis type 1
–2+ features of NF required for dx
Tx of
Cafe au lait
None
Definition/Incidence of
Cherry Angioma
- Round, slightly raised bright red papule
- MC vascular growth on the skin
- Incidence increases with age
- Asymptomatic
- Most commonly on the trunk
- Persistent
Characteristics of
Cherry angioma
- dome-shaped
- smooth
- cherry-red
- superficial trauma may induce bleeding
Characteristics and Incidence of
Cutaneous Horn
•Common, hyperkeratotic lesion
•Skin colored, horney growth
•Most frequently on face/scalp
–Also on hands, penis, eyelids
•Usually asymptomatic
•Increased incidence with age
–Risk of underlying malignancy increases with age, fair complexion
Tx of
Cherry angioma
•Reassurance – no treatment required
•Cosmetic removal
–Electrocautery
–Vascular laser (PDL, KTP)
This lesion can arise from…
Cutaneous Horn
•Can arise from benign, pre-CA, malignant lesions
Tx of
Cutaneous Horn
•Excisional biopsy
–Must include base in order to determine underlying diagnosis
–Then treatment of underlying lesion if necessary
Defintion and Incidence of
Dermatofibroma
•Common
•Firm, dense, dermal papule or nodule
•Female > Male
–Lower extremities MC
–UE above elbows
•Arise secondary to skin injury?
Characteristics of
Dermatofibroma
•Papule or nodule
•0.5 to 1 cm diameter
–max. size over mos to yrs
–usually stable thereafter
•Feels firm to touch
•Dimple sign: depression noted over thin/flat/nodular DF when grasped between thumb and forefinger
•Skin-colored to pink
What is Dimple Sign and what lesion does it indicate?
A depression noted over thin/nodular skin when grasped between thumb and forefinger
Indicative of Dermatofibroma
D/dx of
Dermatofibroma
- amelanotic melanoma
- molluscum contagiosum
- neurofibroma
- DFSP
Tx of
Dermatofibroma
- reassurance
- elliptical excision – linear scar
- shave removal – DF may recur
- Cryosurgery – can lead to PIH
- ILK if pruritic
- Excisional biopsy imperative if enlarges >2cm diameter: r/o DFSP
Definition and Indicence of
Epidermal Inclusion Cyst
•One of the most common benign tumors
•Benign, firm, mobile nodule filled with keratin
•Begin as plugged hair follicle
–common on face, neck, trunk
•Arise spontaneously
•Predisposing factors
–hair-bearing region
–trauma, friction
•Solitary > Multiple
•Usually asymptomatic
–May become inflamed s/p ruptureàconfused with infection (redness, pain, swelling, warmth)
Characteristics of
Epidermal Inclusion Cyst
- firm, dome-shaped nodule
- mobile with central plug
- soft cheese-like keratinous contents
- can be inflamed, red
- rarely infected
- grow slowly, persist indefinitely
Tx of
Epidermal Inclusion Cyst
•Reassurance
•I&D
•Excision
–If cosmetically undesirable or recurrent inflammation
–Must excise cyst wall
•Rarely antibiotics
Definition and Incidence of
Infantile Hemangiomas
- MC vascular tumor of infancy
- Red/purple/violaceous-colored benign vascular neoplasm
- Usually occurs during first year after birth (1/3 present at birth)
- 60% appear on head and neck
Superficial versus Deep Cavernous Characteristics of
•Superficial (“strawberry”)
–Dull to bright red
–Proliferate 8-18 months, then regress
•Deep Cavernous
–deeper variant
–often multiple, ill defined
–Dark red/blue
–tend to persist
–Can ulcerate, painful
Proliferative versus Involutional Phase of
Infantlie Hemangiomas
•Proliferative phase: during the first year
– with the most growth occurring during the first 4-6 months of life
–slows between the middle and end of the first year of life
•Involutional phase: rapid or prolonged
–30% by 3 yo, 50% by 5 yo, 70% by 7 yo
–Remainder take 3-5 years to involute
–Streaks or areas of white as lesion involutes
–After 6 y.o, ~40% have residual scar formation, telangiectasia, anetodermatype skin changes (increased skin laxity)
Tx of
Infantile Hemangiomas
•Usually left to involute
•Intervention when lesions interfere with function/development
–*Specialist
–Laser surgery - PDL
–Corticosteroids
–Beta Blockers
•DOC for complicated lesions
–Interferon
–Imiquimod (rarely used)
–Cryosurgery
–Excision
Defintion and Location of
Port Wine Stain
•AKA Nevus Flammeus
•Capillary malformation during development
–Always present at birth
–Pink to dark/bluish red
–Smooth texture; nodules may develop over time
•Location
–MC head and neck
•Think Sturge-Weber syndrome when in distribution of CN5
Evolution of
Port Wine Stain
–Begin as pink or red lesion
–Become more bluish or purple with age
–Nodules may develop in adulthood
What is this and who does it occur in
Nevus Simple (Salmon Patch)
40% of newborns on nape of neck or forehead
Characteristics of
Keloid
- develop early in healing
- linear to nodular
- pink, red-purple, flesh-toned, or black
- raised
- extends beyond margins
- tender
- can enlarge over time
D/dx and tx of
Differential Diagnosis
- sarcoidosis
- hypertrophic scar
- recurrent malignancy
Treatment
•discourage piercing
•Reassurance
•Treatment if sx or cosmetically undesirable
–Serial intralesional steroid injections
–Laser: PDL or FCO2
–Silicone gel sheets – symptomatic tx
•dermatology/plastics referral
What are soft, skin-colored to brown, compressible papules or nodules?
Neurofibromas
What is this?
Neurofibroma
Distinguishing features of neurofibromatosis
>6 cafe au lait spots
>2 neurofibromas
axillary freckling
Characteristics of Nevi (moles)
Flat, round, uniformly colored
Pigmented (pink, tan, dark brown)
- darker skin types have darker moles
Stimulated by sun exposure
Mostly asymptomatic
Common proliferation of melanocytes
Type of nevi that are flat, more common in children, and are nests of melanocytes at the dermoepidermal junction
Junctional
(Junctional nevi are usually on palms, soles, genitalia, and mucosa)
Features of dermal nevus
Course, dark hairs grow from the nevus
Found within the dermis
Pigmentation often arranged in flecks
Defining characteristic of halo nevus found in adolescents
A rim of hypopigmentation that surrounds the nevus
Identify
Halo nevus
What’s the name for this condition which consists of multiple, atypial nevi that are at risk for becoming malignant?
Dysplastic Nevus Syndrome
Meaning of the A, B, C, D, E’s in evaluating pigmented lesions
A- asymmetry
B- borders
C- color
D- diameter
E- evolution
Also can evaluate with the ugly duckling sign
The type of blue/black gray nevus that is 2-8cm, often located in the sacral region is sometimes mistaken for bruises in children.
Mongolian spot
Treatment and prevention for nevi
Total body skin exams by self and provider
Sun protection
If suspicious, biopsy or refer
Tyndall effect
Light dispersion that causes dermal brown melanin to appear blue-gray
-seen in Blue Nevus and Mongolian spots
Characteristics of
Solar lentigo (sun spots)
- 2 -20 mm
- oval, irregular macules
- hyperpigmentation
- associated with sun damage and common in fair skin types
Treatment of solar lentigo
- Hydroquinone cream
- Tretinoin cream
- Chemical peels
Common locations for a venous lake
- lips
- face
- ears
- neck
- dorsum of hands
- forearms
Skin findings of
- dark blue to purple papule
- 2-10mm
- will blanch with pressure
Venous lake treatment
- Reassurance
- Can be cauterized and excised for cosmetic reasons
Features of
Alot of variability- can be raised, flat, and variety of colors
“stuck on” appearance
surface will crumble when picked
Differential diagnosis of
- skin tags
- warts
- melanoma
Treatments for symptomatic seborrheic keratosis lesions
- cryotherapy
- cautery and curettage
-shave removal is uncertain because highly pigmented lesions resemble melanoma
