Benign Skin Lesions Flashcards
Benign skin lesions
-Viral warts
-Epidermoid and pillar cysts
-Seborrhoeic keratosis
-Dermatofibroma
-Lipoma
-Common vascular lesions
Overview of epidermoid cysts
-Common and affect face and trunk, adults (young/middle), more common in men, genetic disorders (Gardner)
-They have a central punctum, they may contain small quantities of sebum. Firm, fleshy, round papule or nodule fixed to skin surface but mobile over deeper layers
-The cyst lining is either normal epidermis (epidermoid cyst) or outer root sheath of hair follicle (pilar cyst)
-Management: surgical excision with intact cyst capsule/ incision and drainage
Overview of seborrhoeic keratosis
-Most commonly arise in patients over the age of 50 years, often idiopathic
-Equal sex incidence and prevalence
-Usually multiple lesions over face and trunk
-Flat, raised, filiform and pedunculated subtypes are recognised/ stuck on appearance
-Milia-like cysts, can be crusted
-Variable colours and surface may have greasy scale overlying it
-Dermoscopy
-Christmas tree distribution
-Treatment options consist of leaving alone or simple shave excision (curettage, cryosurgery, shave biopsy)
Overview of dermatofibroma
-Solitary dermal fibrous nodules
-Usually affect extremities of young adults
-Mostly seen in adults. People of every ethnicity can develop dermatofibromas. Ordinary dermatofibromas are more common in women than in men, although some histologic variants are more commonly identified in males
-Lesions feel larger than they appear visually, tethered to the skin surface and mobile over subcutaneous tissue, overlying skin dimples on pinching the lesion
-Histologically they consist of proliferating fibroblasts merging with sparsely cellular dermal tissues
-Dermoscopy, diagnostic excision or skin biopsy
-Management, none, cryotherapy, excision
Overview of lipoma
-Benign tumour of adipocytes.
-Generally found in subcutaneous tissues
rarely, they may also occur in deeper adipose tissues. Malignant transformation to liposarcoma is very rare
-Common, with an annual incidence of around 1 in 1,000, most commonly seen in middle-aged adults: most noticeable during middle age. They affect both sexes equally, although solitary lipomas are more common in women whilst multiple lipomas occur more frequently in men.
-Smooth, soft, mobile, painless lump (dome/egg shaped)
-The diagnosis is usually clinical based on the typical examination findings/ deep skin biopsy
-Management: may be observed, if diagnosis uncertain, or compressing on surrounding structures then may be removed
Describe liposarcoma
-Features suggestive of sarcomatous change:
=Size >5cm
=Increasing size
=Pain
=Deep anatomical location
-In one series the presence of all 4 features was associated with up to 85% being sarcomatous
Describe cherry haemangioma
-Abnormal proliferation of capillaries.
-They are more common with advancing age and affect men and women equally.
-Erythematous, papular lesions
-Typically 1-3 mm in size
-Non-blanching
-Not found on the mucous membranes
-No treatment
Describe pyogenic granuloma
-Trauma/ pregnancy/ more common in women and young adults
-Children around 6 years of age and during teenage and young adult life. There is an overall male predominance (3:2) except oral lesions (pregnancy and oral contraceptive use)
-Most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
-Initially small red/brown spot
-Rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
-The lesions may bleed profusely or ulcerate
-Management
=Lesions associated with pregnancy often resolve spontaneously post-partum
=Other lesions usually persist. Removal methods include curettage and cauterisation, cryotherapy, excision
Describe venous lake
-Bluish soft squashable macule or papule due to vascular dilatation.
-It is most often seen on the lower lip, middle aged/older
-Investigation: colour disappears on compression of the macule or papule due to the clearance of blood from the dilated venule. This is most easily seen using a glass slide or the lens of a contact dermatoscope. A venous lake has a structureless blue or purple appearance on dermoscopy. A biopsy is rarely necessary and shows a dilated venule.
-Management:
=None/ cryotherapy/ laser
Describe sebaceous hyperplasia
-Enlarged sebaceous glands seen on the forehead or cheeks of the middle-aged and older people.
-Small yellow bumps up to 3 mm in diameter.
-Close inspection reveals a central hair follicle surrounded by yellowish lobules.
-There are often prominent blood vessels, best seen using dermoscopy.
-Form of benign hair follicle tumour.
-Immunosuppressed patients
-No treatment/ electrocautery or laser vaporisation/ oral isotretinoin/ antiandrogens
Describe Molluscum contagiosum
-Common skin infection caused by molluscum contagiosum virus (MCV), a member of the Pox viridae family.
-Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels.
-Children (often in children with atopic eczema), with the maximum incidence in preschool children aged 1-4 years.
-Characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter.
-Lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet).
-In children, lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur.
-In adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen. Rarely, lesions can occur on the oral mucosa and on the eyelids.
-Treatment:
=Self limiting, not recommended, spontaneous resolution 18 months, avoid sharing towels, do not scratch
-Cryotherapy
-Corticosteroid for itching/ antibiotic if infected
Describe acrocordon
-Skin tag
-Cryotherapy/ curette for histology
-Not pigmented lesions
