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Fall 2014 - CM Dermatology > Benign Skin Lesions > Flashcards

Benign Skin Lesions Flashcards

1
Q

ACRODCORDON

A
  • common, fleshy lesions along skin folds (neck, eyes, intertriginous)
  • usually asymptomatic, but can become irritated by clothing/jewelry/trauma
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2
Q

ACRODCORDON

Predisposing

A
  • incidence: F > M
  • uncommon before age 30
  • more common with familial tendency and obesity
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3
Q

ACRODCORDON

Clinical features

A
  • skin-toned to medium brown color
  • flat, fleshy, mobile
  • attached via stalk (pedunculated)
  • most persist lifelong
  • symptomatic due to clothing, jewelry, trauma
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4
Q

ACRODCORDON

D Dx

A
  • wart

- nevus

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5
Q

ACRODCORDON

Tx

A
  • reassurance
  • snip incision
  • electrodessication
  • cryotherapy
  • pathology not required, but send if uncertain
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6
Q

Café au Lait Spot

A
  • uniformly pigmented light brown macule/patch
  • usually present at birth, almost all present by 1 yr
  • 6+ cafe au lait macules > 1.5cm diameter may indicated neurofibromatosis type 1 (2+ features of NF required for Dx)
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7
Q

Café au Lait Spot

Tx

A

none required

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8
Q

CHERRY ANGIOMA

A
  • round, slightly raised bright red papule
  • MC vascular growth on the skin
  • incidence increases with age
  • asymptomatic
  • MC on the trunk
  • persistent
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9
Q

CHERRY ANGIOMA

Characteristics

A
  • dome-shaped
  • smooth
  • cherry red
  • superficial trauma may induce bleeding
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10
Q

CHERRY ANGIOMA

Tx

A
  • reassurance - no tx required

- cosmetic removal: electrocautery, vascular laser (PDL, KTP)

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11
Q

CUTANEOUS HORN

A
  • common, hyperkeratotic lesion
  • skin colored, horny growth
  • can arise from benign (MC), pre-CA (20%+ AK), malignant lesions (20% SCC/BCC)
  • most frequently on face and scalp, ears, chest
  • usually asymptomatic
  • increased incidence with age; risk of underlying malignancy increases with age and fair complexion
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12
Q

CUTANEOUS HORN

Factors for higher malignancy risk

A
  • all cutaneous horns should be biopsied even if “low risk”
  • older
  • M>F
  • pain
  • large size
  • induration/erythema at the base
  • anatomic site on the nose, ears, back of hands, scalp, forearms, face, penis
  • wide base or low height to base ratio
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13
Q

DERMATOFIBROMA

A
  • common
  • firm, dense, dermal papule or nodule
  • F>M
  • lower extremities MC
  • UE above elbows
  • usually asymptomatic
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14
Q

DERMATOFIBROMA

Clinical features

A
  • papule or nodule
  • 0.5 to 1 cm diameter, reaches max size over months to years
  • feels firm to touch
  • DIMPLE SIGN: depression noted over thin/flat/nodular DF when squeezed btw thumb and forefinger
  • skin-colored to pink
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15
Q

DERMATOFIBROMA

D dx

A
  • amelanotic melanoma
  • molluscum contagiosum
  • neurofibroma
  • DFSP
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16
Q

DERMATOFIBROMA

Tx

A
  • reassurance
  • elliptical excision: linear scar
  • shave removal: DF may recur
  • cryosurgery (can lead to post-inflam hyperpig)
  • interlesional Kenalog if pruritic
  • excisional biopsy imperative if enlarges >2cm diameter
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17
Q

EPIDERMAL INCLUSION CYST

A
  • one of the most common benign tumors
  • benign, firm, mobile nodule filled with keratin
  • begin as plugged hair follicle (face, neck, trunk)
  • arise spontaneously
  • solitary > multiple
  • usually asymptomatic
  • predisposing factors: hair bearing region, trauma, friction
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18
Q

EPIDERMAL INCLUSION CYST

Clinical features

A
  • firm, dome-hsaped nodule
  • mobile with central plug
  • soft cheese-like keratinous contents
  • can be inflamed, red
  • rarely infected
  • grow slowly, persist indefinitely
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19
Q

EPIDERMAL INCLUSION CYST

Tx

A
  • reassurance
  • I&D (incise and drain)
  • excision if cosmetically undesirable or recurrent inflammation
  • rarely Abx
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20
Q

INFANTILE HEMANGIOMAS

A
  • MC vascular tumor of infancy
  • red/purple/violaceous-colored benign vascular neoplasm
  • usually occurs during first year after birth
  • asymptomatic, but cosmetically bothersome
  • 60% on head and neck
  • fingers, eyes, lips, nasal tip, ears, face, airway
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21
Q

INFANTILE HEMANGIOMAS

Risk factors

A
  • female
  • premature
  • multiple birth
  • low birth weight
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22
Q

INFANTILE HEMANGIOMAS

  1. Superficial/strawberry
  2. Deep cavernous
A
  1. dull to bright red, proliferate 8-18 months then regress

2. less common; deeper variant; often multiple and ill-defined; dark red/blue; tend to persist; can ulcerate; painful

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23
Q

INFANTILE HEMANGIOMAS

  1. Proliferative phase
  2. Involutional phase
A
  1. during the first year w/ most growth occurring during the first 4-6 months of life; slows between the middle and end of 1st year
  2. rapid or prolonged; 30% by 3, 50% by 5, 70% by 7; remainder take 3-5 years to involute; streaks or areas of white as lesion involutes; after 6 yo, 40% have residual scar formation, telangectasia, increased skin laxity
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24
Q

INFANTILE HEMANGIOMAS

Tx

A
  • usually left to involute
  • intervention by specialist when lesions interfere w/ function/development
  • laser surgery - PDL
  • corticosteroids
  • beta blockers
  • interferon
  • cryosurgery
  • excision
25
Q

PORT WINE STAIN

A
  • aka neves flammeus
  • capillary malformation during development
  • always present at birth
  • pink to dark bluish/red
  • smooth texture; nodules may develop over time
  • MC head and neck (Sturge-Weber syndrome in CNS distribution)
  • grows w/ child, does not involute
26
Q

PORT WINE STAIN

Evolution

A
  • begin as pink or red lesion
  • become more bluish or purple with age
  • nodules may develop over time
27
Q

NEVUS SIMPLEX (Salmon Patch)

A
  • 40% of newborns
  • stork bite @ nape of neck
  • angel’s kiss on forehead between eyebrows
  • eyelids
  • most spontaneously resolve during childhood (5+% persist to adulthood)
28
Q

KELOID

How distinguished from hypertrophic scars?

A
  • hypertrophic scarring spread beyond limit of original injury
  • clawlike projections
  • unique histologically
29
Q

KELOID

Predisposing factors

A
  • most common before age 30
  • MC and large in Af American population
  • s/p injury: piercing, surgery, laceration, acne
  • MC location chest; frequently neck, ears, extremities
  • rarely on face, palms, soles
30
Q

KELOID

Clinical features

A
  • develop early in healing
  • linear to nodular
  • pink, red-purple, flesh-toned or black
  • raised
  • extends beyond margins
  • tender
  • can enlarge over time
31
Q

KELOID

D dx

A
  • sarcoidosis
  • hypertrophic scar
  • recurrent malignancy
32
Q

KELOID

Tx

A
  • discourage piercing
  • reassurance
  • treatment if sxs or cosmetically undesirable (serial intralesional steroid injections, laser, silicone gel sheets)
  • derm/plastic surg referral
33
Q

NEUROFIBROMA

A
  • soft, often compressible papule or nodule
  • skin-colored to brown
  • usually asymptomatic, unless traumatized
34
Q

NEUROFIBROMA

Tx

A
  • excision if symptomatic

- pathology if suspicious

35
Q

NEUROFIBROMA

Neurofibromatosis

A
  • autosomal dominant disorder that affects the bone, nervous system, soft tissue, skin
  • more than 6 cafe au lait spots, more than 2 neurofibromas, axillary freckling, 1st degree relative
  • requires multidisciplinary treatment
36
Q

NEVI

A
  • common proliferation of melanocytes
  • majority have no malignant potential
  • can be congenital or acquired
  • usually stimulated by sun exposure
  • most asymptomatic
  • many variations
37
Q

NEVI

Clinical features

A
  • pigmented: pink, tan, dark brown
  • darker skin types usually make darker moles
  • remain stable for years then can gradually regress, lighten with age
38
Q

NEVI

Junctional nevus

A
  • nests of melanocytes at dermis-epiderm junction
  • flat
  • MC in children
39
Q

NEVI

Dermal nevus

A
  • nests of melanocytes in dermis
  • raised
  • with or w/o coarse hair
40
Q

NEVI

Compound nevus

A
  • nests of melanocytes at dermis-epiderm junction and dermis
  • central raised area
  • may be surrounded by flat pigmentation
41
Q

NEVI

Halo nevus

A
  • MC in adolescence
  • MC on trunk
  • surrounding hypopigmentation
  • more likely with history of malignant melanoma, vitiligo
42
Q

NEVI

Evaluation of pigmented lesions

A 
A = asymmetry
B = border
C = color
D = diameter
E = evolution
  • *ugly duckling sign
  • do not hesitate to biopsy
43
Q

NEVI

Dysplastic Nevus - Characteristics

A
  • variegated tan, brown, pink coloration
  • may be larger than common nevi 5+ mm
  • irregular borders
  • atypical mole: higher risk than normal mole to become MM; higher risk of developing de novo MM
  • grade: mild, moderate, severe
44
Q

NEVI

Dysplastic Nevus - Biopsy/Tx

A
  • -biopsy: broad saucerization with 2 mm border
  • if + margin, reexcise with wider saucerization high grade DNs are difficult to distinguish from MM insitu
  • recurrent DNs should be removed
  • TBSE, sun protection education of pt
45
Q

NEVI

Hereditary Dysplastic Nevus Syndrome

A
  • aka familial atypical mole-malignant melanoma syndrome
  • autosomal dominant
  • increased risk melanoma: may be up to 150x greater than normal population
46
Q

NEVI

Congenital Hairy Nevus

A
  • dark brown, thickened, irregular surface with hair
  • trunk
  • 2-15% incidence of MM; 60% of these appear before 10 y.o; no increased evidence of MM in hairy nevi < 20cm
47
Q

NEVI

Blue Nevus

A
  • solitary bluish macule/papule
  • enlarge slowly, persist
  • Tyndall effect: light dispersion causes dermal brown melanin to appear blue gray
  • Ddx: malignant variants, MM
48
Q

NEVI

Mongolian Spot

A
  • blue/black to gray (Tyndall effect)
  • MC in dark skin types
  • 2-8 cm
  • MC in sacral region
  • usually fades during childhood
49
Q

Nevi

Tx

A
  • yearly TBSE, more frequent for pt w/ history of skin CA
  • patient education
  • instruction on importance of self-examination
  • refer if uncertain
50
Q

SEBORRHEIC KERATOSIS

A
  • common, persistent epidermal lesion
  • various presentations possible: stuck on, tan, brown, black
  • rule out wart and MM
  • asymptomatic vs itchy when inflamed
  • less common before age 30; increase w/ age
  • multiple lesions show hereditary disposition
51
Q

SEBORRHEIC KERATOSIS

Clinical appearance

A
  • usually oval
  • can be flat or raised
  • 0.2-2.0 cm or larger, discrete
  • pink to dark brown
  • stuck on keratotic appearance
  • crumble when picked
52
Q

SEBORRHEIC KERATOSIS

Ddx

A
  • skin tags
  • wart
  • melanocytic nevus
  • melanoma
  • pigmented actinic keratosis
53
Q

SEBORRHEIC KERATOSIS

Tx

A
  • reassure

- tx for inflamed/irritated SK: cryosurgery or shave removal

54
Q

SOLAR LENTIGO

A
  • common condition with brown macules/hyperpigmentation
  • light skin types
  • associated w/ sun or actinic damage
  • increase in size/# with age
  • usually persistent
  • asymptomatic, but often cosmetic concern
55
Q

SOLAR LENTIGO

Clinical characteristics

A
  • 2-20 mm
  • oval, often irregular macules
  • surrounding actinic change
  • sharp borders
  • consistent pigmentation
56
Q

SOLAR LENTIGO

Tx

A
  • sunscreen, sun avoidance (prevention)
  • monitor for change, biopsy
  • tx if cosmetically undesirable
  • hydroquinone crean
  • azeleic acid cream
  • tretinoin cream
  • chemical peel
  • cryosurgery
  • laser
57
Q

VENOUS LAKE

A
  • common, soft, compressible venous papule
  • typically blue-purple in color
  • associated with sun exposure
  • usually found on lips, face, ears, neck, forearms, back of hands
58
Q

VENOUS LAKE

Clinical features

A
  • 2-10 mm
  • well defined
  • bluish
  • will typically blanch
  • surrounding actinic damage
  • can bleed with trauma
  • compressible
59
Q

VENOUS LAKE

Tx

A
  • reassurance
  • cautery
  • excision w/ frequent trauma or interference w/ ADL/cosmetic concerns
  • recurrence is common

Fall 2014 - CM Dermatology (11 decks)

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