Benign Skin Tumors Flashcards
Chrondrodermatitis nodularis helicis population affected
40 yo
Chrondrodermatitis nodularis helicis cause
unknown, actinic damage, cold exposure, trauma, local ischemia, those who work outside during winter
Chrondrodermatitis nodularis helicis sx
Early: central crust at apex
Late: dense rolled edge
Pain with anything touching the ear
well-circumscribed, rounded nodule with raised edges and a crust in its center, often overlying an ulcer which may occasionally have exposed cartilage at the bottom w/ erythema around it
diameter of 4 mm to 6 mm
Chrondrodermatitis nodularis helicis TX
Co2 laser
Injectable collagen implants
Intralesional steroid injections
Nitroglycerin gel-2% gel – regeneration of and regrowth
Photodynamic therapy (PDT)
Removal of causative factor/relieving pressure (Doughnut pillow)
Topical steroids
Cartilage excision
Curettage
Wedge excision
Chrondrodermatitis nodularis helicis ddx
Squamous cell carcinoma
Basal cell carcinoma
Actinic keratosis
Chrondrodermatitis nodularis helicis
Dermatofibroma
Area of focal dermal fibrosis, often with overlying epidermal hyperpigmentation and thickening
Dermatofibroma population affected
young adults, female
Dermatofibroma sx
Small brown papules
Indurated
1-10
Asymptomatic
Purutius
>15 Multiple can be seen with SLE
On trunk or extremities
Dermatofibroma PE
Typically about 3-10 mm in size, slightly elevated, scaly lesions
Vary in color from light tan to dark brown
Firm, fibrotic consistency on palpation
Dople sign: central dimpling in the center with lateral compression
Dermatofibroma tx
Not needed
Excision
Dermatofibroma ddx
Nevi
Malignant melanoma
Dermatofibrosarcoma protuberans
Dermatofibroma
Dermatosis Papulosa Nigra population affected
Fitzpatrick Skin Type III-VI
Dermatosis Papulosa Nigra sx
bumps are about 1-5 millimeters in diameter and 1-3 millimeters high
are harmless and don’t cause any ulcerations (breaks in the skin), scaling, or crusting
Smooth in adolescence, freckle-like bumps and gradually become rougher with time, may grow in size and number with age
On face and neck
Dermatosis Papulosa Nigra tx
Cryotherapy
Shave
Dermatosis Papulosa Nigra ddx
Sebaceous cyst
Dermatosis Papulosa Nigra
Digital mucous cyst population affected
middle aged and elderly
Digital mucous cyst sx
Over DIP or nail base
usually solitary, rubbery, can be translucent
filled with clear gelatinous viscous fluid
Digital mucous cyst tx
Puncture and drainage w/ compression
Excision
Intralesional corticosteroids
Cryotherapy
Epidermal Inclusion Cysts cause
traumatic implantation or spontaneous from upper portion of hair follicle of epidermis into dermis.
giant comedones (blackheads or whiteheads)
Epidermal Inclusion Cysts sx
Appear as flesh-colored, firm, but often malleable, skin nodules with surface opening appears as a small, round, sometimes imperceptible pore
Range in size from 0.5 - 5 cm
Located anywhere, most commonly on the scalp, neck, and trunk.
Asymptomatic
Oily and foul smelling inside
Epidermal Inclusion Cysts complications
Infection: tender and increased discharge
Epidermal Inclusion Cysts tx
Don’t need
Excision- make sure to remove entire cyst and lining but not when inflamed
Corticosteroid when inflamed but not infected
Incision and drainage
Take at least 4-6 weeks
Poultice or antibiotics
Epidermal Inclusion Cysts ddx
Pilar cyst
Milia
Digital mucous cyst
Ganglion cyst
Lipoma
Nasal gliomas
Epidermal Inclusion Cysts
Ganglion cyst
cystic swelling surrounded by a fibrous tissue wall occurring in the vicinity of joint capsules and tendon sheaths
Ganglion cyst population
female, second and third decade
Ganglion cyst cause
degenerative process in the mesoblastic tissues surrounding the joint, herniation of a tendon sheath, trauma
Ganglion cyst sx
Dorsum of the wrist, flexor aspect of the wrist adjacent to the radial artery, elbow, ankle, foot, and back of knee
Usually smooth and rounded; at other times multilocular, hard/firm, crystal clear, very thick gelatinous content occasionally tinged with blood, cystic and fluctuant.
increases in size after excessive movement or use and size decreases with rest
Pain dull and constant or painless or sharp pain
Weakness
Ganglion cyst complications
Infection risk with aspiration
Sclerosing agent can cause damage to surrounding structures
Ganglion cyst tx
Intentional rupture: smack the cyst
Aspiration
Injection of sclerosing solution- Sodium morrhuate
Excision
Compression early
Acupuncture
Corticosteroid injections
Ganglion cyst
Gardner’s syndrome cause
autosomal dominant, heritable disorde
Gardner’s syndrome sx
multiple epidermal cysts
fibromas
osteomas
and intestinal polyps, which often undergo malignant degeneration.
Gardner’s syndrome
Hypertrophic scar
Enlargement of the sar within the boundary of the original scar
Hypertrophic scar cause
Genetics
Body site
Quality of the surgery
Skin tension
Skin type
The patients health status at the time
Hypertrophic scar RF
young age, female gender, dark skin, neck or upper limb burns, multiple surgical procedures, greater than 3 weeks to healing, meshed skin graft use, and burn severity
Hypertrophic scar sx
1 to 2 months after injury
Irritation
pruritus
neuropathic pain
increased induration and often dyspigmentation over the site of a wound
Hypertrophic scar Tx
Surgery
Corticosteroid
Cryotherapy
Laser
Hypertrophic scar ddx
Keloid scarring
Sarcoma
dermatofibrosarcoma protuberans
Dermatofibroma
nodular scleroderma
Lobomycosis
Keloid scarring
Enlargement of the scar beyond the original scar boundary
Keloid scarring cause
Genetics
Body site
Quality of the surgery
Skin tension
Skin type
The patients health status at the time
Response to trauma
* Acne
* Body piercing
* Tattoos
* Insect bites
* Vaccination
* Surgery
Keloid scarring population
darker skin types, 10-30 years
Keloid scarring RF
darker skin type
Keloid scarring Tx
Silicone-based therapy (gel, sheets, spray)- week or 2 after surgery
Intralesional corticosteroids
Acupuncture
Topical steroids
Laser therapy
Radiation therapy
Cryotherapy
Pressure therapy(local hypoxia)
Surgery–last option d/t recurrence
Hypertrophic scar
Keloid scarring
Lipoma
Lipoma
Deeper than an epidermal inclusion cyst
Lipoma population
middle life
Lipoma cause
genetics, trauma, fat metabolism problems
Lipoma sx
Feel rubbery but is usually not malleable
Move freely
only slightly elevated above the skin’s surface, but easily palpable deep to the skin
Asymptomatic and slow growing
trunk, neck, and upper extremities
Flesh-colored
Range in size from 1 - 10 cm
May be solitary or multiple
Lipoma diagnosis
Slightly malleable
If the skin moves over top of the lesion, the lesion is sub-dermal in origin and probably is a lipoma
Biopsy
MRI
US
Lipoma complications
Gardner’s syndrome
Multiple symmetrical lipomatosis
Dercum’s disease
Lipoma tx
Not required
Incision and blunt dissection
Liposuction
Injection with low dose deoxycholate
Meibomian cyst cause
blockage of meibomian gland of eye
Meibomian cyst sx
Painless
Initial lid edema and irritation
firm nodule on eyelid
Meibomian cyst tx
Hot compress 10-15 min qid/ 2-3 weeks
Steroid injection after 6 weeks
Incision and curettage w/ or w/o antibiotics
Meibomian cyst
Milia
Small epidermoid cysts
Milia cuase
trauma
Milia sx
Face
1-2 mm white to yellow
Single or multiple
Milia Tx
Lidocaine, scalpel, express it
Retinoid therapy
Nasal Gliomas population
children at birth
Nasal Gliomas cause
genetics
Nasal Gliomas
Neurofibromas/Von Recklinghausen’s disease
Focal proliferation of neural tissue within the dermis
Neurofibromas/Von Recklinghausen’s disease types
Neurofibromatosis type 1: most common
Neurofibromatosis type 2
Schwannomatosis: enlargement of nerve bundles
Neurofibromas/Von Recklinghausen’s disease population
20-40 yo, childhood (NF1), 16-20 (NF2)
Neurofibromas/Von Recklinghausen’s disease
cause
inherited disorder or no known cause
Neurofibromas Type 1 sx
Cafe au lait spots: Flat, light brown spots on the skin birth-1 year
Freckling in the armpits or groin area 3-5
Bone defects: bowed legs or Scoliosis
Lisch nodules: tiny bumps on the iris of the eye
Optic glioma: at age
Soft, pea-sized bumps on or under the skin
Learning difficulties
Larger than average head size
Short stature
Neurofibromatosis type 2 sx
Hearing loss
Tumors in both ears
Ringing in the ears
Poor balance
Headaches
Soft, pea-sized bumps on or under the skin
Schwannomatosis sx
Numbness and weakness in the arms or legs
Pain
Balance difficulties
Facial drop
Vision problems or the development of cataracts
Soft, pea-sized bumps on or under the skin
Neurofibromas PE
on compression, invaginate into a slit-like defect in the skin = “buttonhole” sign
Neurofibromas diagnosis
Crowe’s Criteria for Diagnosis of Neurofibroma
Six or more café-au-lait spots, each greater than 1.5 cm in diameter, are diagnostic.
Axillary freckling
Biopsy
Neurofibromas tx
Don’t need to remove
Lift and snip
Shave
Hyfrecator
Radiosurgery
nevi
A nevus (mole) is a benign neoplasm derived from the pigment-forming (melanocyte) nevus cell.
nevi population
white, middle-aged adult,
nevi cause
congenital or acquired
Junctional Nevi
Initial pinpoint (1-2 mm)
Expands to 4-6 mm
Flat, slightly elevated
Smooth or slightly elevated
Sharply circumscribed
Uniformly pigmented (brown, tan, black)
Nevus cells at dermo-epidermal junction
Round or oval and symmetrical border
Hairless
0.1-0.6 cm
Develop after age 2 years
Palms, soles, and genitalia
Very rare to melanoma
Can change into compound
25-40 moles is normal
Appear singularly and rarely in crops
Compound Nevi signs
Slightly elevated dome shaped, papule, Smooth or warty, Flesh, brown, halo nevus (white halo at the periphery) , Uniformly, round, oval, and symmetric
Hair may be present
Appear singularly and rarely in crops
milia
Neurofibroma
Junctional nevi
compound nevi
Intradermal/dermal nevi
Dome shaped
Verrucoid (warty)
Pedunculated
Sessile
Brown or black, but may become lighter or flesh-colored with age
Vary in size from a few millimeters to a centimeter
Variety of shapes
intradermal/dermal nevi
Atypical nevi sx and signs
Slow growing
3-15mm
Irregular, ill defined
Asymmetrical
Tan, brown, dark brown, black, pink
Central papule surrounded by macular ring
Asymptomatic
Risk of melanoma
Back, upper, lower limbs, female breasts, scalp, buttock, groin
atypical nevi
Nevi diagnosis
When to work up
* Symptomatic should be worked up
* Blue nevus
* Asymmetric
* Changing
Pilar or Trichilemmal Cyst population
women with family history
Pilar or Trichilemmal Cyst sx
Scalp
5-5 cm nodule/tumor - smooth, firm, dome
Pain free
Pilar or Trichilemmal Cyst Tx
Excision
Pilar or Trichilemmal Cyst
Sebaceous cyst cause
poor hygiene
Sebaceous cyst sx
flesh-colored, dome-shaped nodules that feel firm (not hard)
Range in size from 0.5 to 5 cm
Sebaceous cyst dx
an oily substance rather than macerated keratin.
Biopsy is usually not necessary
Sebaceous cyst tx
Don’t need
Excision- make sure to remove entire cyst and lining but not when inflamed
Corticosteroid when inflamed but not infected
Incision and drainage
Take at least 4-6 weeks
Poultice or antibiotics
Sebaceous cyst
Sebaceous hyperplasia
Small tumors of enlarged sebaceous glands
Sebaceous hyperplasia population
> 30 yo
Sebaceous hyperplasia cause
sun exposure, trauma
Sebaceous hyperplasia sx
On Forehead, cheek, lower lid, and nose
1-3 mm
Telangiectasia
Central umbilication
Soft
Blood vessels occur in the valleys between lobules
Sebaceous hyperplasia dx
Biopsy
Sebaceous hyperplasia tx
Carbon dioxide laser ablation
Shave excision
Electrodessication with curettage
Trichloroacetic acid
Photodynamic therapy
Cryotherapy
Not required
Sebaceous hyperplasia
Seborrheic keratosis population
middle age
Seborrheic keratosis cause
autosomal dominant, benign proliferation of immature keratinocytes,
Seborrheic keratosis sx
Vary in size from 2 mm to more than 3 cm
Slightly to markedly elevated
Rough
verrucous or crumbly, dry and cracked with accentuation of the hair follicles, papule or plaque
Smooth
smooth dome- shaped surface with tiny, round, 1 mm in diameter white or black horny cysts/pearls embedded in the surface, papule or plaque
Seborrheic keratosis types
Rough
* verrucous or crumbly, dry and cracked with accentuation of the hair follicles.
Smooth
* smooth dome- shaped surface with tiny, round, 1 mm in diameter white or black horny cysts/pearls embedded in the surface
Seborrheic keratosis dx
Excisional or shave biopsy
Seborrheic keratosis TX
No treatment
Liquid nitrogen cryotherapy
Light electrocautery
Dermabrasion
Laser treatment
* Only for darker lesions
Trichloroacetic acid
Topical tretinoin
Local anesthesia by shaving/curetting along with hyfrecation or radiosurgery
Seborrheic keratosis
Seborrheic keratosis
Skin Tag (acrochordon) population
adulthood
Skin Tag (acrochordon) cause
obesity, diabetes, metabolic syndrome, aging
Skin Tag (acrochordon) sx
Increase with age
soft, skin-colored to slightly pigmented
pedunculated papule-neck, axilla, groin, eye, mouth
Multiple in one spot
May appear necrotic
Hyperpigmentation
Skin Tag (acrochordon) PE
tan to flesh-colored, 1 -10 mm., soft, fleshy, pedunculated, papules
Skin Tag (acrochordon) TX
Cosmetic or irritation but not pathological
Scissor excision
Cryotherapy
Radiosurgery
Electrodesiccation
Lift-and-snip
Shave procedure
Dental floss
Skin Tag (acrochordon) ddx
Intradermal nevi
Neurofibromata
Seborrheic keratosis ddx
Warts
Actinic keratosis
Nevi
Pigmented basal cell carcinomas
Dermatofibroma
Malignant melanomas
Sebaceous hyperplasia ddx
Basal Cell Carcinoma
Small keratoacanthoma
Molluscum contagiosum
Syringoma
Sty or external hordeolum Tx
Hot and cold compress
Sty or external hordeolum
Syringoma
Most common tumor of the intraepidermal eccrine sweat glands
Syringoma population
women, any age, >30
Syringoma cause
autosomal dominant
Syringoma sx
Symmetrical
Small, firm, multiple, flesh-colored papules
Occur on lower lids, and less commonly on forehead, chest, abdomen and vulva
No malignant potential
syringoma dx
Shave biopsy
syringoma Tx
Electrodessication and curettage
Cryotherapy
Laser
trichloroacetic acid
Glycolic acid at 10%-20% concentration
May cause scarring
Venous ulcers
Location: Medial lower leg
Irregular margins
Superficial
Ruddy granular tissue
Painless-moderate pain
Exudative
Periwound is weepy or dry and thin
Firm edema/woody
Lipodermatosclerosis
Hemosiderin staining
syringoma
venous ulcers
Arterial ulcers
Location: lateral malleolus, between toes, phalangeal heads
Even wound margins
Pale deep wound bed
Pale dry granulation
Painful
Minimal exudate-dry
Thin, shiny dry skin
Pallor elevation/dependent rubor
Cool
Diminished/absent pulses
