Benign Skin Tumors Flashcards
What are cherry hemangiomas?
- they are RED
- arise in middle age
- most common vascular tumor
- no underly disease
On trunk – can be multiple maybe hundreds
What is the tx for cherry hemangiomas?
- Superficial electrodesiccation
What is infantile hemangioma?
- Most common soft tissue tumor of infancy
- 10-12% in infants
- Benign endothelial
- Stain with Glut-1
- Rapid proliferation in first 1-3 months
- Precursor lesion noted at birth
- Spontaneous involution over years
AKA strawberry/capillary hemangioma
Primary pop’n for infantile hemangioma
- Girls
- Premature infants
- Infants of moms post-chorionic villus sampling
What are complications associated with infantile hemangioma?
- Location:peri-ocular (probs w/ vision), beard area (airway involvemnet), lip, anogenital, nasal tip
- Ulceration
- Size (large distorts normal tissue/function)
- Multiple => maybe internal involvement
- Congenital syndromes (PHACES)
What is the tx for infantile hemangioma?
- Observation
- Local wound care
- Pulse dye lase
- Topical, intralesional and systemic steroids
- Bta-blockers
What is port wine stain?
- Vascular malformation
- Present at birth => persists through adulthood
- Often irregular vascular channels => DO NOT stain w/ Glut-1
- Somatic mutation in GNAQ
No gender/gestational predilection
What are complications are associated w/ port wine stain?
- Klippel-trenaunay syndrome
- Overgrowth of an extremity
- Varicose veins => venous stasis, edema, ulceration
- Sturge-Weber Syndrome (on face, developmental delay, seizures, glaucoma)
What is the tx for port wine stain?
- Pulse dye laser
Why treat?
- Persist into adulthood
- Get worse with time
- Dark purple, nodular, bleeding blebs
What is nevus sebaceus?
- Enlargement of sebaceus glands => associated with alopecia
- rapid growth occur at puberty => epidermal hyperplasia
- Somatic mutation: HRAS and KRAS
- Yellow-orange linear plaque on face/scalp
What are complications associated with nevus sebaceus?
- Epidermal nevus syndrome (neuro probs)
- Epithelial neoplasms
What is tx for nevus sebaceus?
- Observation
- Surgical excision
What is sebaceous hyperplasia?
- common benign tumor of oil gland
- increased frequency after mid age
- Distribution: face>trunk>extremities
- Primary lesion: 1-6mm => yellow-white papule w/ central dell
What is the tx for sebaceous gland hyperplasia?
a
What is acrochordon?
Skin tages, fibroepithelial polyps
- Common => 1/4 of all adults have at least one
- Solitary or multiple
- Soft, flesh colored (1-4mm)
- Large ones: soft fibroma
Complications: recurrent trauma, torsion
What is the tx for acrochordon?
a
What is lipoma?
a
what is the tx for lipoma?
- No tx (observation)
- Surgical excision
What is dermatofibroma?
- Distribution: legs (80%)
- Typically solitary (80%)
- Primary lesion
- Positive dimple (fitzpatrick) sign — when you squeeze it, you make a dimple
Complications: pain, pruritis
What is the tx of dermatofibroma>
a
What are keloid scars?
type of scar
What is the tx for keloid scars?
- Topical steroids under occlusion
- Intralesional steroids
- Surgical excision (best for ear keloids)
- Surgery +/- radiation
What are seborrheic keratosis?
Barnacles of life
- Benign tumor of hair follicle
- Primarily head, neck, trunk
Describe the primary lesion of seborrheic keratosis?
- white-gray to tan to brown to black
- exophytic papule
- Smooth to verrucous
- Often friable
- Studded w/ small pits
What are the clinical variants of seborrheic keratosis?
a
What is the tx for seborrheic keratosis?
- Moisturizers
- Cryosurgery (liquid nitrogen)
- Surgical removal
What are nevocellular nevi?
MOLES
- infancy to adults
- any skin surface area
- # increased w/ sun exposure
Types
- intradermal
- junctional
- compound
Describe intradermal nevus
a
Describe junctional nevus
a
Describe compound nevus
a
What are indications for tx for nevocellular nevi?
- No tx for most
- ABCDE is unsure
What are appropriate tx’s for nevocellular nevi?
a
What are inappropriate tx’s for nevocellular nevi?
a
What are blue nevus?
- Dermal proliferation of melanocytes => produce lots of melanin
What are the clinical features of blue nevi?
- Congenital or acquired (more common)
- Most common in Asians and whites
- Primary lesion: blue to blue-gray
- 1mm to 2cm
What is the tx for blue nevi?
- No tx
- Monitor
- Surgical removal (PUNCH IT!)
What are congenital nevi?
- Solitary or multiple
- Cutaneous surfaces
- 1mm to HUGE
Complications
- head, neck, posterior midline => risk for cancer
What is the tx for congenital nevi?
Monitor over time — look for ABCDE
Sometimes elective surgery (not usually recommended)
What are dysplastic nevi?
- acquired melanocyte proliferation
- epidermal a/o dermal proliferation
- Abnormal growth
Wha tare the clinical features of dysplastic nevi?
Males = females
- Age of onset: 20
- Location: any cutaneous, usually trunk
- Number: 1 to 100s
Describe the primary lesion of dysplastic nevi
- Round to oval, irregular
- Varying colors
- Margins: fuzzy, pigment bleeds into surrounding skin
- No size limit
What is the clinical importance of dysplastic nevi?
- Could be w/ melanomas
- Familial atypical mole and melanoma syndrome (increased risk)
What is the tx of dysplastic nevi?
Biopsy the ugly duckling
Atypical ones: difficult to get it all => potentially not worth the procedure
What is neurofibromatosis?
- AD inheritance w/ variable expression
- 50% of cases b/c of spontaneous mutations
- Defect in neurofibromin gene on chromosome 17 (tumor suppressor)
What is the diagnostic criteria of neurofibromatosis?
1) 6 or more cafe au lait patches (>1.5cm)
2) 2 or more neurofibromas, 1 plexiform
3) Axillary/inguinal freckling
4) Optic glioma
5) 2 or more Lisch nodules
6) Osseous lesion
7) First degree relative w/NF
What are neurofibromas?
- Soft flesh colored papules (button hole sign)
- Focal proliferation of neural tissue w/in the dermis
- solitary? => don’t worry
- multiple? => maybe NF, worry
What are cafe au lait spots?
- Subtle increase of melanocytes # w/ increase melanin production
- Congenital/early childhood
- On trunk, proximal extremities
- Usually solitary
- Multiple?? => THINK neurofibromatosis
What is the tx of cafe au lait spots?
- No tx (cosmetic concern)
- Pigmented laser (expensive, varying results)
