Benign skin tumours

Question 1

LIPOMA
i) what is it? where does it grow?
ii) name three potential causes?
iii) name three features? is it moved under the skin easily? what is it likely to be if it is painful?
iv) is treatment usually given? name two ways it can be treated

Answer 1

i) non cancerous tumour made up of fat cells that slowly grows in the subcut tissue
ii) dome/egg shaped lump 2-10cm diamter, soft and smooth, rubbery or doughy, shoulders/neck/trunk/arms
* if painful its more likely to be an angiolipma
iv) not usually treated but may do simple surgical excision, squeeze technique (incision then squeeze through the hole), liposuction

Question 2

DERMATOFIBROMA
i) what is it? where is it usually found? what cells are they comprised of?
ii) name three things that can precipitate it? when may multiple dermatofibromas arise?
iii) how does it look? how does the skin lie around the lesion? what sign can be seen?
iv) how does it look on dermoscopy? when may excision or skin biopsy be done?
v) is treatment usually given?

Answer 2

i) common bengin fibrous nodule usually found on skin of lower legs comprised of proliferating fibroblasts and sometimes histiocytes
ii) ppt by minor trauma - insect bites, injections, rose thorn injury > multiple may arise when altered immunity eg HIV, immsupp or AI conditions
iii) solitary firm papule or nodule on a limb - overlying skin dimples on pinching the lesion = dimple/pinch sign
iv) dermoscopy - central white area surrounded by a faint pigment network - do excision or skin biopsy if atypical features eg ulceration, assymetry or enlargement
v) dont usually treat

Question 3

PYOGENIC GRANULOMA
i) what is it? where is it found? (2)
ii) who does it most commonly occur in?
iii) name three things that can cause it
iv) how does it look on dermoscopy?
v) what is the main treatment approach? name two topical treatments and two physical tx

Answer 3

i) benign proliferation of capillary blood vessels of the skin and oral cavity most commonly on fingers and face
ii) most commonly occ in children around 6 years of age/teenage/young adults
iii) causes - recent trauma, hormonal influence (pregnancy and COCP), medications eg oral retinoids/protease inhibitors/immsupp and infection (s aureus)
iv) on dermoscopy - distinct keratinised border w vaascular structures - linear white ‘rail lines’
v) treatment is usually based around removing triggers eg drugs, oral hygiene, removal of piercings
* topicals - imiquimod cream, steroid injection, cryo
* physical - curette and cautery, surgical excision and lasers