Benign Tumors of the skin- Fisher

Question 1

Describe the appearance of Milia

Answer 1

Clustered, small epidermoid cysts

Question 2

Where are milia commonly located?

Answer 2

cheeks, eyelids, forehead, genitals (because, derm)

Question 3

What age group does milia most commonly present in? What is the course of disease?

Answer 3

Infants, they resolve spontaneously

Question 4

Describe the appearance of a dermatofibroma? How do you distinguish it from a malignancy?

Answer 4

Classically a 3-10 mm papule on the distal lower extremity with excess pigmentation (red/brown); exhibits no keratosis, scaling, or translucent appearance

Question 5

What is the pathogenesis of a dermatofibroma?

Answer 5

A proliferation of fibroblasts, often following a localized trauma (such as a bug bite)

Question 6

Describe the appearance of a seborrheic keratosis

Answer 6

Oval in shape with a waxy, hyper-keratotic surface. Feels very rough on the surface and is brown in color

Question 7

Which skin layer is a seborrheic keratosis located?

Answer 7

Epidermis

Question 8

Seborrheic keratosis: benign or malignant?

Answer 8

Benign

Question 9

What are seborrheic keratosis often confused with?

Answer 9

Melanomas; due to the deep brown pigmentation

Question 10

Where on the body are seborrheic keratosis found? How do they organize there?

Answer 10

Commonly on the trunk (especially back); organize along skin tension lines in a “Christmas tree” formation

Question 11

Patient presents with acute onset of multiple seborrheic keratosis. What do you do?

Answer 11

Immediately screen them for cancer; most commonly associated with colon cancer

Question 12

What is the sign of Leser-Trelat

Answer 12

Sudden eruption of multiple seborrheic keratosis signifying underlying cancer; adenocarcinoma of colon, breast, stomach, and lung

Question 13

Classic description of a seborrheic keratosis

Answer 13

round/oval, skin colored–> brown/black, slightly raised, “stuck on” papules; he said they look like you could “pick them right off the epidermis”

Question 14

Someone presents with bright red papules on their trunk. What are they?

Answer 14

Cherry angiomas

Question 15

Where are cherry angiomas commonly located? How old is the patient normally at presentation?

Answer 15

On the trunk; over 40 years

Question 16

Difference between a hypertrophic scar and a keloid

Answer 16

Hypertrophic scar will not extend past the borders of the initial insult; keloids grow extensively outside of the borders

Question 17

What is the risk of surgical excision of a keloid?

Answer 17

It will come back and most likely be worse

Question 18

Who is at most risk for keloids?

Answer 18

African americans; equally affects men and women

Question 19

Most common location for keloids?

Answer 19

Central chest

Question 20

If you excise a keloid, what is done immediately post excision to reduce the chance of recurrence?

Answer 20

Corticosteroids are injected in the wound, inhibit fibroblasts

Question 21

Describe an epidermal (epidermoid) cyst

Answer 21

A mobile dermal nodule with a central punctum

Question 22

What is an epidermoid cyst filled with?

Answer 22

keratinaceous debris and sebum (cheesy appearing); smell awful when expressed

Question 23

Where specifically do epidermoid cysts originate from?

Answer 23

The infundibulum of the hair follicle

Question 24

What is a pilar cyst?

Answer 24

smooth, firm, dome-shaped, keratin-containing tumor

Question 25

Where are pilar cysts almost always located?

Answer 25

the scalp (90% of the time)