Bullous & pigmented skin lesions Flashcards
epidermoid cysts
-common cutaneous cysts
classified by anatomic location (as they can occur in any organ)
-true cysts have epithelial lining
-only true sebaceous cyst is steatocystoma
Lipomas
-benign tumors of mature fat
-most common neoplasms in humans
-usually solitary
-
epidemiology of lipomas
occur at any age, usually over age 40
pathogenesis of lipomas
most are incidental; don’t know how they occur
-sometimes hereditary component
Differential for lipomas
often mistaken for epidermoid cysts
treatment for lipomas
- excised
- larger lesions-liposuction
Milia
-small epidermoid cysts, common in young children and older ppl
S/S milia
1-2mm white to yellow sub epidermal papules
treatment milia
incising epidermis over milium
-topical retinoids in adults
What does histologic examination show of cysts?
cystic cavity filled with laminated keratin lined by stratified squamous epithelium
S/S epidermoid cysts
- well demarcated dermal nodules
- may have visible central punctum from follicle where it’s derived
- smell of sebum if cyst ruptures
Treatment of cysts
- excision is curative
- entire wall must be removed
- inflamed epidermoid cysts may require I&D
- inject triamcinolone or kenalog
neurofibromatosis inheritance pattern
autosomal dominant
clinical features of neurofibromatosis
(NF1)
- cafe-au-lait macules, neurofibromas, freckling in axillae and groin
- can develop internal tumors
Diagnostic criteria for NF-1
six or more cafe a lat spots, two or more neurofibromas, freckling in axilla or groin, distinctive bony lesions of sphenoid bone
tx for neurofibromatosis
- multidisciplinary approach
- surgical excision, laser ablation
Key features of hidradenitis suppuritiva (HS)
- poral occlusion of pilosebaceous units in axillary and anogenital regions
- secondary inflammation of the apocrine glands
- inflamed nodules and sterile abscesses followed by sinus tracts, fistulas
epidemiology Hidradenitis suppuritiva
- starts soon after puberty
- woman more affected than men
- autosomal dominant
- african american higher incidence
Pathology of HS
- heavy mixed inflammatory cells infiltrate lower half of dermis
- abscesses present in active cases and may connect with sinus tracts leading to skin surface
- chronic cases may have extensive fibrosis
HS clinical features
- initially inflammatory nodules and sterile abscesses develop in axillae, groin, perianal areas
- tender, painful
- drainage of serous, exudate, pus, blood
HS treatment
- weight reduction IF over weight
- smoking cessation IF
- absorbent powder & antiseptic soaps
- intralesional triamcinolone & topical clindamycin
epidemiology of Albinism
- present at birth
- puerto ricans, madras
- different genetic pathways
Pathology of albinism
-defect in melanin synthesis resulting from absence of the activity of tyrosinase
What is tyrosinase
copper containing enzyme that catalyzes the oxidation of tyrosine to dopa, then dehydrogenation of dopa to dopa-quinone
S/S of Albinism
“poring eyes” half closed
- snow white skin
- white, yellow, or light brown hair
- nystagmus always present in eyes
-translucency in eyes
What type of disorder is vitiligo?
pigment disorder
epidemiology of vitiligo
any age, all races, both sexes
-appears to be inherited
pathophysiology of vitiligo
-autoimmune hypothesis, destroys melanocytes
-neurogenic hypothesis: interaction b/t melanocytes & nerve cells,
self destruct hypothesis: melanocytes destroyed b
S/S vitiligo
- chalky, pale macules
- depigmentation induced by physical trauma
- lesions can occur anywhere
Treatment for Vitiligo
- no cure; chronic
- sunscreens, glucocorticoids, bleaching agents
Key features of Seborrheic Keratosis
- very common
- brown macules, papules, plaques
- usually over 30yo
- often appear verrucous/stuck on
- predilection for face, neck, trunk
Rare sign of seborrheic keratosis
Leser-Trelat: striking proliferation or increase in size and # of SKs may be a marker for internal malignancy
What does seborrheic keratosis resemble?
melanoma
What is the textbook/test description for SK’s lesions?
stuck on
Epidemiology of seborrheic keratosis
- familial predisposition
- probably autosomal dominant
- risk factor MAY be sunlight
Pathophysiology of SKs
base of lesion lies on flat horizontal plane flanked by normal epidermis on the other side
treatment of SKs
- largely cosmetic purposes
- cryosurgery, laser ablation
- shave exicision
skin tags are also called
acrochordon, fibroepithelial, polyp, soft fibroma
Pathology of skin tag
polyploid growth or variably loose to dense collagenous storm with thin walled dilated blood vessels in center
treatment for skin tags
more of a cosmetic issue unless irritated or infarcted
-scissor excision or cryosurgery
Key features of Capillary Hemangiomata
- soft tissue tumor of infancy
- benign endothelial cell neoplasms
Treatment of hemangiomas
- preventing function loss, etc
- treat ulcerations
- prevent permanent disfigurement
- avoid overly aggressive, potentially scarring procedures
Keloids have a higher incidence in which two populations?
darker pigmented, african american population and women
Where do keloids appear?
spread outside of injury zone
treatment for keloids
- often ineffective
- steroids injections
- laser therapy
- surgery
Pigmented lesions in dark skin
harder to diagnose, more likely to die from melanoma because might not know they have it
