DCNP - Benign Lesions

Question 1

dermatofibroma

Answer 1

dimple sign when pinched
ILK may dec size
Immunosuppression, pregnancy, and HIV infection can lead to eruptive dermatofibromas

Question 2

Dermatofibrosarcoma protuberans (DFSP)

Answer 2

flesh-colored, indurated nodule that grows slowly over time (months to years)

Question 3

seborrheic keratosis

Answer 3

immature keratinocytes
UV radiation and HPV infection may play role

Leser-Trélat – an acute eruption of multiple, pruritic SKs on the back, often with a “Christmas tree” pattern w/in 3-6 mos, can be sign of GI, lymphoid, breast & lung cancer or during chemo

variants: Dermatosis papulosa nigra (LN2 often leaves pigmentary alteration), large cell acanthoma, clonal SK

Question 4

multiple lipomas

Answer 4

consider tuberous sclerosis, Gardner syndrome, familial multiple lipomatosis, proteus syndrome

Question 5

keloids

Answer 5

can arise spontaneously w/o trauma
intralesional interferon/5-FU/ILK w cryo, lasers, radiation

Question 6

hemangiomas

Answer 6

dilated capillaries
shave excision, cryotherapy, lasers, ED&C

Question 7

pyogenic granuloma

Answer 7

aka lobular capillary hemangioma
yellow to red
may be covered in crust or surrounded by collarette of scale
Predisposing factors include injury/trauma, hormonal changes (including OCP), infectious organisms, and medications (retinoids, EGFRs, BRAF inhibitors, topical fluorouracil, tacrolimus, cyclosporine, HIV protease inhibitors)
May occur spontaneously within capillary vascular malformations or following laser treatment
5% of pregnant women in 2nd or 3rd trimester develop on oral mucosa
Excision with linear closure
Shave excision with electrocautery
Cryotherapy
ED&C
Laser – If <0.5mm 585nm pulsed-dye, if >1cm CO2 laser
Always send for histopathology to rule out malignancy/melanoma
Recurrence rate is high

Question 8

glomus tumor

Answer 8

Proliferation of glomus cells in arteriovenous vessel
Blue-red papule, sometimes nodular or plaque
Favors upper extremities, especially fingernails, but can be on the lower extremities, penis, head and neck
paroxysmal tenderness, local tenderness, cold sensitivity
Surgical excision (may have residual nail deformities if periungual)* Less often: sclerotherapy, carbon dioxide lasers

Question 9

corns & calluses

Answer 9

thickened stratum corneum
corns have central hyperkeratotic core
Salicylic acid pads* Pare with scalpel* Avoid ill-fitted shoes* Orthotics and podiatry referral may be necessary

Question 10

lentigines

Answer 10

Lentigo simplex - anywhere on body, inc melanin not assoc w/ uv
solar lentigo - result of UVB which triggers increased keratinocyte growth factor, which induces tyrosinase and melanin in melanocytes

Lentigo maligna – asymmetrical follicular pigmentation, rhomboidstructures, circles within circles (concentric), structureless areas

Cryotherapy, pulsed light, chemical peels, and laser* Topical therapies – retinoids and phenols. Avoid concurrent use of laser andretinoids