Lumps in Head + Neck + Skin

Question 1

How do you take a history of lumps

Answer 1

Length of time
hurt/pain
other symptoms (itchiness)
getting bigger?
recent travel
other lumps
is this the only symptoms? Otherwise the well being?

Question 2

How do you make a physical exam of a lump?

Name the 6 S’s

Answer 2

examine the regional lymph nodes
examine the lump
- is the lump a node? see where it drains
examine circulation + nerve supply distal to any lump

site size shape surface surroundings smoothness

temperature tenderness pulsatile (use duplex scanner)
Fluctuate / compressible
transilluminate
fixed/tethered to the skin or underlying structures

Question 3

What is the difference between an intradermal and a subcutaneous lump?

Answer 3

Intradermal: cannot draw the skin over it
- sebaceous cyst, abscess, dermoid cyst, granuloma
Subcutaneous: manipulate the lump independantly from the skin
- lipoma, ganglion, neuroma, lymph node

Question 4

Name 10 different lumps

Answer 4

Lipomas
Sebaceous cyst/Epidermal/Pilar cyst
Lymph nodes
Cutaneous abscesses
Rheumatoid nodules
Ganglia
Fibroma
Dermoid cyst
Malignant tumours of connective tissue
Keloids

Question 5

What are lipomas

Answer 5

benign fatty lumps where fat can expand to (not in scalp or palms)
malignant changeover is rare
Dercum’s disease: multiple lipomas everywhere

• fluctuance
• smooth/imprecise margins
• not fixed to skin + deep structures
• symptoms caused by applying pressure

Question 6

What is the difference between sebaceous cysts, epidermal cysts and pilar cysts

Answer 6

Sebaceous cyst: firm, round, mobile, subcut nodules
Epidermal: sebaceous in origin with sebum
Pilar cyst: a cyst made of keratin

have central punctum (pus exits from here)
vary in size
seen at face / neck / scalp

Question 7

What are lymph nodes

Answer 7

can be enlarged by infection

• glandular fever
• brucellosis
• TB
• HIV
• taxoplasmosis
• syphilis
• actinomycosis

can be enlarged by infiltration

• malignancy (ca or lymphoma)
• sarcoidosis

Question 8

What is a cutaneous abscess

Answer 8

a staphylococcus infected abscess
Haemolytic staphy in hand abscesses
Proteus in axillary abscesses
Faecal organisms @ waist

Boils / Fununcles: hair follicle + gland + abscess
Curbuncle: area of subcut necrosis which discharges itself otnto the surface through multiple sinuses
Hidvandenitis suppurutiva if recurrent inguinal/axillary abscess

Question 9

What is a rheumatoid nodule

Answer 9

collagenous granulomas @ extensor aspects of joints

Question 10

What is a ganglia

Answer 10

a degenerative cyst from an adjacent joint/synovial sheathe @ dorsum of hand/foot/ wrist
it transilluminates

Question 11

What is a fibroma

Answer 11

found under the skin

a whitish benign tumour having collagen/fibroblast + fibrocytes

Question 12

What is a dermoid cyst

Answer 12

a dermanl structure found in a cyst

found at the junction of embryonic cutaneous boundaries

Question 13

Name 4 different tumours of connective tissues

Answer 13

• Fibrosarcomas
• Liposarcomas
• Rhabdomyosarcomas
• Leiomyosarcoma
  Staged with a TNM system including tumour grade
  1. Needle-core excision
  2. excised
  3. tested

Question 14

What is a keloid

Answer 14

an irregular hypertrophy of vascularised collagen
raised edges @ sites of previous scar
can extend outside of scar
at dark skin

Question 15

Name 5 Malignant Tumours

Answer 15

Malignant melanoma
Squamous Cell Ca
Basal cell ca
Pre-malignant tumour
Other: secondary ca, leprosy, syphilis, mycosis fungoides, leucoplakia

Question 16

What is the ABCD of a malignant tumour

Answer 16

Asymmetry
Border
Colour
Diameter
Elevation