Other Lesions Flashcards
What is this and how do you treat it?
Xanthelsmata (local accumulation of lipid deposits in eyelids)
Rx: surgical excision traditional w/ good cosmetic outcomes. Can do cryotherapy, laser ablation, chemical peels
What is an effective management strategy for keloids?
Keloid excision followed by radiation therapy performed within 1-3 days after surgery (10 and 15 Gy given over 2-3 days).
Describe the appearance/ characterization of hidradenitis supurrativa and cause.
- Characterized by recurrent nodules and abscesses, typically of apocrine gland-bearing skin
- can advance to large areas of abscesses and subcutaneous scarring and draining sinus tracts
- Axillary, inguinal, perianal, and perineal most common. Lesions correspond with the milk line pattern of apocrine-related mammary tissue
- Mechanism: follicular occlusion - hair follicles become occluded due to an overproliferation of ductal keratinocytes, rupture, and subsequently re-epithelialize. As this cycle continues, sinus tracts that house bacteria and cause chronic, painful infections and inflammation that can involve the skin and subcutaneous structures including muscle, fascia, and lymph nodes.
Describe Hurley Classification for HA.
- stage I as transient nonscarring inflammatory lesions
- stage II as separate lesions consisting of recurrent abscesses with tunnel formation and scarring, and single or multiple lesions separated by normal-looking skin
- stage III as coalescent lesions with tunnel formation, scarring and inflammation.
Describe Hidradentitis supurrativa treatment.
- Weight loss, hygiene, wound care and antibiotics.
- Topical and systemic antibiotics are still the mainstay of treatment for mild HS.
- Antibiotics do offer relief by reducing the burden of abscesses and pustules in some, but recurrence is frequent.
- First line: 1% topical Clindamycin applied BID
- clindamycin +/- resorcinol
- Moderate disease: oral antibiotics instead of topical
- 500 mg tetracycline BID
- Refractory disease»_space; antibiody therapy or surgical intervention
- Humira (adalimumab) FDA approved for moderate to severe disease where patients have required long-term antibiotics or rapid flares upon cessation of antibiotics.
- Surgical intervention once failed medication management (after 6 weeks of antibiotics or rapid therapy). This includes Wide excision to reduce recurrence (reserved for severe disease) Skin grafting vs. local flap may be required to close.
What are the common signs and symptoms of a Pilar Cyst?
Firm, slow-growing subcutaneous nodules, commonly on the scalp
They are similar to epidermoid cysts. They originate from the outer root sheath of the hair shaft.
What type of epithelium lines a Pilar Cyst?
Stratified squamous epithelium
This epithelium undergoes keratinization.
What is a Cylindroma?
Benign adnexal tumors showing eccrine and apocrine differentiation
Commonly found on the scalp and face, more frequent in women.
What syndrome is associated with multiple cylindromas?
Brooke-Spiegler syndrome
This genetic condition is inherited in an autosomal dominant manner with variable penetrance.
What is the recommended treatment for Cylindroma?
Surgical excision with close postoperative follow-up
Due to high recurrence rates.
What is a Pilomatricoma?
A benign, slow-growing skin tumor of hair follicle origin
Also known as pilomatrixoma or calcifying epithelium of Malherbe.
What is the common age group for Pilomatricoma occurrence?
Most common in children, but found in all ages
Tends to develop in the head and neck region.
What gene mutation is related to Pilomatricoma?
CTNNB1 gene mutation
This mutation is implicated in the tumorigenesis of hair matrix cells.
What are the characteristics of a Pilomatricoma? Treatment?
Slow-growing, firm to touch, mildly tender, slightly bluish without ulceration
Malignancy is very rare but can transform into malignant pilomatric carcinoma.
Rx: excision
What is a Spiradenoma?
Well-differentiated, benign dermal neoplasms
Their origin is controversial, possibly from sweat glands or hair follicles.
What age group is most commonly affected by Spiradenomas? How do they present?
Patients between 15 to 35 years of age
They present as small, solitary, painful nodules that can grow several cm, often with bluish hue
What is the treatment for Spiradenoma?
Excision
If pathology confirms diagnosis, observe and reassure.
What is Microcystic Adnexal Carcinoma (MAC)? How does it present?
A slow-growing skin cancer primarily affecting the head and neck
It usually presents as a fleshy, plaque-like lesion.
What is the common misdiagnosis for MAC?
Basal or squamous cell carcinomas
MAC can have perineural invasion.
What is the typical treatment for MAC?
Complete circumferential, peripheral, and deep margin assessment, usually with Mohs micrographic surgery
What is Keratoacanthoma?
A low-grade malignancy resembling squamous cell carcinoma (SCC)
It typically has a rapid growth followed by spontaneous regression.
What is the clinical presentation of Keratoacanthoma?
Solitary papule that rapidly increases in size with a crateriform center
Can progress to SCC with metastasis, but most commonly spontaneously regresses over several months
What is Merkel Cell Carcinoma?
An aggressive neuroendocrine tumor
It presents in older, immunocompromised individuals in sun-exposed areas.
What are the clinical features/ presentation of Merkel Cell Carcinoma summarized by the acronym AEIOU?
Asymptomatic, expanding, immunosuppressed, older than 50 years, ultraviolet-exposed fair skin
80% secondary to polyomavirus, 20% secondary to UV damage
