Skin lumps (548-561)

Question 1

What are characterisitc features of lipoma?;

Answer 1

Hemi-spherical. Non-tender. Lobulated. Smooth. Soft. Slippage sign (the swelling slips under palpating finger).

Question 2

How would you manage a lipoma?;

Answer 2

Always benign (never malignant/metastatic spread) - reassure patient. Treatment depends on patient choice (conservative vs surgery to remove). Generally if lipoma >5cm need further investigation with US +/- MRI.

Question 3

What is Dercum’s disease?;

Answer 3

Multiple painful lipomas

Question 4

What features would you look for in a patient with neurofibromatosis?;

Answer 4

Multiple cutaneous neurofibromas. Café au lait spots. Lisch nodules (bumps on iris of eye). Associted with MEN 1 syndrome (3Ps- pituatory adenoma, parathyroid hyperplasia, pancreatic tumours). Accoustic neuromas.

Question 5

What are the characteristic features of a sebaceous cyst?;

Answer 5

Punctum present. Attached to skin (immobile). Cheese like sebum.

Question 6

How would you treat a sebaceous cyst?;

Answer 6

Conservative- antbiotics. Surgery- excise under local anaesthetic (eplipse). [Note 30-40% will reoccur]

Question 7

What is a dermoid cyst?;

Answer 7

A dermoid cyst is a teratoma of cystic nature containing epidermis, hair follicles and sebaceous glands. Derived from residual embroyinc cells and develop at sites of embryonic developmental fusion.

Question 8

What are the types of dermoid cyst and how are they managed?;

Answer 8

1. Congential dermoid - only ectoderm. 2. Acquired dermoid. Management- 1. Conserative. 2. Surgery- if surgically removed will need imaging prior to excision as root may go to the brain (intracranial or intraspinal extension).

Question 9

What is a hamartoma?;

Answer 9

A hamartoma is a benign developmental malformation of cells and tissues normally found in the area of the body where the growth occurs.

Question 10

What is a desmoid tumour?;

Answer 10

Desmoid tumours are fibrous neoplasms arising from musculoaponeurotic structures (e.g. linea alba). They typically contain clonal proliferations of myofibroblasts

Question 11

What conditions are assoicated with desmoid tumours?;

Answer 11

Familial adenomatous polyposis (FAP) - APC mutation. Gardener syndrome

Question 12

Name three salient differences between a hypertropic scar and a keloid scar;

Answer 12

Hypertrophic scar- contained within site of injury, may regres over time, usually occurs within weeks, can be excised or given collangeous, pink/red. Keloid scar- grow beyond would area, occurs months to years, should not be excised, purplish/red

Question 13

Name some premalignant skin conditions;

Answer 13

Actin keratosis & Bowens disease - BCC or SCC. Dysplastic naevus- malaenoma.

Question 14

How are these premalignant skin conditions (actin keratosis, bowens disease, dysplastic naevus) managed?;

Answer 14

1st line- topical 5FU, 2nd line- immune modulator gels. 3rd line- photodynamic therapy. 4th line- cryotherapy. If lesion becomes malignant needs excision.