Skin Lumps Flashcards
Sebaceous cyst
- two types
- pathophysiology of these types
Sebaceous cysts is a general term which encompasses both:
- epidermoid cyst
- pilar cyst
Epidermoid cysts → proliferation of epidermal cells within the dermis
Pilar cysts (also known as trichilemmal cysts or wen) derive from the outer root sheath of the hair follicle
Inspection of Sebaceous cyst
- location
- what’s often seen
- Occur @ sites of hair growth
- Scalp, face, neck, chest and back
- NOT soles or palms
- Central Punctum
How does sebaceous cyst feel on palpation?
- Firm
- Smooth
- Intradermal
Complications of Sebaceous cyst
Complications
- Infection: pus discharge
- Ulceration
- Calcification
Two conditions associated with sebaceous cysts
Cock’s Peculiar Tumour
- Large ulcerating trichilemmal cyst on the
scalp
- Resemble an SCC
Gardener’s Syndrome: FAP + TODE
- Thyroid tumours
- Osteomas
- Dental abnormalities
- Epidermal cysts
Management of sebaceous cyst
- generally do not require medical treatment
- if they continue to grow → may become unsightly, painful, infected, or all of the above.
Surgical excision of a sebaceous cyst → a simple procedure to completely remove the sac and its contents
There are three general approaches used: traditional wide excision, minimal excision, and punch biopsy excision
What’s lipoma?
Lipoma → is a common, benign tumour of adipocytes
Lipoma
- location
- can they become malignant?
- Occur anywhere fat can expand
- i.e. NOT scalp or palms
- can occur even on spermatic cord, submucosa
- rarely, they may also occur in deeper adipose tissues
- malignant transformation to liposarcoma is very rare
Palpation of lipoma
- Soft
- Subcutaneous
- Imprecise margin
- Fluctuant
Conditions associated with Lipoma
Dercum’s Disease / Adiposis dolorosa
- Multiple, painful lipomas
- Assoc. peripheral neuropathy
- Obese postmen women
Familial Multiple Lipomatosis
Madelung’s Disease
Bannayan-Zonana Syndrome
- Multiple lipomas
- Macrocephaly
- Haemangiomas
Management of lipoma
Management
- may be observed
- if diagnosis uncertain, or compressing on surrounding structures then may be removed
What’s ganglion?
A ganglion presents as a ‘cyst’ arising from a joint or tendon sheath
- Myxoid degeneration of fibrous tissue
- Contain thick, gelatinous material
Ganglion
- common location
- common gender
- They are most commonly seen around the back of the wrist
- 3 times more common in women
- Ganglions often disappear spontaneously after several months
Inspection of ganglion
- Can be found anywhere → 90% on dorsum of hand or wrist or dorsum of ankle
- May be scar from recurrence
- Weakly transilluminable
Management of ganglion
Ganglions often disappear spontaneously after several months
Non-Surgical
- Aspiration followed by 3wks of immobilisation
Surgical Excision
- Recurrence can be 50%
- Neurovascular Palpation damage
What is Seborrhoeic keratoses?
- pathophysiology
Seborrhoeic keratoses are benign epidermal skin lesions seen in older people
Pathophysiology:
- Benign hyperplasia of basal epithelial layer
- Hyperkeratosis: keratin layer thickening
- Acanthosis: prickle layer thickening
Features (on inspection/palpation) of seborrhoeic keratosis
- large variation in colour from flesh to light-brown to black
- have a ‘stuck-on’ appearance
- keratotic plugs may be seen on the surface
- Greasy
Management of Seborrhoeic keratosis
- reassurance about the benign nature of the lesion is an option
- options for removal include curettage, cryosurgery and shave biopsy
What’s neurofibroma?
Pathophysiology
Benign nerve sheath tumour arising from schwann cells
Inspection and palpation in neurofibroma
Inspection
- Solitary or multiple
- Pedunculated nodules
Palpation:
- Fleshy consistency
- Pressure can → paraesthesia
What else to inspect/examine if neurofibroma is present?
Examine for neurofibromatosis:
- Examine the eyes
- Examine the axilla
- Examine the cranial nerves (esp. 8)
- BP
Features of NF1
NF 1: von Recklinghausen’s
- AD, Chr 17
- Cafe-au-lait spots (>6)
- Freckling
- Neurofibromas
- Lisch nodules (iris)
Management of neurofibroma
- Surgical excision only indicated if malignant growth suspected
- Local regrowth is common
What’s papilloma?
Overgrowth of all layers of the skin with a central vascular core
Appearance of skin papilloma
- Skin tag / fibroepithelial polyp
- Pedunculated
- Flesh coloured
Management of papilloma / skin tag
(Like moles) removal of skin tags poses a threat of exacerbation of the tumorous site.
Though rare, it is possible to develop a malignant tumor by removal
- If removal is desired or warranted, it can be achieved using a home treatment kit, dermatologist, general practitioner → use cauterisation, cryosurgery, excision, laser or surgical ligation
What’s Pyogenic granuloma?
- Benign skin lesion → rapidly growing capillary haemangioma
- Neither pyogenic, nor a granuloma → neither true granulomas nor pyogenic in nature
Cause of pyogenic granuloma
The cause of pyogenic granuloma is not known but a number of factors are linked:
- trauma
- pregnancy
- more common in women and young adults
Features of Pyogenic Granuloma
- common locations
- lesion progression
- appearance
- most common sites: are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
- initially small red/brown spot → rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
- the lesions may bleed profusely or ulcerate
Management of pyogenic granuloma
- lesions associated with pregnancy often resolve spontaneously post-partum
- other lesions usually persist
- Removal methods include: curettage and cauterisation, cryotherapy, excision
What’s a dermoid cyst?
- where do they develop?
Epidermal-lined cyst deep to the skin
- develop at sites of embryonic developmental fusion
- may develop at other sites such as the ovary and in these sites are synonymous with teratomas
(2) types of dermoid cyst
Congenital / Inclusion Cysts
- Developmental inclusion of
epidermis along lines of skin fusion
- Midline of neck and nose
- Medial and lateral ends of eyebrows
Acquired / Implantation Cyst
- Implantation of epidermis in dermis
- Often secondary to trauma (e.g. piercing)
Inspection and Palpation signs of dermoid cyst
Inspection
- Smooth spherical swelling
- Sites of embryological fusion
- Scar from recurrence
Palpation
- Soft
- Non-tender
- Subcutaneous
Management of dermoid cyst
Congenital
- CT to establish extent
- Surgical excision
Acquired
- Surgical excision
What’s dermatofibroma?
Benign neoplasm of dermal fibroblasts → overgrowth of fibrous tissue in the dermis
Inspection and palpation of dermatofibroma
- Can occur anywhere
- Mostly on the lower limbs of young to middle-aged women
- Small, brown pigmented nodule
Palpation
- Firm, woody feel: characteristic
- Intradermal: mobile over deep tissue
- may feel larger than they appear on a visual inspection
Management of dermatofibroma
- A dermatofibroma is harmless and seldom causes any symptoms
- Usually, only reassurance is needed
- If it is nuisance or causing concern, the lesion can be removed surgically
*Cryotherapy, shave biopsy and laser treatments are rarely completely successful
What’s Karatocanthoma?
Keratoacanthoma
- benign epithelial tumour → overgrowth of hair follicle cells
- Cytologically similar to well-differentiated
SCCs - more common with advancing age and rare in young people
Features of keratoacanthoma
- progression
- appearance
Progression
- initially a smooth dome-shaped papule
- rapidly grows to become a crater centrally-filled with keratin
Appearance
- Said to look like a volcano or crater
- Dome-shaped with a keratin plug
- Intradermal
Management of keratoacanthoma
- Spontaneous regression of keratoacanthoma within 3 months is common ⇒ often resulting in a scar
- should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma
- Removal also may prevent scarring
