Superficial Lesions Flashcards
What are the key points to assess for a lump examination?
Site
Size
Shape
Colour
Consistency
Contour
Cough impulse
Tenderness
Temperature
Transilluminence
Tethering
Fluctuance
Pulsatility
Spread (LNs)
What is the main examination difference between intradermal and subcutaneous lumps?
Intradermal - cannot draw skin over lumo.
Subcutaneous - can move lump independently from skin
How would you like to complete a lump examination?
- Examine draining lymph nodes
- Neurovascular function distal to lump
- Look for similar lumps elsewhere
What are the examination features of a lipoma?
Inspection:
- Occur anywhere fat can expand - i.e. NOT scalp or palms. Inc. spermatic cord, submucosa
- May be a scar from recurrence
Palpation:
- Soft
- Subcutaneous
- Imprecise margin
- Fluctuant
What conditions are associated with lipomas?
Dercum’s Disease / Adiposis dolorosa
- Multiple, painful lipomas
- Assoc. peripheral neuropathy
- Obese, postmenopausal women
Familial Multiple Lipomatosis
Madelung’s Disease
Bannayan-Zonana Syndrome
- Autosomal dominant
- Multiple lipomas
- Macrocephaly
- Haemangiomas
What is the management of a lipoma?
Most do not require surgery.
Surgical excision can be used for symptomatic lesions, or enlarging lesions on sites that are likely to become symptomatic. Lipomas can be much bigger than they appear, so surgery should only be performed by trained medical professionals.
What is a Sebaceous cyst?
Sebaceous cyst:
Sebaceous cysts should be called epidermal cysts (as nothing to do with sebaceous glands). They are cysts containing keratin and its breakdown products which are surrounded by an epidermoid wall. (Epithelial-lined cyst containing keratin).
Two histological subtypes:
- Epidermal Cyst - Arise from hair follicle infundibulum.
- Trichilemmal Cyst / Wen - Arise from hair follicle epithelium. Often multiple. May be autosomal dominant
What are examination features of a Sebaceous cyst?
Inspection:
- Occur at sites of hair growth - Scalp, face, neck, chest, back. NOT soles or palms.
- Central punctum
Palpation:
- Firm
- Smooth
- Intradermal
What are the complications of a sebacous cyst?
Complications:
Infection: pus discharge
Ulceration
Calcification
Describe the management for a Sebaceous cyst
Does not need treatment, but patient may opt to have it removed if it is unsightly or interferes with daily life (e.g. combing).
Minor surgical excision of the entire cyst is preferred to incision and drainage to reduce the chance of re-occurrence.
What is a Ganglion?
Mucin-filled synovial cyst caused by either trauma, mucoid degeneration or synovial herniation. It is filled with fluid from tendon sheath or joint, with no true epithelial lining.
It is the most common hand mass (60-70).
What are the examination features of a Ganglion?
Inspection:
- Can be found anywhere Often dorsum of hand or wrist May be scar from recurrence Weakly trans-illuminable.
Palpation:
- Firm and well circumscribed
- Subcutaneous so not tethered to skin
- Often tethered to tendon to subcutaneous tissue.
What are the potential complications of Ganglion?
Can cause median or ulnar nerve compression, as well as hand ischaemia due to vascular occlusion. Therefore should perform Allen’s test to ensure radial and ulnar artery flow in ganglia of the volar aspect of the wrist (palm side).
Describe the management for a Ganglion
Non-Surgical:
- Observation is the first line treatment.
- Closed rupture (hitting with a Bible) is a home remedy with a high recurrence rate.
- Aspiration has a higher recurrence rate than surgical excision, but minimal risk to reasonable to attempt. However avoided in volar aspect of wrist (palm side) due to radial artery.
Surgical resection for ganglia with severe symptoms or neurovascular manifestations.
What is a Neurofibroma?
Neurofibroma are benign nerve sheath tumours arising from Schwann cells.
What are the examination features of a Neurofibroma?
Inspection:
- Solitary or multiple
- Pedunculated nodule
Palpation:
- Fleshy consistency
- Pressure can cause paraesthesia
Ensure to examine the skin for Café-au-Lait macules, the eyes for Lisch nodules, axilla for freckles and cranial nerves.
Describe the management for a solitary Neurofibroma
Surgical resection only indicated if malignant growth suspected.
Local regrowth is common.
What is a papilloma and what are its features?
A papilloma is an overgrowth of all layers of the skin with a central vascular core. It is also called a skin tag.
It is pedunculated and flesh coloured.
What is a pyogenic granuloma?
A pyogenic granuloma is a rapidly growing capillary haemangioma.
Neither pyogenic, nor a granuloma
What are the examination features of a pyogenic granuloma?
Inspection:
- Most commonly on hands, face, gums and lips.
- Bright red hemispherical nodule. May have serous / purulent discharge.
Palpation:
- Soft
- Bleeds easily
What features of a lipoma would suggest a liposarcoma instead?
Features suggestive of sarcomatous change:
- Size >5cm
- Increasing size
- Pain
- Deep anatomical location
