Superficial Lesions Surgery Flashcards
What is a lipoma?
Benign tumour of mature adipocytes
Sarcomatous change probably does’nt occur.
Liposarcomas arise de novo
- Older patients
- Deeper tissues of the lower limb.
On inspection - Anywhere fat can expand (not on scalp or palms).
May be a scarfrom recurrence.
Palpation
- Soft, subcutaneous, imprecise margin, fluctuant.
Management - Non-surgical/surgical excision.
What are the syndromes associated with Lipomas?
Dercum’s Disease (painful lipomas, associated with peripheral neuropathy, obese postmenopausal women)
Familial Multiple Lipomatosis
Madelung’s disease
Bannayan-Zonana Syndrome
- Multiple lipomas
- MAcrocephaly
- Haemangiomas
What is a sebaceous cyst?
Epithelial lined cyst containing keratin
Two histological subtypes
- 1) Epidermal cyst (arise from hair follicle infundibulum)
-2) Trichilemmal cyst (arise from hair follicle epithelium, often multiple)
Inspection
- Occurs at site of hair growth
- Scalp, face, neck, chest, back.
- Not soles or palms
- Central punctum.
Palpation
- Firm, smooth, intradermal.
What are the complications of a sebaceous cyst ?
Infection: pus discharge
Ulceration
Calcification
Cock’s peculiar tumour
- large ulcerating trichilemmal cyst on the scalp
- Resemble an SCC
Gardener’s Syndrome: FAP + thyroid tumours, osteomas, dental abnormalities, epidermal cysts.
Manage with non-surgical or surgical excision .
What is a ganglion?
Cystic swelling related to a synovial lined structure: joint, tendon
Myxoid degeneration of fibrous tissue
Contain thick, gelantinous material.
Inspection
- Can be found anywhere
- 90% on dorsum of hand or wrist
- Dorsum of ankle
- May be a scar from recurrence
- Weakly transilluminal
Differentials for a ganglion?
Bursea
- Cystic protrusion form synovial cavity of arthritic joint
Non-surgical
- Aspiration followed by 3 weeks of immobilisation
Surgical excision
- recurrence can be 50%
- Neurovascular damage
Seborrheic keratosis?
Benign hyperplasia of basal epithelial layer
- Hyperkeratosis: keratin layer thickening
- Acanthosis: prickle layer thickening
Stuck on appearance. Dark brown. Greasy.
What is a neurofibroma?
Benign nerve sheath tumour arising from schwann cells.
Inspection: Solitary or multiple pedunculated nodules.
Palpation: Fleshy consistency, pressure can –> Paraesthesia
Extra - Examine eyes, axilla, cranial nerves, BP.
NF1 = AD, Chr 17, cafe-au-lait spots (>6), Freckling, neurofibromas, lisch nodules.
What is a Papilloma?
Overgrowth of all layers of the skin with a central vascular core.
Skin tag/fibroepithelial polyp.
Peduncuated, flesh coloured.
Manage = Excision + diathermy to control bleeding.
Pyogenic granuloma - what is it?
Rapidly growing capillary haemangioma
Neither pyogenic, nor a granuloma.
Inspection = Most commonly on hands, face, gums, lips. Bright red hemispherical nodules. May have serious/purulent discharge.
palpation: - soft, bleed very easily.
Possible assoc with previous trauma. Common in pregnancy.
- Surgery = curettage with diathermy of the bases.
Dermoid cyst - what is it?
Epidermal-lined cyst deep in the skin.
Congenital (developmental inclusion of epidermis along lines of skin fusion. Midline of neck and nose. Medial and lateral ends of the eyebrows.
Acquired
- Impantation of epidermis in dermis
- Often 2ndry to trauma (piercing)
Inspection
- Smooth spherical swelling
- Sites of embroyological fusion
- Scar from recurrence
Palpation
- Soft, non-tender, subcutaneous.
Child/young adult: congenital
Adult: congeital - ask re.trauma.
Congenital = CT To establish extent , surgical excision.
Dermatofibroma?
Benign neoplasm of dermal fibroblasts
- 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.
Differential
- Malignancy: melanoma, BCC.
Excision + histology
Kerato-acanthoma?
Benign overgrowth of hair follicle cells.
Cytologically similar to well-differentiated SCCs
Fast-growing dome-shaped with a keratin plug.
INtradermal.
Regress within 6 weeks. Excise to reduce scarring and obtain histology.
Diagnosis of neck lumps generally? - Top causes
85% of neck lumps are LNs: esp if present <3 weeks.
Infection: EBV, tonsillitis, HIV
Ca: Lymphoma or mets.
8% are goitres
7% other: Sebaceous cyst or lipoma
What investigations are required for Neck lumps?
Triple assessment
- Clinical assessment
- Imaging: US
- Cyto/Histo: aspiration or biopsy
What is the anterior triangle?
Ant margin or SCM
Midline
Ramus of the mandible
Roof: investing fascia
Floor: pre-vertebral fascia.
What are the causes of a pulsatile anterior triangle mass?
Carotid artery aneurysm
Tortuous carotid artery
Carotid body tumour (chemodectoma)
What are the causes of a non-pulsatile anterior triangle mass?
Branchial cyst
Laryngocele
Goitre
Parotid tumour (lump in postero-superior area)
What is the submandibular triangle?
Mental process
Ramus of the mandible
Line between two angles of the mandible
Causes of masses in submandibular triangle?
Salivary stone
Sialadenitis
Salivary tumour
What is the posterior triangle?
Posterior margin of SCM
Anterior margin of trapezium
Mid 1/3 clavicle.