Benign Skin Lesions Flashcards
(59 cards)
1
Q
ACRODCORDON
A
- common, fleshy lesions along skin folds (neck, eyes, intertriginous)
- usually asymptomatic, but can become irritated by clothing/jewelry/trauma
2
Q
ACRODCORDON
Predisposing
A
- incidence: F > M
- uncommon before age 30
- more common with familial tendency and obesity
3
Q
ACRODCORDON
Clinical features
A
- skin-toned to medium brown color
- flat, fleshy, mobile
- attached via stalk (pedunculated)
- most persist lifelong
- symptomatic due to clothing, jewelry, trauma
4
Q
ACRODCORDON
D Dx
A
- wart
- nevus
5
Q
ACRODCORDON
Tx
A
- reassurance
- snip incision
- electrodessication
- cryotherapy
- pathology not required, but send if uncertain
6
Q
Café au Lait Spot
A
- uniformly pigmented light brown macule/patch
- usually present at birth, almost all present by 1 yr
- 6+ cafe au lait macules > 1.5cm diameter may indicated neurofibromatosis type 1 (2+ features of NF required for Dx)
7
Q
Café au Lait Spot
Tx
A
none required
8
Q
CHERRY ANGIOMA
A
- round, slightly raised bright red papule
- MC vascular growth on the skin
- incidence increases with age
- asymptomatic
- MC on the trunk
- persistent
9
Q
CHERRY ANGIOMA
Characteristics
A
- dome-shaped
- smooth
- cherry red
- superficial trauma may induce bleeding
10
Q
CHERRY ANGIOMA
Tx
A
- reassurance - no tx required
- cosmetic removal: electrocautery, vascular laser (PDL, KTP)
11
Q
CUTANEOUS HORN
A
- common, hyperkeratotic lesion
- skin colored, horny growth
- can arise from benign (MC), pre-CA (20%+ AK), malignant lesions (20% SCC/BCC)
- most frequently on face and scalp, ears, chest
- usually asymptomatic
- increased incidence with age; risk of underlying malignancy increases with age and fair complexion
12
Q
CUTANEOUS HORN
Factors for higher malignancy risk
A
- all cutaneous horns should be biopsied even if “low risk”
- older
- M>F
- pain
- large size
- induration/erythema at the base
- anatomic site on the nose, ears, back of hands, scalp, forearms, face, penis
- wide base or low height to base ratio
13
Q
DERMATOFIBROMA
A
- common
- firm, dense, dermal papule or nodule
- F>M
- lower extremities MC
- UE above elbows
- usually asymptomatic
14
Q
DERMATOFIBROMA
Clinical features
A
- papule or nodule
- 0.5 to 1 cm diameter, reaches max size over months to years
- feels firm to touch
- DIMPLE SIGN: depression noted over thin/flat/nodular DF when squeezed btw thumb and forefinger
- skin-colored to pink
15
Q
DERMATOFIBROMA
D dx
A
- amelanotic melanoma
- molluscum contagiosum
- neurofibroma
- DFSP
16
Q
DERMATOFIBROMA
Tx
A
- reassurance
- elliptical excision: linear scar
- shave removal: DF may recur
- cryosurgery (can lead to post-inflam hyperpig)
- interlesional Kenalog if pruritic
- excisional biopsy imperative if enlarges >2cm diameter
17
Q
EPIDERMAL INCLUSION CYST
A
- one of the most common benign tumors
- benign, firm, mobile nodule filled with keratin
- begin as plugged hair follicle (face, neck, trunk)
- arise spontaneously
- solitary > multiple
- usually asymptomatic
- predisposing factors: hair bearing region, trauma, friction
18
Q
EPIDERMAL INCLUSION CYST
Clinical features
A
- firm, dome-hsaped nodule
- mobile with central plug
- soft cheese-like keratinous contents
- can be inflamed, red
- rarely infected
- grow slowly, persist indefinitely
19
Q
EPIDERMAL INCLUSION CYST
Tx
A
- reassurance
- I&D (incise and drain)
- excision if cosmetically undesirable or recurrent inflammation
- rarely Abx
20
Q
INFANTILE HEMANGIOMAS
A
- MC vascular tumor of infancy
- red/purple/violaceous-colored benign vascular neoplasm
- usually occurs during first year after birth
- asymptomatic, but cosmetically bothersome
- 60% on head and neck
- fingers, eyes, lips, nasal tip, ears, face, airway
21
Q
INFANTILE HEMANGIOMAS
Risk factors
A
- female
- premature
- multiple birth
- low birth weight
22
Q
INFANTILE HEMANGIOMAS
- Superficial/strawberry
- Deep cavernous
A
- dull to bright red, proliferate 8-18 months then regress
2. less common; deeper variant; often multiple and ill-defined; dark red/blue; tend to persist; can ulcerate; painful
23
Q
INFANTILE HEMANGIOMAS
- Proliferative phase
- Involutional phase
A
- during the first year w/ most growth occurring during the first 4-6 months of life; slows between the middle and end of 1st year
- rapid or prolonged; 30% by 3, 50% by 5, 70% by 7; remainder take 3-5 years to involute; streaks or areas of white as lesion involutes; after 6 yo, 40% have residual scar formation, telangectasia, increased skin laxity
24
Q
INFANTILE HEMANGIOMAS
Tx
A
- usually left to involute
- intervention by specialist when lesions interfere w/ function/development
- laser surgery - PDL
- corticosteroids
- beta blockers
- interferon
- cryosurgery
- excision
25
PORT WINE STAIN
- aka neves flammeus
- capillary malformation during development
- always present at birth
- pink to dark bluish/red
- smooth texture; nodules may develop over time
- MC head and neck (Sturge-Weber syndrome in CNS distribution)
- grows w/ child, does not involute
26
PORT WINE STAIN
Evolution
- begin as pink or red lesion
- become more bluish or purple with age
- nodules may develop over time
27
NEVUS SIMPLEX (Salmon Patch)
- 40% of newborns
- stork bite @ nape of neck
- angel's kiss on forehead between eyebrows
- eyelids
- most spontaneously resolve during childhood (5+% persist to adulthood)
28
KELOID
How distinguished from hypertrophic scars?
- hypertrophic scarring spread beyond limit of original injury
- clawlike projections
- unique histologically
29
KELOID
Predisposing factors
- most common before age 30
- MC and large in Af American population
- s/p injury: piercing, surgery, laceration, acne
- MC location chest; frequently neck, ears, extremities
- rarely on face, palms, soles
30
KELOID
Clinical features
- develop early in healing
- linear to nodular
- pink, red-purple, flesh-toned or black
- raised
- extends beyond margins
- tender
- can enlarge over time
31
KELOID
D dx
- sarcoidosis
- hypertrophic scar
- recurrent malignancy
32
KELOID
Tx
- discourage piercing
- reassurance
- treatment if sxs or cosmetically undesirable (serial intralesional steroid injections, laser, silicone gel sheets)
- derm/plastic surg referral
33
NEUROFIBROMA
- soft, often compressible papule or nodule
- skin-colored to brown
- usually asymptomatic, unless traumatized
34
NEUROFIBROMA
Tx
- excision if symptomatic
| - pathology if suspicious
35
NEUROFIBROMA
Neurofibromatosis
- autosomal dominant disorder that affects the bone, nervous system, soft tissue, skin
- more than 6 cafe au lait spots, more than 2 neurofibromas, axillary freckling, 1st degree relative
- requires multidisciplinary treatment
36
NEVI
- common proliferation of melanocytes
- majority have no malignant potential
- can be congenital or acquired
- usually stimulated by sun exposure
- most asymptomatic
- many variations
37
NEVI
Clinical features
- pigmented: pink, tan, dark brown
- darker skin types usually make darker moles
- remain stable for years then can gradually regress, lighten with age
38
NEVI
Junctional nevus
- nests of melanocytes at dermis-epiderm junction
- flat
- MC in children
39
NEVI
Dermal nevus
- nests of melanocytes in dermis
- raised
- with or w/o coarse hair
40
NEVI
Compound nevus
- nests of melanocytes at dermis-epiderm junction and dermis
- central raised area
- may be surrounded by flat pigmentation
41
NEVI
Halo nevus
- MC in adolescence
- MC on trunk
- surrounding hypopigmentation
- more likely with history of malignant melanoma, vitiligo
42
NEVI
Evaluation of pigmented lesions
```
A = asymmetry
B = border
C = color
D = diameter
E = evolution
```
* *ugly duckling sign
- do not hesitate to biopsy
43
NEVI
Dysplastic Nevus - Characteristics
- variegated tan, brown, pink coloration
- may be larger than common nevi 5+ mm
- irregular borders
- atypical mole: higher risk than normal mole to become MM; higher risk of developing de novo MM
- grade: mild, moderate, severe
44
NEVI
Dysplastic Nevus - Biopsy/Tx
- -biopsy: broad saucerization with 2 mm border
- if + margin, reexcise with wider saucerization high grade DNs are difficult to distinguish from MM insitu
- recurrent DNs should be removed
- TBSE, sun protection education of pt
45
NEVI
Hereditary Dysplastic Nevus Syndrome
- aka familial atypical mole-malignant melanoma syndrome
- autosomal dominant
- increased risk melanoma: may be up to 150x greater than normal population
46
NEVI
Congenital Hairy Nevus
- dark brown, thickened, irregular surface with hair
- trunk
- 2-15% incidence of MM; 60% of these appear before 10 y.o; no increased evidence of MM in hairy nevi < 20cm
47
NEVI
Blue Nevus
- solitary bluish macule/papule
- enlarge slowly, persist
- Tyndall effect: light dispersion causes dermal brown melanin to appear blue gray
- Ddx: malignant variants, MM
48
NEVI
Mongolian Spot
- blue/black to gray (Tyndall effect)
- MC in dark skin types
- 2-8 cm
- MC in sacral region
- usually fades during childhood
49
Nevi
Tx
- yearly TBSE, more frequent for pt w/ history of skin CA
- patient education
- instruction on importance of self-examination
- refer if uncertain
50
SEBORRHEIC KERATOSIS
- common, persistent epidermal lesion
- various presentations possible: stuck on, tan, brown, black
- rule out wart and MM
- asymptomatic vs itchy when inflamed
- less common before age 30; increase w/ age
- multiple lesions show hereditary disposition
51
SEBORRHEIC KERATOSIS
Clinical appearance
- usually oval
- can be flat or raised
- 0.2-2.0 cm or larger, discrete
- pink to dark brown
- stuck on keratotic appearance
- crumble when picked
52
SEBORRHEIC KERATOSIS
Ddx
- skin tags
- wart
- melanocytic nevus
- melanoma
- pigmented actinic keratosis
53
SEBORRHEIC KERATOSIS
Tx
- reassure
| - tx for inflamed/irritated SK: cryosurgery or shave removal
54
SOLAR LENTIGO
- common condition with brown macules/hyperpigmentation
- light skin types
- associated w/ sun or actinic damage
- increase in size/# with age
- usually persistent
- asymptomatic, but often cosmetic concern
55
SOLAR LENTIGO
Clinical characteristics
- 2-20 mm
- oval, often irregular macules
- surrounding actinic change
- sharp borders
- consistent pigmentation
56
SOLAR LENTIGO
Tx
- sunscreen, sun avoidance (prevention)
- monitor for change, biopsy
- tx if cosmetically undesirable
- hydroquinone crean
- azeleic acid cream
- tretinoin cream
- chemical peel
- cryosurgery
- laser
57
VENOUS LAKE
- common, soft, compressible venous papule
- typically blue-purple in color
- associated with sun exposure
- usually found on lips, face, ears, neck, forearms, back of hands
58
VENOUS LAKE
Clinical features
- 2-10 mm
- well defined
- bluish
- will typically blanch
- surrounding actinic damage
- can bleed with trauma
- compressible
59
VENOUS LAKE
Tx
- reassurance
- cautery
- excision w/ frequent trauma or interference w/ ADL/cosmetic concerns
- recurrence is common
