Benign Skin Lesions

Question 1

What are benign congenital lesions

Answer 1

Strawberry Naevus / Haemangioma
Port Wine Stain - Naevus flammeus
Salmon patch - Naevus simplex

Question 2

What is strawberry naves

Answer 2

Benign developmental vascular tumour (haemangioma)

Most common tumour of infancy

Question 3

What is DDX

Answer 3

Vascular malformation

Question 4

What are the features

Answer 4

Present 2-3 weeks after birth
Oval / round shape
Well defined borders
Multi-lobed
Scarlet colour
Smooth or lobulated 
Max size reached within 3-6 months 
Common in upper eyelid with orbital extension, face, scalp and back

Question 5

What do you get if 3+ lesions

Answer 5

Full body MRI

Question 6

How do you Rx

Answer 6

Conservative as should resolve

Plastics may be needed to remove loose skin or fibro-fatty deposits

Question 7

What are complications and how do you Rx

Answer 7

Obstruct visual feed
Bleeding
Thrombocytopenia
Ambylopia (lazy eye)
Astigmatism
If causing airway obstruction - may need tracheostomy
Intra-lesional steroid / BB will slow growth if going to obstruct

Question 8

What is a port wine stain

Answer 8

Vascular malformation present from birth

Can be missed due to hyperaemia of neonate

Question 9

What are features

Answer 9

Light pink - dark red / purple 
Trigeminal nerve = most common region then upper trunk
Unilateral
Well defined age
Darkens and thickens with age

Question 10

Does it regress

Answer 10

No

Question 11

How do you Rx

Answer 11

Cosmetic camouflage

Lasers to destroy blood vessel under GA

Question 12

What is salmon patch

Answer 12

Vascular malformation

Question 13

What are the features

Answer 13

Macular 
Dull pink colour 
Irregular border
Linear telangiectasia
Trigeminal distrubtion 
Most common on neck, eyed, forehead and nose

Question 14

How do you Rx

Answer 14

Most fade after 1 month

Laser therapy if persist

Question 15

What are sebaceous cyst

Answer 15

Epidermoid

Pilar

Question 16

What are the features

Answer 16

Encapsulated lesion containing fluid
Found under skin
Central pedunctum = Dx
Firm
Mobile 
Very common

Question 17

Complications

Answer 17

Can rupture causing inflammation

Question 18

How do you Rx

Answer 18

Excision

Ax / steroid if infected

Question 19

What is chondrodermatitis nodular helicus

Answer 19

Small inflamed hard painful nodule
Upper part of ear
Red / yellow
Crust and scale may form

Question 20

What should you do and why

Answer 20

Biopsy to rule out
BCC
SCC
Keratocanthoma
Acitinic keratosis

Question 21

What causes

Answer 21

Unknown
Repeat damage to ear / trauma / cold exposure
More common in M and increasing age

Question 22

How do you Rx

Answer 22

Reduce pressure on ear 
Ax if infected
Topical / intralesional steroid 
Cryotherapy
Laser therapy
Curettage and electrocauterization
Surgery if doesn't work

Question 23

What are seborrheic keratosis

Answer 23

Benign epidermal skin lesions
Warty growth
Dry or sclary
Stuck on appearance 
Fleshy colour to light brown

Question 24

What do you often have

Answer 24

Multiple lesions +- cherry angioma

Question 25

How do you Rx

Answer 25

Conservative Cryotherapy or curettage if troublesome Can mimic melanoma so remove if suspect

Question 26

What is Laser-trelat sign

Answer 26

Abrupt onset of widespread seborrheic keratosis Signify underlying GI adenocarcinoma - DO OGD + biopsy

Question 27

What is a dermatofibroma

Answer 27

``` Benign fibrous nodule Firm Pale pink or brown Can be tender Tethered to skin Mobile over fat so will dimple if squeeze ```

Question 28

How do you Rx

Answer 28

Excision if concern e.g. of melanoma

Question 29

What is a lipoma

Answer 29

Benign tumour of subcutaneous / fatty tissue

Question 30

What is very rare complication

Answer 30

Malignant transformation to liposarcoma

Question 31

What are features

Answer 31

``` Smooth Rubbery Mobile Painless Felt or seen underneath the skin ```

Question 32

If painful what should you suspect

Answer 32

Angiolipoma | Liposarcoma

Question 33

How do you Dx

Answer 33

Clinical | Remove if uncertain or compressing structure

Question 34

What features are suggestive of liposarcoma requiring USS

Answer 34

>5cm Increased size Pain Deep anatomical lesion

Question 35

What is an angioma

Answer 35

Overgrowth of blood vessels in the skin

Question 36

What are types of angioma

Answer 36

``` Spider naevi Cherry haemangioma (Cambell de Morgan) ```

Question 37

What are spider naevi

Answer 37

Central red papule Blanches Surrounding capillaries Usually upper part of body

Question 38

How do you differentiate from telangiectasia

Answer 38

Press and watch filling Spider will fill from central Telangiectasia fills from the edge

Question 39

What are Cambell de Morgan

Answer 39

Erythematous papular lesion Non-blanching 1-3mm

Question 40

What are associations with spider naevi

Answer 40

Pregnancy Liver disease OCP

Question 41

How do you Rx

Answer 41

Excision | Laser

Question 42

What is a pyogenic granuloma

Answer 42

Rapidly enlarging red or brown growth at site of trauma or infection Pedunculated mass May bleed or ulcerate

Question 43

How do you Rx

Answer 43

Excision | Curettage and cautery if not related to pregnancy