This 56 yo light-skinned woman complains of these persistent, firm bumps on the cheeks
They have been present for months without change
They are asymptomatic
She has tried scrubbing them and even squeezing them without benefit
What are milia?
Small epidermoid cysts common on cheeks, eyelids, forehead, genitals
Occur at any ages, including infants and often seen in sun-damaged skin
May resolve spontaneously or be easily removed with blade or needle
This would be described as a papule (less than 1cm)
Your 35 yo physician partner requests removal of this nodule on her calf
It seemed to start as a bug bite, but has persisted for months
It is asymptomatic, but she always cuts it when shaving
It has not grown
How would you manage this lesion?
Reassure her that it is benign and tell her to quit shaving it. There's no need to excise because it is not cancerous, or to freeze it- this is Dermatofibroma
This would be described as a nodule (more than 1cm)
What is a Dermatofibroma?
A common, benign fibrotic tumors frequently found on extremities commonly associated with a history of trauma (esp. bites) common (although etiology not well understood).
•Horizontal compression (pinching) of the lesion can lead to dimplingn
Treatment of Dermatofibromas?
If stable and asymptomatic, require no treatment
•If lesion is unusual, growing or irregular, consider further evaluation
What is this?
This would be described as a plaque (greater than 1cm, flat topped, raised lesion)
A seborrheic keratosis is a BENIGN lesion located in which skin layer? What happens?
Epidermis- becomes slightly acanthotic (increased epidermal thickness due to hyperplasis of keratinocytes mostly in the spinosum) and hyperkeratotic (thickening of the stratum corneum)
There are hereditary (AD) and usually do not appear until after 30 MOSTLY classically described as round or oval, skin colored to brown or black, slightly raised, "stuck on" papules and plauqes on the face and upper extremities
Acute onset of multiple seborrheic keratosis (many coming on at once) is suggestive of what?
cancer (paraneoplastic from underlying GI adenocarcinoma)
What is 'The sign of Leser-Trélat'?
Sudden eruption of multiple SKs that can be marker for underlying cancer
•Associated cancers include adenocarcinoma of colon, breast, stomach, lung (However, many adults have many SKs and this is thought to be rare sign)
What are these small red spots?
Cherry angiomas- COMMON benign acquired vascular neoplasms common on trunk in people over 40 (never associated with malignany)
These would be described as macules (flat, less than 1cm) or the raised one is a papule
What is this?
•May be pruritic or painful, but often asymptomatic
•Often the cosmetic appearance is the chief complaint
What causes Keloid?
Result from an exuberant fibrous repair of tissue following a cutaneous injury, **extending beyond the original site** (note that if a scar just becomes puffy, it is called a hypertrophic scar)
•Usually follows injury to skin, but may also arise spontaneously
What is the common patient population for keloid?
•Most common in 30s, but can vary widely
•Equally affects men and women
•Genetic predisposition (African-American most frequent)
How are keloids managed?
•No treatment for keloids is perfect
•Intralesional corticosteroid injections (painful)
•Surgical excision—high rates of recurrence; may come back even bigger!
•Cryotherapy (also painful)
•Combined cryotherapy and intralesional triamcinolone (possible more painful)
Note about keloids
•PREVENTION IS KEY!
•Avoid piercings and tattoos, along with other injuries to skin
What is this?
Epidermal (epidermoid) cyst
Notes about Epidermal (epidermoid) cysts
•Mobile dermal nodule, usually with central punctum that drains fluid! Stabile in size and can persist for years!! Dont middiagnose
•Filled with keratinaceous debris, oils. If expressed, liberate rancid smelling, cheesy material
How should Epidermal cysts be managed?
•Many probably remain quiescent for years without treatment
•Surgical removal of entire lesion has best “cure” rate
•If inflamed, may need incision and drainage acutely
What is a Pilar Cyst?
•The second most common cutaneous cyst
•A smooth, firm, dome-shaped 0.5 to 5 cm, keratin-containing, nodule to tumor, with a predilection for the scalp (90%)-
very hard to touch, no central punctum, and tend to run in families
Pilar cysts can be hereditary. MOI?
What is orthokeratosis?
normal, basket woven stratum corneum
What is parakeratosis?
retention of nuclei in the stratum corneum (if your epidermis is prolfierating too fast)