Name Background Presentation Interview ?s Diagnostics Differentials TreatmentMelanocytic Nevus

Congenital or acquired; composed of melanocytes; can change to dysplastic nevus or melanoma w/ sun expoxure

<1cm; evenly colored tan to brown; can be elevated

Symptomatic, changing,

itching, bleeding,

bothersome to pt.

ABCDE; dermoscopy;If in doubt biopsy

Melanoma, dysplastic nevus

No need to treat if normal; 3 reasons to treat 1)clinically atypical 2) irritated or bothersome 3) cosmetic

Dysplastic Nevus

Inherited or acquired through lifetime; require monitoring

Varies; exhibit ABCDE; usually sun exposed areas; irregular borders, deeply pigmented; clinically different than pts. other moles

Personal history of melanoma or dysplastic nevi; family history of melanoma; sun

exposure

Can be mild, moderate or severe on pathology exam

Malignant melanoma, melanocytic nevus; seborrheic keratosis

Medical – full body skin exam, pt. counseling, photography to follow progression; annual exam

Surgical – removal with shave biopsy or excision with margins

Seborrheic Keratosis

Most common benign tumor >40 yrs of age; hereditary

Characteristic “stuck on” appearance; color varies from pale brown to dark black; velvety or verrocous (warty) feeling; can be several cms

Symptomatic, irritated, daily reminder to pt.

Can be single or double; usually seen in elderly pts.

Melanoma; dysplastic nevus; genital warts;

nevus; sign of ; Sign of Leser-Trelat- abrupt eruption of sk’s associated with adenocarcinoma of the GI tract, lymphoma, leukemia (rare

Medical – alpha hydroxy acid; retinoid (prevents warty look, keeps them flat)

Surgical – shave removal, cryosurgery, electrodessication, excision (remove if symptomatic)

Often fall off on own

Verruca Vulgaris

100 types of HPV; common warts; genital warts; flat; plantar; occur from breakdown in skin barrier; spread by direct or indirect contact;

Most commonly on hands and knees; hyperkeratotic; rough surface

How long has it been present;

previous treatments tried

Actinic keratosis, SCC, seborrheic keratosis, cutaneous horn, prurigo nodularis

Very difficult, often resistant start with least painful

Medical – salicylic acid, veregen, imiquimod

Surgical – cryosurgery, laser, intralesional candida (yeast –

autoinoculation stim. Immune response)Epidermal Inclusion Cyst

Most common cutaneous cysts; proliferation of epidermal cells inside dermis

Flesh colored nodule; firm; central pore; erythematous if inflamed

Usually asymptomatic; can discharge foul smelling chees-like material; can become inflamed or infected

Lipoma, milia, pilar cyst, cutaneous malignancy

No treatment necessary if not symptomaticMedical – antibiotic, intralesional kenalog (steroid)

Surgical – I&D, excision

Cherry Hemangioma

Most common cutaneous vascular proliferation; increase in presence w/ age

Range from small red macules to papules; often bright red; can be violet

Bothersome to pt.; may bleed

w/ trauma; cosmetic

Usually after age 40

Malignant melanoma; urticaria; kaposi’s sarcoma; milia

No treatment necessary if not bothersome; abrupt eruption can signal internal malignancy

Surgical – electrodessication; punch removal preferred due to vascular nature

Acrochordon (Skin Tag)

Often found in obese, diabetics, areas of friction (neck, axillae, groin, intertriginous areas)

Small, soft, pedunculated, 2-5mm, flesh colored papule

Bothersome to pt.; may rub on

clothing and jewelry; cosmetic

Can spontaneously fall off; often numerous

Seborrheic keratosis, warts, nevus, neurofibroma

Medical – generally cosmetic reason for tx

Surgical – cryosurgery; tangential removal w/ scissors; excision if large

Sebaceous Hyperplasia

Overgrowth of sebaceous gland; can be associated w/ oily skin

Yellowish, soft papules, most common on nose, cheeks, forehead, 2-9mm w/ central umbilication; can be solitary or numerous lesions

Pt. may be concerned

about malignancy; can

become traumatized;

cosmetic

Most common in middle and older age

BCC, fibrous papule, milia

Medical – biopsy to rule out BCC if unsure

Surgical – shave removal, laser, electrodessication

Dermatofibroma

Unknown etiology; form from scar tissue in dermis; can be due to trauma (bug bite)

0.5-1cm; firm; pea like nodule in skin; range in color from flesh toned to brown

Can become traumatized and

painful; especially w/

shaving; may be present for

decades

Occurs more commonly in women on lower legs; dimple sign w/ lateral pressure

BCC, SCC, keratoacanthoma, malignant melanoma, keloid scar, nevus, prurigo nodularis

Medical – if unsure of lesion biopsy (excisional best)

Surgical – excision if bothersome; CO2 laser

Excision best because pathology in dermis

Milia Common keratin filled cysts; common after dermabrasion procedures where there is damage to the pilosebacous units

Superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2mm, most commonly on face and periorbital area

Cosmetic concern to pt.;

rarely symptomatic

Seen mostly in infants but also seen in kids and adults

Acne, syringoma Medical – topical retinoid to soften lesionsSurgical – I&D, scissor excision, electrodessication

Syringoma Benign adnexal neoplasm of eccrine origin; 4 variants 1)localized 2)associated w/ downs syndrome 3)eruptive form 4)familial form

Skin colored dermal papules; may appear transulacent; usually < 3mm; usually in multiples on cheeks and eyelids

Usually asymptomatic;

may become pruritic w/

perspiration

Most often form at puberty but can form later in life

BCC, acne, milia, hidrocystoma, molluscum

Medical – cosmetic reasons

Surgical – surgical excision w/ sutures due to recurrent nature; electrodessication; cryosurgery

Stucco Keratosis Keratotic papule due to thickening of the epidermis;

Most common on lower extremities (knees down); characteristic “stuck on” appearance; white to yellowish crusted papule

Usually asymptomatic; often unnoticed

by pt.

More common in men; appear after age 40

Actinic keratosis; wart; seborrheic keratosis

Medical – topical moisturizers w/ alpha hydroxy acid, salicylic acid gently exfoliates skin

Surgical – cryosurgery; curettage

Fibrous Papule Relatively common benign papule

Usually domed shaped lesion w/ shiny skin colored appearance; can be papillomatous, firm, indurated range in size from 1-5 mm

Symptomatic?; bleed w/ trauma

Occurs most often on the face (nose and chin)

BCC, Nevus Medial – mainly cosmetic

Surgical – shave removal; electrodessication

*often recurrent in pts. under 30

Keloid and Hypertrophic Scar

Overgrowth of fibrous tissue, mainly fibroblast and collagen that occur after injury to skin

Common on earlobes, face, chest, back & shoulders; erythematous; highly vascularized; can be soft or hard consistency; no hair follicles

Tender; irritated; pruritic;

cosmetic reason

Most common in 10-30 age range

Keloid – extends beyond the original wound; often recurrent after excision; do not regress spontaneously

Hypertrophic – pruritic; do not extend beyond original wound; may regress spontaneously

Dermatofibroma; marginal cancer recurrence in are of previously excised skin cancer

Medical – requires multiple modalities (keloids are very hard to treat; warn pts. that it can occur after excisions in prone areas; especially if patient is young)

Surgical – compression; silicone sheeting (patch lays over scar and moisturizes); intralesional kenalog (painful!); 5 –flurouracil injections, laser therapy, excision (high recurrence rate)

*if need excision refer to plastic surgeon

Lipoma Benign tumors composed of adipose tissue

Soft, rubbery on palpation, easily movable; 2-10 cm; skin overlying tumor is normal, encapsulated

Slowly enlarging over

many years, rarely painful

Onset usually early adulthood, most common on trunk

Dermatofibroma, cyst, malignancy

Medical – no tx necessary if not bothersome

Surgical – excision, liposuction