benign neoplasms

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Post on 21-Jul-2016




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derm diseases


NameBackgroundPresentationInterview ?sDiagnosticsDifferentialsTreatment

Melanocytic NevusCongenital or acquired; composed of melanocytes; can change to dysplastic nevus or melanoma w/ sun expoxure40 yrs of age; hereditaryCharacteristic stuck on appearance; color varies from pale brown to dark black; velvety or verrocous (warty) feeling; can be several cmsSymptomatic, 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 sks associated with adenocarcinoma of the GI tract, lymphoma, leukemia (rareMedical 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 Vulgaris100 types of HPV; common warts; genital warts; flat; plantar; occur from breakdown in skin barrier; spread by direct or indirect contact; autoinoculation Most commonly on hands and knees; hyperkeratotic; rough surfaceHow long has it been present; previous treatments triedActinic 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 stim. Immune response)

Epidermal Inclusion CystMost common cutaneous cysts; proliferation of epidermal cells inside dermisFlesh colored nodule; firm; central pore; erythematous if inflamedUsually asymptomatic; can discharge foul smelling chees-like material; can become inflamed or infectedLipoma, milia, pilar cyst, cutaneous malignancyNo 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 violetBothersome to pt.; may bleed w/ trauma; cosmeticUsually after age 40Malignant melanoma; urticaria; kaposis sarcoma; miliaNo 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 papuleBothersome to pt.; may rub on clothing and jewelry; cosmetic Can spontaneously fall off; often numerousSeborrheic keratosis, warts, nevus, neurofibromaMedical generally cosmetic reason for tx

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

Sebaceous HyperplasiaOvergrowth of sebaceous gland; can be associated w/ oily skinYellowish, soft papules, most common on nose, cheeks, forehead, 2-9mm w/ central umbilication; can be solitary or numerous lesionsPt. may be concerned about malignancy; can become traumatized; cosmeticMost common in middle and older ageBCC, fibrous papule, miliaMedical biopsy to rule out BCC if unsure

Surgical shave removal, laser, electrodessication

DermatofibromaUnknown 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 brownCan become traumatized and painful; especially w/ shaving; may be present for decadesOccurs more commonly in women on lower legs; dimple sign w/ lateral pressureBCC, SCC, keratoacanthoma, malignant melanoma, keloid scar, nevus, prurigo nodularisMedical if unsure of lesion biopsy (excisional best)

Surgical excision if bothersome; CO2 laser

Excision best because pathology in dermis

MiliaCommon keratin filled cysts; common after dermabrasion procedures where there is damage to the pilosebacous unitsSuperficial, uniform, pearly white to yellowish, domed lesions measuring 1-2mm, most commonly on face and periorbital areaCosmetic concern to pt.; rarely symptomaticSeen mostly in infants but also seen in kids and adultsAcne, syringomaMedical topical retinoid to soften lesionsSurgical I&D, scissor excision, electrodessication

SyringomaBenign adnexal neoplasm of eccrine origin; 4 variants 1)localized 2)associated w/ downs syndrome 3)eruptive form 4)familial formSkin colored dermal papules; may appear transulacent; usually < 3mm; usually in multiples on cheeks and eyelidsUsually asymptomatic; may become pruritic w/ perspirationMost often form at puberty but can form later in lifeBCC, acne, milia, hidrocystoma, molluscumMedical cosmetic reasons

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

Stucco KeratosisKeratotic papule due to thickening of the epidermis;Most common on lower extremities (knees down); characteristic stuck on appearance; white to yellowish crusted papuleUsually asymptomatic; often unnoticed by pt. More common in men; appear after age 40Actinic keratosis; wart; seborrheic keratosisMedical topical moisturizers w/ alpha hydroxy acid, salicylic acid gently exfoliates skin

Surgical cryosurgery; curettage

Fibrous PapuleRelatively common benign papuleUsually domed shaped lesion w/ shiny skin colored appearance; can be papillomatous, firm, indurated range in size from 1-5 mmSymptomatic?; bleed w/ traumaOccurs most often on the face (nose and chin)BCC, NevusMedial mainly cosmetic

Surgical shave removal; electrodessication

*often recurrent in pts. under 30

Keloid and Hypertrophic ScarOvergrowth of fibrous tissue, mainly fibroblast and collagen that occur after injury to skinCommon on earlobes, face, chest, back & shoulders; erythematous; highly vascularized; can be soft or hard consistency; no hair folliclesTender; irritated; pruritic; cosmetic reasonMost 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 cancerMedical 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

LipomaBenign tumors composed of adipose tissueSoft, rubbery on palpation, easily movable; 2-10 cm; skin overlying tumor is normal, encapsulatedSlowly enlarging over many years, rarely painfulOnset usually early adulthood, most common on trunkDermatofibroma, cyst, malignancyMedical no tx necessary if not bothersome

Surgical excision, liposuction


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