benign neoplasms
Post on 21-Jul-2016
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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
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