Benign Skin Tumors.pdf

DERMATOLOGY (IM) Topic: Benign Skin Tumors Lecture by: Dr. Del Rio SEBORRHEIC KERATOSIS ACROCHORDON...

DERMATOLOGY (IM) Topic: Benign Skin Tumors Lecture by: Dr. Del Rio SEBORRHEIC KERATOSIS ACROCHORDON  In Tagalog, it is “kuntil”  In English, it is “skin tags”  Small, flesh colored to dark-brown, pinhead sized and large, sessile and pedunculated papillomas on the neck, axilla and eyelids  Trunk and groins: soft, pedunculated growths hangs on thin stalks  Onset: 10-50 years old  Increase in number during pregnancy and weight gain o ↑ weight or pregnancy = ↑ acrochordon  Appear to be more prevalent in those with colonic polyps Treatment:  Multiple, oval, slightly raised, light brown to black, sharply  Electrocautery with clipping off the demarcated papules or plaques, rarely 3 cm in diameter (on the base surface it is covered by crusting ; scrape the surface leaves a moist o You give anesthesia  then base cut the stalk  then cauterize  Nummular warty lesions often become crumbly, like a crust that is loosely attached  raw, moist base  Sites: chest, back, scalp, feet, neck and extremities, genital area DERMATOFIBROMA  A single round or ovoid papule or nodule about 1 cm in diameter, with a reddish brown, sometimes yellowish hue  Adherent to the overlying epidermis  dell-like depression  DIMPLE SIGN: Depression over dematofibroma when it is grasped gently between the thumb and forefinger  (+) itching  Onset: 4th to 5th decade  Result from a local arrest of maturation of keratinocytes that are normal in all aspects  Usually originate de novo but may involve from lenitigines Lentigines  starts as hyperpigmented patches or macules which Picture Above: eventually develop crumbly, crusty surface (seborrheic keratosis) (On the left) The dermatofibroma has a central depression which is easily seen  Increase in number when a patient is gaining weight (On the right) If the dermatofibroma is smooth, you pinch it gently  you o ↑ weight = ↑ seborrheic keratosis will then see a central depression (dimple sign)  Sudden eruption of may seborrheic keratoses  inflammatory cutaneous disorder such as exfoliative dermatitis  Sites: lower extremities, above elbow, sides of trunk  Rarely, SCC and BCC may arise  Initiated by injuries to the skin, such as insect bites or blunt trauma o Common in children (you wait for it to involute) Sign of Leser-Trelat  Size: 4-20 mm (>5 cm)  Sudden appearance of numerous itchy seborrheic keratoses in an  Progressive enlargement to >2-3 cm suggest a malignant fibrous adult may be a sign of internal malignancy histiocytoma or dermatofibroma sarcoma protuberans  60% - Adenocarcinoma (stomach) o Might need a excision biopsy o Others: lymphoma, breast, SCC of lung, melanoma Treatment & Prognosis: Differential Diagnosis:  Excisional biopsy  Melanoma  Spontaneous involution may occur  Actinic keratosis  Nevi Treatment:  Liquid nitrogen (cryotherapy) and curettage  Liquid fulguration  Carbon dioxide laser  Electrocautery #GrindNation Page 1 of 4 Strength in knowledge  DERMATOLOGY (IM) Topic: Benign Skin Tumors Lecture by: Dr. Del Rio KELOID & HYPERTROPHIC SCARS Treatment: Keloid & Hypertrophic Scars:  IL (intralesional) triamcinolone every 6-8 weeks  Both are usually caused by trauma  Flashlamp pulsed dye laser  Firm irregularly-shaped thickened, hypertrophic fibrous, pink or red  Excision followed by IL excrescence  Silicone sheet  Arises as a result of cut, laceration, burn or acne pustule on the chest or upper back Lecture Discussion: Hypertrophic scar  responds to IL better than keloid (keloid will take years Keloid: before it flattens)  Keloid  spreads beyond the limits of original injury often sending Before, keloids are removed surgically (scar revision). But surgeons noticed out clawlike (cheloid) projections that when patients became lost to follow up  keloid grow back larger.  Overlying epidermis is smooth, glossy and thinned from pressure So whenever patients get scar revision, ask them to go a dermatologist as  Early lesion: red, tender, rubbery, surrounded by an erythematous soon as their scar heals to control its growth (will not get bigger) halo, may be telangiectatic If patients opt to do conservative treatment with triamcinolone injections or  Chronic: brown, tender, painful, pruritic, hard and stationary silicone sheet/gels  it will take a long time before it get smaller  Most common location: Sternal region  Other sites: neck, ears, extremities, trunk KERATOACANTHOMA 4 Types: 1. Solitary KA 2. Multiple KA 3. Eruptive KA 4. Keratoacanthoma centrifugum marginatum  Sunlight appears to play an important role in the etiology So the sun-exposed areas are the ones affected  Isomorphic phenomenon may occur This means the lesions will appear on areas of trauma. Picture Above: Isomorphic is also known as the lines of trauma (On the Left) A keloid on the sternum  usually it started as a acne lesion. You can see the clawlike lesion (it spreads beyond the original injury). Skin is Muir-Torre Syndrome smooth, glossy and thin as seen in the picture. In a more chronic keloid, there  Sebaceous tumors and KA occur in association with multiple low is pain and tenderness on slight touch grade malignancies (On the Right) A keloid on the earlobe that happened after an ear piercing. It is a round nodule with telangiectasia on the surface Keratoacanthoma Visceral Carcinoma Syndrome (KVACS)  Multiple or large KA which appear at the same time as an internal malignancy, always of the GUT (Genitourinary tract) Solitary Keratoacanthoma  Rapidly growing papule that enlarges to as much as 25 mm in 5-8 weeks  Hemispheric, dome shaped, skin colored nodule with a smooth crater filled with a central keratin plug  Sites: central part of the face, back of hands, arms, less frequent Picture Above: buttocks, thighs, penis, ears and scalp (On the Left) A keloid which resulted from a trauma or immunizations  Seen mostly in middle-aged and elderly (On the Right) A keloid that is due to acne  Lesions of the dorsal hands are more common in men and KA of the legs are more common in women Differential Diagnosis:  Hypertrophic scar o No clawlike projections and does not extend beyond the Picture on Left: original wound There is a single popular nodule o Spontaneous improvement during the first 6 months that is erythematous with a scaly surface. The scale here is a called a central keratin plug  it will gradually slough-off and it will form a crater. After a few weeks it will eventually flatten and resolve #GrindNation Page 2 of 4 Strength in knowledge  DERMATOLOGY (IM) Topic: Benign Skin Tumors Lecture by: Dr. Del Rio Solitary Keratoacanthoma continued….. Treatment:  Most interesting feature:  Biopsy excision or curettage and fulguration of lesion 40 years old  Histologically: hypertrophied sebaceous gland, multilobulated, each dividing into other lobules to produce a cluster resembling a bunch of grapes #GrindNation Page 3 of 4 Strength in knowledge  DERMATOLOGY (IM) Topic: Benign Skin Tumors Lecture by: Dr. Del Rio Sebaceous hyperplasia continued….. Familial Presenile Sebaceous Hyperplasia  Extensive sebaceous hyperplasia on the face, neck, upper thorax with onset at puberty and worsen with age  Autosomal dominant Treatment of Sebaceous Hyperplasia:  Electrodessication  Curettage  Shave biopsy  Lasers  Isotretinoin SYRINGOMA  Small translucent yellowish, brownish or pinkish globoid papules 1- 3 mm in diameter that develop slowly and persist without symptoms  Sites: more common on the eyelids and upper cheeks, rarely on the axilla, abdomen, forehead, penis, and vulva  Familial patterns may occur  Occur in 18% of adults with Down syndrome, especially females  Histologic: dilated sweat ducts, some of which have small commalike tails resembling tadpoles  Probably represent adenomas of intradermal eccrine ducts Lecture Discussion: Patients with syringoma during summer (hot weather)  lesions are more prominent (because the sweat ducts are dilated) But during winter (cold weather)  lesions are less obvious (flat) Treatment:  Electrodessication  Laser ablation  Cryotherapy References:  PPT  Lecture Notes #GrindNation Page 4 of 4 Strength in knowledge