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Seborrheic Keratosis
Keratocanthoma
Nevi
Port-wine stain
Angioma/Hemangioma
Telangectasia
Dermatofibroma
Keloids
Acrochordon
Cysts
Lipoma
Seborrheic Keratosis
Pathophysiology
Etiology
Epidemiology
Prognosis
Benign
Secondary tumors
Can become irritated, itch, grow, bleed
Clinical Features
Examination
Differential Diagnosis
Acrochordon
Verruca vulgaris
Epidermal nevi
Melanocytic nevi
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Treatment
Consultation
None
Keratoacanthoma
Pathophysiology
Poorly understood
Most likely derived from follicular infundibulum
Etiology
Epidemiology
Cutaneous tumor
Fair complexion
Male to female, 2:1
All age groups, increases with age
o Rare under 20 years old
Prognosis
Clinical Features
Rapid growth over a few weeks to months, spontaneous resolution in 4-6 months
Solitary lesion
Begin as firm, round, skin-colored/red papules
Progress to come-shaped nodules with a smooth shiny surface
Central ulceration or keratin plug
Examination
Differential Diagnosis
Actinic keratosis
Cutaneous horn
Squamous cell carcinoma
Molluscum contagiosum
Treatment
Surgical excision
Laser therapy
Cryotherapy
Systemic retinoids
Intralesional Methotrexate, 5-fluorouracil, Bleomycin, Prednisone
Consultation
Etiology
Congenital malformation of the superficial dermal blood vessels
Idiopathic
Epidemiology
Most common vascular malformation
Present at birth and grows
More common in Caucasian than African Americans
Prognosis
No increase in mortality
Clinical Features
Flat, well-circumscribed patch
Pink, red, purple
Color mar darken with crying or fever
Unilateral
May evolve into a raised plaque
Examination
CT or MRI if it involves the upper facial dermis
Ophthalmology evaluation if it involves CN V1 and CN V2 or eyelid
Histology – ectasia and erythrocytes
Differential Diagnosis
Hemangioma
Coats disease
Cobb Syndrome
Treatment
Tattoo with skin colored pigment
Cosmetic cover-up
Flashlamp pumped pulsed-dye laser
Consultation
Dermatologist – early intervention
Opthalmologist – exclude glaucoma
Neurologist – Sturge-Weber syndrome
Associated syndromes
Sturge-Weber
o triad of capillary malformations involving the upper facial dermis, the ipsilateral
leptomeninges, and the ipsilateral cerebral cortex
o facial skin supplied by the ophthalmic branch (CN V1) of the trigeminal nerve must be
involved
o Complications include glaucoma, seizures, hemiplegia, mental retardation, cerebral
calcifications, subdural hemorrhage, and an increased prevalence of underlying soft
tissue hypertrophy
Klippel-Trenaunay
o triad of capillary malformation, congenital varicose veins, and hypertrophy of
underlying tissues, particularly skeletal overgrowth
o Complications include varicose veins with venous thrombosis and pulmonary embolism;
bleeding from varices, the rectum, or the bladder; skin ulceration; increased sweating
overlying the capillary malformation; leg circumference or length discrepancy with
resultant scoliosis; edema; and recurrent infections
Cherry Angioma/Hemangioma
Pathophysiology
Proliferation of dilated venules
Etiology
Unknown
Epidemiology
Frequency increases with age
Prognosis
Benign
When present at birth they usually resolve by age 5
Clinical Features
ranging from a small red macule to a larger dome-topped or polypoid papule
Examination
Histology – ranging from a small red macule to a larger dome-topped or polypoid papule
Differential Diagnosis
Angiokeratoma
Milia
Insect bites
Treatment
Shave biopsy
Electrodesiccation
Laser ablation
Cryotherapy
Consultation
Dermatologist - if multiple appear in a short period of time
Telangiectasia
Pathophysiology
Broken capillaries in skin
Etiology
Can be associated with rosacea
Treatment
Laser
Electrodessication
Dermatofibrosis
Pathophysiology
Benign fibrous papule
Etiology
Unknown
Possible reactive
Epidemiology
More common in female than males
Prognosis
Benign
Clinical Features
Pink, tan, brown, gray
Nodule or papule
Examination
Dimple sign
o Lateral compression causes dimple
Histology – whirling fascicles of spindle cell proliferation with excessive collage deposition in the
dermis
Treatment
Liquid nitrogen may flatten it
Surgical removal is unnecessary
Keloids
Pathophysiology
Excessive proliferation of tissue
Epidemiology
More common in females
More common in individuals with darker pigmentation
Average age of onset 10-30 years old
Clinical Features
Abnormal proliferation of scar tissue
Grows beyond original margins of the scar
Examination
Soft and doughy or rubbery and hard
Histology
o Keloidal hyalinized collagen
o Tongue-like advancing edge underneath normal-appearing epidermis and papillary
dermis
o Horizontal cellular fibrous bands in the upper reticular dermis
o Prominent fascia-like fibrous bands
Treatment
Occlusive dressing
Compression
Corticosteroid injection
Surgical excision
Cryotherapy
Laser therapy
Etiology
Frequent irritation
HPV
Epidemiology
All races, equal among male and females
Increase in frequnecy through the fifth decade of life
Prognosis
Benign
Clinical Features/Examination
Small, furrowed papules of approximately 1-2 mm in width and height, located mostly on the
neck and the axillae
Single or multiple filiform lesions of approximately 2 mm in width and 5 mm in length occurring
elsewhere on the body
Large, pedunculated tumor or nevoid, baglike, soft fibromas that occur on the lower part of the
trunk
Histology – rarely BCC or SCC
Differential Diagnosis
Pedunculated seborrheic keratosis
Nodular polypoid melanoma
Treatment
Scissors
Electrodessication
Cryotherapy
Epidermoid cysts
Cystic enclosure within the epidermis, filled with keratin
Not an infection but can become inflammed
Epidemiology
Adult life
Male:Female 2:1
Prognosis
Prognosis is good if early surgical excision
Clinical Features
flesh–colored to yellowish, adherent, firm, round nodules of variable size.
A central pore or punctum may be present.
Keratinous contents are soft, cheese-like and malodorous.
Treatment
I&D
Treat with oral abx if inflamed prior to excision
Consultation
Dermatologist/General Surgeon
Mucocele
A cyst in the lip may be due to occlusion of the salivary duct
It is a soft to firm firm, 5–15 mm diameter, semi-translucent nodule.
Ganglion cyst
Most often involves scapholunate joint of dorsal wrist
Epidemiology
These arise in young to middle-aged adults
They are 3 times more common in women than in men
Clinical Features
The cyst is a unilocular of multilocular firm swelling 2–4 cm in diameter that transilluminates
Cyst contents are mainly hyaluranic acid, a golden-colored goo
Lipoma
Most common soft tissue tumor
Slow growing, benign fatty tumor
Pathophysiology
Can be subcutaneous, duodenal, colon, esophagus, stomach
Etiology
Trauma
Genetic, rearrangement of chromosome 12
Prognosis
Excellent when removed
Clinical Features/Examination
Soft, fluctuant, lobulated
“slippage sign” - slip from under your finger
Differential Diagnosis
Hibernoma
Liposarcoma
Treatment
Removal for cosmetic reasons
Consultation
Dermatologist/General Surgery/Plastic Surgery