POM II - Benign Skin Neoplasms - Exam 1

Benign Nevus

-common mole

-benign skin tumors composed of melanocytic derived cells

-distinctions are based upon the location of melanocytic nests in the epidermis, dermis, or both and age of onset

-junctional nevi are flat

-dermal and compound nevi are elevated

Benign Nevi - Etiology

-typically arise during childhood, adolescence, or very early adulthood, and then senesce in later years

-during pregnancy, existing nevi may darken and become noticeable

-compound nevi are more common in lighter skin phototypes

-not common to get new moles after 50

ABCDE - moles

-A: asymmetrical

-B: borders irregular

-C: colors not uniform

-D: diameter >6 mm

-E: evolving or changing over time

Congenital Nevus

-benign nevus present at birth or within first two weeks of life (1-2% worldwide)

-often flat and tan in color

-may change in color, become papillated, or display hair growth during first few years of life and can vary tremendously in size

Congenital Nevus - Presentation

-been reported to have an increased risk for transformation to melanoma

-risk of melanoma is believed to correlate with CMN size

-most common locations: buttocks, thigh, trunk; can also occur on face, extremities, palms, soles, scalp

Dysplastic Nevus

-a melanocytic proliferation showing atypia and sharing some features of melanoma

-controversial d/t lack of consensus on how it is defined and what it represents biologically: graded mild, mod, or severe

-believed to correlate with the overall number of melanocytic lesions in an individual

-4-15 fold increased risk of melanoma

Mongolian Spot

-congenital dermal melanocytosis

-common newborn pigmented lesion usually in sacral area

-benign, ill-defined, blue-to-gray patch present at birth or shortly after

-commonly seen in the sacrococcygeal area in infants of Asian or African descent but may be found on any cutaneous surface in infants of all ethnicities

-pigmentation most intense at 1 y.o., reaches peak diameter by 2 y.o., usually fades by adulthood

port wine stain

-a congenital benign capillary malformation

-most common type of vascular malformation

-occurs in about 3 in 1000 people

-swollen blood vessels create a reddish-purple discoloration of skin

-rare cases are a sign of sturge-weber syndrome

Port Wine Stain - Presentation

-most often on face but can be anywhere

-persists for life

-may become more violaceous and take on a cobblestoned texture with age

-can be cosmetically disturbing to the patient

-lesions may be associated with a number of other findings or conditions

pulsed-dye laser

what is the tx for port wine stain?

Cafe au lait spot

-a well-defined, evenly pigmented brown macule or patch

-light to dark brown depending on pts skin pigment

-onset is usually evident in early childhood as solitary lesion

-a single lesion is present in 10-20% of US population, and 1% of healthy YA have up to 3 spots

Cafe Au Lait Spot - Presentation

-located anywhere on the body

-typically appear on the trunk or LE and rarely on the face

-increase proportionally in size as a child grows

Neurofibromatosis

-multisystem genetic disorder with hallmark cutaneous findings including cafe au lait macules, neurofibromas, and axillary freckling

Acrochordon

-skin tags or fibroepithelial polyps

-common, benign, pedunculated growths

-most commonly found in areas of frequent friction such as the eyelids, neck, axillae, and inguinal area

-usually asx but can become irritated by clothing or jewelry

-associated with increasing age, pregnancy, DM, and obesity

Acrochordon - Incidence

-men and women are affected equally

-there is no difference in prevalence among different ethnicities and races

Acrochordon - Tx

LN2 or snip removal

Lipoma

-benign tumors of slow-growing, mature fat cells - most common soft tissue tumor

-present as soft, rubbery, freely mobile subcutaneous masses without overlying skin change

-most often solitary, but can be multiple

-found in areas where there is fat

-can range in size, usually slow growing

Lipoma - Presentation

-usually asx

-large tumors that compress nerves or limit normal tissue movement can cause lymphedema with discomfort and pain

Lipoma - Tx

-not necessary

-can be surgically excised if bothersome

Cherry Angiomas

-most common type of acquired benign vascular proliferation and area composed of thin-walled, dilated capillaries

-often present in early to mid-adulthood and appear as small red or violaceous macules or papules that increase in number and incidence with age

-benign and thus do not require treatment unless irritated or bleeding, but are often of cosmetic concern

Pyogenic Granuloma

-benign vascular lesion of skin and mucosa, rapidly growing

-a glistening, friable, bright red papule or nodule that bleeds spontaneously or after trauma

-unknown cause

-not infectious or granulomatous

-most often on hand, neck, extremities, trunk, but can also arise on the gingiva or oral mucosa

-can arise in pregnancy

Xanthoma

-a deposit of yellow cholesterol rich material in tendons or other parts of body

-commonly seen on eyelids

-cutaneous manifestations of lipidosis

-associated with hyperlipidemia

Seborrheic keratosis

-most common benign tumor in older individuals

-raised, "stuck-on" appearing papules and plaques with well-defined borders

-unusual before age 30 and increase in amount by age

-etiology unknown

-usually asx but can be itchy or rub on clothing

Seborrheic Keratosis - Presentation

-waxy texture

-color can be white, pink, brown, black

-look scary but are benign; will not turn into cancer

-if you are unsure, BX

-can leave them alone or can treat with LN2 if desired

Dermatosis papulosa nigra

common variant of SKs in african americans

Dermatofibroma

-common, benign skin neoplasms composed of collagen, macrophages, capillaries, and fibroblasts

-etiology is unknown, though some may arise at sites of trauma or insect bites

-most common on the legs of women and usually appear in young adulthood

Dermatofibroma - Presentation

-firm, skin-colored pink or slightly pigmented papules or nodules

-usually asx but may be tender or pruritic

-often persist for life

-tenderness may occasionally be elicited with manipulation of the lesion

-dimple sign

Dimple Sign - Dermatofibroma

-squeezing results in a dimple or puckering inward

-aka Fitzpatrick sign

Dermatofibroma - Tx

-unnecessary

-can be excised if bothersome

-intralesional steroids may help

-cryotherapy less effective

Keratoacanthoma

-rapidly growing, well-differentiated neoplasm of squamous epithelium

-considered by many to be a low-grade SCC

-appear and grow rapidly over a few weeks and spontaneously involute and resolve within 6 months, leaving an atrophic scar

-immune system is thought to play a role in the spontaneous regression of these

Keratoacanthoma - Incidence

-most commonly seen in individuals aged 60 years and older with lighter light skin colors and a history of prolonged sun exposure

-men more common than women

Keratoacanthoma - Etiology

-trauma

-HPV

-genetics

-immunologic status

Keratoacanthoma - Presentation

-solitary, crater-shaped nodules measuring a couple centimeters in diameter

-often with a central keratin plug on sun-exposed skin

surgical excision or mohs surgery

what is the tx for keratoacanthoma?

keloid

-hypertrophic scar that extends beyond the area of trauma, injury, or surgical scar

-raised, smooth, firm, hairless, and shiny papules, plaques, or nodules

-found at areas of previously traumatized skin or arising spontaneously on normal skin

Keloid - Presentation

-may be painful, tender, pruritic, and can grow to become very large

-can cause chronic discomfort, be disfiguring, and restrict normal tissue motion

-most often occurring in areas of high skin tension

Keloid - Incidence

-can affect individuals of any race and ethnicity, but most common in african americans

-likely a genetic basis for the tendency to develop

-may occur in acne scars

keloid - tx

-extremely difficult

-prevention is key - surgical wounds should follow skin lines

-try to avoid cutting over joints when there is high mobility or in areas of high tension

-intralesional steroid tx q4 wks

Inclusion Cyst

-dome-shaped, firm, skin-colored nodule that is freely movable on palpation and sometimes has a small, dilated punctum

-filed with thick, cheesy material (keratin and lipid-rich debris) with a foul odor that can be expressed

-can be well-defined or it may have an irregular border and surface d/t prior rupture, scarring, and regrowth

-benign and usually asx, can be painful

Inclusion Cyst - Incidence

-can arise on face, trunk, extremities, in mouth, or in genitals at any age

-more common in men

inclusion Cyst - tx

-not necessary

-can be expressed

-excision (when not inflamed)

-if infected --> incision and drainage +/- packing and definitely abx

Milia

-very common benign small cysts

-typically seen in infants, but can be seen at any age

-asx, superficial, usually 1-2 mm in diameter

-can easily be punctured with 18 gauge needle and expressed but not necessary