Derm E1: Benign Neoplasms and Hyperplasia

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What is another name for Acquired Melanocytic Nevi?

Nevo melanocytic nevus (moles)

What are the clinical features of Acquired Melanocytic Nevi?

Asx, well-circumscribed, pigmented macules, papules or nodules, can arise anywhere, can disappear, may itch during growth

What are the features of Junctional melanocytic NMN?

at the level of DEJ, macular or minimally raised, preserved skin markings, brown/black in color

What are the features of Compound melanocytic NMN?

DEJ and Intradermal, pigmented papules, tan/brown, smooth, dome-shaped or papillomatous

What are the features of Dermal melanocytic NMN?

grows or remains intradermal, gradual fibrosis, skin colored/speckled brown, papules are dome shaped/pedunculated, soft rubbery texture

When is a biopsy of a NMN indicated?

if any of the melanoma ABCDE criteria is met; concern for melanoma

What is another name for Atypical Nevi?

dysplastic nevi or atypical melanocytic nevi

What are Atypical Nevi?

benign acquired melanocytic nevi, precursor of malignant melanoma

What are the clinical features of Atypical Nevi?

> 5mm, asymmetrical, variegated color, prominent macular component, papular center (“fried egg”), w/ notched, irregular, or ill-defined borders

A family hx of FAMMM syndrome increases risk of developing what?

Atypical Nevi

How do you dx Atypical Nevi?

clinical, refer to derm, biopsy

When would you refer an Atypical Nevi to derm?

assymmetry, > 6mm, irregular borders, abnormal color

What is a Halo Melanocytic Nevus?

melanocytic nevus surround by a round/oval, symmetric , halo of depigmentation

What increases your risk of developing a Halo Melanocytic Nevus?

hx/Fmhx of vitiligo

What are the 4 stages of a Halo Melanocytic Nevus?

• stage 1: pigmented nevus surrounded by a halo

• stage 2: pink nevus surrounded by halo

• stage 3: disappearance of nevus w/ circular area of depigmentation

• stage 4: normal skin w/ repigmentation

Where do Halo Melanocytic Nevus typically appear?

back and trunk

What is a Blue Nevus?

benign proliferations of dendritic dermal melanocytes that actively produce melanin; tindle effect influences color

What are the clinical features of a Common Blue Nevus?

< 1 cm, firm, blue/black, sharply defined papule or nodule; found on dorsal hands and feet

What are the clinical features of a Cellular Blue Nevus?

> 1 cm, congential/acquired, elevated nodule or plaque, slightly irregular border; found on scalp, buttocks, sacrum, face

What is the tx for a Blue Nevus?

common: observe, typically benign

cellular: excised; may progress to melanoma

What is a Spitz Nevus?

uncommon melanocytic lesion composed of large epithelioid or spindled cells

What are the clinical features of a Spitz Nevus?

rapid initial growth, dome-shaped, reddish/brown/tan nodule or papule, symmetric, sharply circumscribed, 1-2 cm

Who is most likely to develop a Spitz Nevus?

children, adolescents, and young adults < 20

What would you see in the dermatoscopy of a Spitz Nevus?

starburst or globular pattern of pigmentation, prominent punctate or rounded blood vessels, regularly distributed dotted vascular pattern

What is a Becker Nevus?

common cutaneous hamartoma w/ epidermal or dermal elements

What are the clinical features of a Becker Nevus?

well-defined unilateral brown patch w/ sharply demarcated borders, macular w/ papular/verrucous surface, hypertrichosis

What is the tx for a Becker Nevus?

• Laser therapy

  • Q-switch Nd:YAG

  • Pulse dye laser

  • Fractional laser resurfacing

What are vascular tumors?

neoplastic, grow independently, due to increased proliferation rates of endothelial and vascular cells

What are vascular malformations?

non-neoplastic structural abnormalitites, normal endothelial cell growth, includes capillary, lymphatic, venous, arteriovenous malformations

What is another name for Pyogenic Granuloma?

lobular capillary hemangioma

What is a Pyogenic Granuloma?

benign vascular tumor of the skin or mucous membranes

What are the clinical features of a Pyogenic Granuloma?

starts as small, red papule that grows rapidly, friable and bleeds, ± collarette scale at the base of the lesion

What would you see on a dermoscopy of a Pyogenic Granuloma?

pink homogenous papule w/ white septa

What is the tx for Pyogenic Granuloma?

• topical

  • Imiquimod or Timolol

• procedural

  • cryotherapy, laser, excision

• avoid trauma

• table salt

What is an Infantile Hemangioma?

most common vascular tumor characterized by a growth phase and an involution phase

What are clinical features of a superficial Infantile Hemangioma?

soft bright red papule or nodule

What are clinical features of a deep Infantile Hemangioma?

not visible to the naked eye; may cause proptosis, strabismus, decreased VA in compressing the optic nerve

What are clinical features of a mixed Infantile Hemangioma?

combination of superficial and deep components

What is the proliferative growth pattern of Infantile Hemangioma?

3-9 mo; rapid growth and enlargement during the first year

What is the involution growth of Infantile Hemangioma?

2-6 yr; regresses and completely resolves by age 4

What is the tx for Infantile Hemangioma?

• 1st line

  • uncomplicated: topical timolol

  • complicated: propranolol

• 2nd line

  • pulsed dye laser

  • excisional surgery

What is another name for a Cherry Angioma?

Campbell de Morgan spots

Who are more likely to get Cherry Angioma?

middle-age and older populations

What are the clinical features of a Cherry Angioma?

dome shaped, 1-4 mm red, purple, blue/black papule; may bleed w/ trauma

What would you see on the dermoscopy of a Cherry Angioma?

red, purple, or blue-black lagoons

What are the tx options for a Cherry Angioma?

electrocautery, laser therapy, shave excision, cryotherapy

What are the clinical features of a Port Wine Stain?

irregulary shaped, painless red or violaceous pathces, present at birth, never disappear spontaneously, blanchable, thicken and darken w/ age

What is a Port Wine Stain?

congenital low-flow vascular malformations of dermal capillaries and post-capillary venules; follows the trigeminal nerve

What syndromes are associated w/ a Port Wine Stain?

Sturge Weber Syndrome, Klippel-Trenaunay Syndrome, CLOVES syndrome

What is needed in diagnostic workup of a Port Wine Stain?

US w/ doppler & MRI

What is the tx for a Port Wine Stain?

Pulse Dye Laser

What is the classic triad for Sturge-Weber Syndrome?

facial port wine stain, leptomeningeal angiomatosis, ocular involvement

What is another name for a Spider Angioma?

spider naevus or spider telangiectasia

What are the clinical features of a Spider Angioma?

central red papule w/ fine red line that extend radially, solitary lesions, diascopy- radiating telangiectasisa blanch and centeral arteriole may pulsate

What are the clinical features of a Venous Lake?

dark blue/violaceous, Asx, soft papule, blanching w/ diascopy, bleed easily

What are Acrochordon?

skin tags

What are the clinical features of Acrochordon?

.1-1 cm soft flesh colored or tan/brown, round or oval, pedunculated lesions (polyp)

What can skin tags + Acanthosis nigrcans indicate?

insulin resistance is present (metabolic syndrome)

What is another name for a Dermatofibroma?

benign fibrous histiocytomas

What are the clinical features of a Dermatofibroma?

solitary, firm, mobile, hyperpigmented nodule, Asx, positive dimple or pinch sign; common on LE

What are the clinical features of a Seborrheic Keratosis?

well demarcated round lesions, dull verrucous surface, typical “stuck on appearance”, slow growing

What is a Seborrheic Keratosis?

common epidermal tumor caused by benign proliferation of immature keratinocytes

What would you see in a biopsy of a Seborrheic Keratosis?

well-demarcated proliferation of keratinocytes w/ characteristic small keratin-filled cysts

What is the most common benign soft-tissue neoplasm?

Lipomas

What must you remove in order to completely get rid of a lipoma and ensure it doesn’t grown back?

must remove the fibrous capsule it is enclosed in

What are the clinical features of a lipoma?

soft, painless subcutaneous nodule consisting of mature fat cells; can be round, oval, or multilobulated

What is a unique feature of angiolipomas?

vascular component that may be tender in cold ambient temperatures and with compression

What are the clinical features of an angiolipoma?

soft subcutaneous tumor of adipocytes and vessels; usually on chest and forearms, occurs in multiples, painful and tender

What are the clincial features of Sebaceous hyperplasia?

2-6 mm enlargement of sebaceous glands, umbilicated yellow/brown papules on the forehead, nose, and cheeks

What are the risk factors for developing Sebaceous Hyperplasia?

elderly, medications -cyclosporine

What are Calluses?

diffuse thickening of the outermost layer of the skin (stratum corneum) in response to repeated friction or pressure

What are corns?

occur at pressure points secondary to ill-fitting shoes, an underlying bony spur, or an abnormal gait; has a central core that is hyperkeratotic and painful

What are the clincial features of Calluses/Corns?

hyperkeratosis, skin ridges or “toe prints” are present w/in the hyperkeratosis

What is the tx for Calluses/Corns?

salicyclic acid plaster/ointment, better shoes, pumice stone, urea or lactic acid creams

What are hypertrophic scars?

do NOT extend beyond the margin of the original wound

What are keloids?

continuous growth and invasion into adjacent skin beyond the original wound

What is the pathophysiology behind Keloids and Hypertrophic scars?

dysregulation of would healing process, local tissue factors, pt related factors

What are the clinical features of Keloids?

disfiguring, painful/pruritc, recur after surgical excision, can form 1 mo-1 yr post injury, do NOT spontaneously regress

Where are keloids more common?

upper chest and back, shoulders, head and neck, ears

Where are Hypertrophic scars more common?

extensor surfaces

What are the clinical features of hypertrophic scars?

more common, usually form 6-8 wks post injury, plateau around 6 mo, regression may occur in 12-18 months

What is the tx for Keloids and Hypertrophic scars?

• 1st line

  • Silicone cream or gel

  • intralesional steroids (triamcinolone)

• 2nd line

  • intralesional 5-Fluorouracil

  • cryotherapy + laser + intralesional steroid

  • surgical excision + intralesional steroid