Benign Cutaneous Neoplasms Lecture

Jun 7, 2024

Review flashcards

Benign Cutaneous Neoplasms Lecture

Introduction

  • Substitute Lecturer: Regular lecturer is sick.
  • Advisory: Study all slides, even if told otherwise.

Neoplasms Overview

Seborrheic Keratosis (SK)

  • Definition: Most common benign cutaneous neoplasm.
  • Etiology: Proliferation of immature keratinocytes; possible relation to sun exposure.
  • Presentation: Stuck-on, greasy appearance, typically in middle-aged/elderly individuals predominantly on sun-exposed areas (face, back, chest).
  • Management: Mostly benign; biopsy if in doubt. Treatments include liquid nitrogen, curettage, or reassurance.
  • Lesser-Trelat Sign: Sudden appearance of multiple SKs might indicate internal malignancy.

Stucco Keratosis

  • Definition: A vascular insufficiency affecting lighter-skinned, elderly individuals with dry skin.
  • Presentation: White lesions, predominantly on ankles, dorsal feet; not sun-exposure related.
  • Management: Usually no treatment; potential complications with poor wound healing.

Dermatosis Papulosa Nigra

  • Definition: Smaller SK due to darker skin tones.
  • Presentation: Brown-black papules on the face around the eyes, common in African-Americans and Hispanics.
  • Management: No treatment needed unless for cosmetic reasons. Risk of hypopigmentation from treatments.

Skin Tags (Acrochordon)

  • Definition: Pedunculated soft lesions common after age 25, especially in obese patients.
  • Presentation: Found in areas of friction (eyelids, neck, groin, armpits).
  • Management: Removal for friction/irritation using scissors/silver nitrate. Large ones require more careful management.

Dermatofibromas

  • Definition: Reactive fibrous tissue growth due to trauma.
  • Presentation: Firm, inverted nodules on extremities, commonly around shaving areas.
  • Management: Removal via punch biopsy if necessary due to itching or pain.

Hypertrophic Scars & Keloids

  • Definition: Overgrowth of scar tissue, hypertrophic stays within initial trauma area, while keloids extend beyond.
  • Management: Intralesional steroids, cryotherapy, silicone gels, 5-FU injections, laser therapy. Often requires multiple treatment approaches.

Specific Tumors

Keratoacanthoma

  • Definition: Rapidly growing benign epithelium tumor, potential for resemblance to SCC.
  • Presentation: Solitary, dome-shaped, with central keratin core on sun-exposed areas.
  • Management: Excision and biopsy to rule out SCC.

Cutaneous Horn

  • Definition: Hyperkeratotic lesion, benign horn with potential SCC base.
  • Management: Excision to assess base lesion, potential for biopsy.

Sebaceous Hyperplasia

  • Definition: Overgrown sebaceous glands.
  • Presentation: Yellowish papules on face; common in oily skin individuals over age 30.
  • Management: Electrodesiccation, curettage, shave excision if desired.

Syringomas

  • Definition: Benign sweat duct tumors common around eyes.
  • Presentation: Small, firm, flesh-colored nodules.
  • Management: Generally no treatment due to benign nature except for cosmetic reasons.

Neurofibromas

  • Definition: Benign nerve sheath tumors, potentially related to genetic conditions.
  • Management: Individual lesion removal, specialist management if associated with syndromes.

Cherry Angiomas

  • Definition: Common vascular tumor seen after age 30.
  • Presentation: Small, red papules that can bleed easily.
  • Management: Shave excision if desired, especially if symptomatic.

Telangiectasia

  • Definition: Permanently dilated small blood vessels.
  • Presentation: Red linear streaks or clusters, often on face.
  • Management: Electrodesiccation or laser treatment.

Pyogenic Granulomas

  • Definition: Acquired vascular tumors, common in children and pregnant women.
  • Presentation: Rapid growth, easily bleeds; bright red, shiny lesions.
  • Management: Curettage, electrodesiccation to remove entire lesion.

Lipomas

  • Definition: Benign adipose tissue tumors.
  • Presentation: Soft, mobile, and can be deep subcutaneous lesions.
  • Management: Excision for symptomatic or large lesions. Differentiate from angiolipomas (lipomas with rich blood supply).

Miscellaneous Notes

  • General Rule: When in doubt, biopsy to rule out malignancy.
  • Common Site: Most benign cutaneous neoplasms appear on sun-exposed areas.
  • Cosmesis: Many benign lesions are removed mainly for cosmetic reasons.
  • Complications: Consider potential complications like poor wound healing, recurrence, and bleeding.
  • Clinical Tools: Use dermatoscope to evaluate lesions.
  • Important Syndromes: Neurofibromatosis can lead to multiple neurofibromas.

Break Reminder

  • Take breaks during long lectures to maintain focus.

Important Names & Signs

  • Morgan Freeman: Reference for Dermatosis Papulosa Nigra (lesions around eyes).
  • Lesser-Trelat Sign: Multiple sudden SKs indicating possible internal malignancy.

Conclusion

  • Study entire lecture material thoroughly.
  • Practical application: handle lesions with care, consider patient comfort, ensure comprehensive management, and biopsy suspicious lesions.