BENIGN NEOPLASMS

Acrochordon Xanthoma Lipoma Pilar Cyst Seb. Keratosis

Presentation (skin tag) cholesterol related benign subcutaneous keratin filled cysts that benign prolif of immature
familial tendency lipid deposits neoplasms, composed orginate from hair follicle keratinocytes
M/C in Females occur in response to of lipid cells develop after puberty common epidermal tumor
and obese abnorm lipid concn's incorrectly labelled as occurs in ppl >50+yoa
or lipoprotein abnorms subaceous cysts but also young adults

Distribution axilla, neck eruptive: sddn, discrete, single or multiple 90% found on scalp trunk, face, upper extrem's
below mammary yellow pap's with red
inguinal areas halo, on extensor surfs
and prssure sites
tuberous: sm, soft, yellw-
org plaques, on elbows,
knees, digits
tendinous: firm, irreg, slow
growing nodules, on
achilles, ext. tendon of
digits
planar: palms, hands, or
feet, periorbital

Lesions soft papules firm macules, papules, benign subcutaneous firm, mobile, keratin cysts papules and plaques
and nodules nodules or plaques neoplasms orginate from epithel cells keratin plug in centre
(Dx) pedunculated, on (lipid deposits) soft, rounded, or lobulated of outer root sheath of appear warty, well circumscribed
narrow stalks moveable against overlying hair follicle scaly and hyperpigmented
site slow growth until stabilize upclose have horns, cysts
and then rupture or dark keratin plugs
inflammatory rxn follows
(PAINFUL)
Colour hyperpigmented yellow-brown, secondary lesion is hyperpig
or skin coloured pinkish or orange and scale

DDx Nevus:
no stuck on or warty appearance
no scale
Melanoma:
not stuck on appearance
assymmetry and blurring
of borders of changing
mole/skin
Basal Cell CA:
usually Hx of slowly chngng
IMAGE lesns, with waxy apprnce
dilated BV's and ulceratn
to suspect BCC
PRE MALIGNANT NEOPLASMS
Leukoplakia Act. Keratosis Keratoacanthoma Basal Cell CA Squam Cell CA Melanoma Kaposi's Sarcoma
Presentation kertinization of muc. mem, premalignt lesions "crateriform ulcers malignancy of basal cells 2nd M/C skin CA malignant turmour from multifocal malig
small white patches, M/C in white, fair of the face" of epiderm malignant tumor of melanocytes tumor of lymphathic
occasnlly ulcerated haired ppl epithelial tumours, suddn M/C human malignancy epithelial keratinocytes endothelial cells
Hairy lesion are keratin onset, M/C in men, whites, MC in males, white, 55 yrs linked to Herpes 8
growths growing 40-80yrs sddn epidemic helped
in males, 50-70yoa identify AIDS

Distribution tongue, buccal mucosa back, sh, face sun exposed areas 85% on head and neck sun exposed areas pigmented areas of skin
sun explosed skin (cheeks, nose, ears, NOSE m/c site and muc mems
(face, dorsa of hands, doras of hands, multiple lesions
and scalp) forearms

Lesions small white patches, papules, plaques with papules, nodules, tumor papule noduel translucnt primary: vary in sz, shape, shade flat, macular, red or
occasionally ulcerated. secondary erythema, secondary erythema waxy or pearly border indurated papule, plaque, most commonly pigmented indurated plaques
Hairy lesion are raised, scale, and occasional and crust ulcer, often crusted nodule, tumor central clearning
with corrugated or "hairy" hyperpigmentation dome shaped nodule pink/red, telagictasea secondary: TYPES: irreg border
surface d/t keratin with central keratotic pgmented- blue, blck erythema, scale, erosion, lentigo maligna
projctns core round, oval, umbilicated crust, ulcer superficial spreading
solitary, rapid growing adenopathy may be presnt nodular
noninvasive but get v. lrg in larger lesions, esp in
lesions assoc with tar mouth
S's and Sx's px's complain of exposure locally invasive/aggrssve extremely aggressive biopsy needed
"stinging" sensation, but limited matastizising often fatal within months
sharp, sticking of recognition
danger: change in assym,
border, colour, diamter,
elevation, enlargement
…etc.
Dx based on clin appearnce Hx of rapidly growing lesn papation is hard firm but any slowly evolving,
& palpatn excisional biopsy rules cystic lesions may occur isolated keratotis or
out Squ. Cell CA eroded papule or
sun exposure d/t chronic sun exposure plaque in suspect px,
some progress to Squ and imm compromised that persists over a mnth
cell CA (not invasive theory that HPV involved.
unless on lip)

DDx Candida: Squ Cell CA: Squ. Cell CA Squ. Cell CA Eczema Bruise
K0H test req'd plaque or papule indurated
slower growing and no no waxy, thready border respnds to corticoster'ds
co-ixn common shave biopsy rules out central karatotic plug or telagiectasia induration is more indicate
Oral Cancer Seb. Keratosis: biopsy confirms of Sq Cell CA
red, erythroplastic lesion pigmented, "stuck on" Scar Basal Cell CA
when dry appr more no "stinging" Hx: trauma? Not umbilicatd waxy border
granular and slightly Nummular Eczema more stable lesion can look v. sim if ulcerated
abraded coin shaped, erythematous Eczema biopsy needed to confirm
Apthae (cankers) lesions with scaling no pearly borders Keratocanthoma
recurrent lesn's, usually located on trunk and prox. or telangiectasia classic Hx of rapid grwth
ulcerated, usually affects extremeties erythmatous scaling plque vs. squ. Cell CA
lips and tongue esp on trunk central keratotic plug
Frictional hyperker dermal nevus (mole) bopsy required
from surface trauma firm, flesh-coloured papule Actinic Keratosis
(dental appliances) that does not gradually not indurated
enlarge precursor to sq. cell CA
IMAGE
DISORDERS OF BLOOD VESSELS
Strawberry Nevus Vascular Malform Cherry Ang Spider Ang Erythema Nodosum Salmon Patch
Presentation capillary hemangioma "port wine stain" common bright focal telengiec netwrk acute inflamm rxn pattern "stork bite"
benign vasc prolif (PWS) red tiny spots of dilated capillaries in thin sheet of tissue very common
of endothelial lining present at birth, embryo numerous radiating from a central (panniculus), around BV present at birth
apprs within 1st few no regression! dilated capillaries arteriole in septum CT and adjcnt mature, dilated dermal
days or mnths of life lined by flat endo fat of cut tissue capillaries that
regress with time cells M/C in females 15-30 yrs resolve spontaneously
arises from various ixn's
Distribution post. neck, glabella, unilat trunk, in middle age usually solitary post. neck, glabella, upper
upper eyelids face, neck M/C and elderly trunks, legs, forarms bilateral, not symmetrical eyelids
ie. women get on legs predilection for lower legs,
knees, arms
rarely face
Lesions more comm in whites irreg shaped, red, nodular vascular telangectasia of capilarries bright red, later violaceous macule with irreg borders
soft bright-red/deep violaceous, macular, myriad of tiny red network…. nodules: oval and arciform
purple vascular nods vascular formation of spots stimulating Spider like arrangement not sharply marginated
or plaques BV's of dermis petechiae Indurated
with age, develop into (broken BV's) tender and warm to
papules or nods bleed profusefly if touch
ruptured.

S's and Sx's Sturge-Weber Synd Metastatic CAR may be assoc with hyper fever, malaise
PWS involves opthalmic estrogenic states arthraligia in 50% px's
br of CV5 and assoc Nodular Melanoma (eg. Pregnancy, HRT, or spontaneous redxn in
calcifications of brain biopsy req'd chronic viral heptatitis, 6 weeks
eye mvment assoc alcholic cirrhosis
with glaucoma

DDx Erysipelas
no nodules, unilateral

Image

DDx
CUTANEOUS BACTERIAL INFECTIONS
Impetigo Folliculitis Abscess Furuncle Carbuncle Erysipelas Cellulitis
Presentation scabby eruption that variety of pustular ixn circumbscribed evolves from bacterial very painful, deep pyogenic acute well demarcated deeper ixn than erysipelas
attacks! of hair follicle/skin collctn of pus, follculitis mass of several ixn of suprfcial layrs into dermis and subcut
contagious, acute, purulent d/t bacterial, fungal, viral, acute or chron interconnctd infected hair of skin & assoc cut aneous tissue
superficial skin ixn M/C in syphilitic ixn localized ixn follicles, with formation of aneous lymphatics
preschool children and destructs assoc CT Streptococcus Ixn
teens tissue also S. Aureus
S. Aureus & BH Strep M/C in infants/child
involved
Distribution face, arms, legs M/C on sites of friction dermis, pst neck, areas with beard sites of chronic edema
but can be anywhere (ie. buttocks) subcut fat, scalp, axillae, buttocks… old scars, extremities,
can also occur on hair muscle or deeper face
bearing areas structures

Lesions primary: primary: starts as tender nodule or abscess several adjacent coalescing primary:
vesicles, pustules nodule, pustule, pierced by nodule, later fills firm, red, not, tender furruncles??? erythema, edema, pain
secondary: a hair with pus necrotic plug at centre, regional lymphadenopathy
honey crusted, erythema secondary: nodule flucturates with secondary:
and erosions erythema, eduma, exudate, abscess formation marginated erythema,
draining sinuses underneath the plug, eduma, vesicles, bullae,
covered by a pustule. and cut hemorrhage

S's and Sx's adenopathy may be presnt After rupture or drainage throbbing pain systemic signs range
itching of pus and plug, a nodule extremely tender from mild to severe:
scratching spreads ixn with cavatation remains low grade fever, malaise chills, headache, fever,
prostration tachycardia & hypotension
Dx finding young child with made from clinical findings
honey coloured crusts

DDx Tinea Tinea barbae Herpes Zoster

central clearng & KOH+ fungal, highly inflamed pain precedes onset of HZ
Varicella (pox) KOH+ Tzanck smear
discrete, sm vesicles on Keratosis pilaris Contact Derm
erythematous base and chronic non bacterial follic pruritic, not systemic
lesions are in various inflamm Perianal candidiasis
stages, "crops" symmetrical on post-lat must culture to determine
*may develop into Impetego upper arms, ant thighs whether cellulitis or cand
d/t excoration and buttocks
Herpes Simplex friction areas
isolated distribution,
prodromall illness, postive
Tzanck test for multi-
nucleated giant cells
Pemph Vulg & B Pemph
more in elderly
Allergic Contact Derm
pruritis
v. specific border in area
of contact
impetigo second d/t
excoriation