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Benign Skin Lesions Module - PPSX
Benign Skin Lesions Module - PPSX
Case One
A 42-year-old white male presents with a new mole on his back, first noticed by his wife 4 months ago. The lesion sometimes itches and it bled once after getting caught on his shirt. Doc, do I have skin cancer?
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Seborrheic keratosis
Seborrheic keratosis Benign superficial (epidermal) growth Common after age 30 Can arise on all body surfaces except palms and soles
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Seborrheic Keratoses
Color can vary from black to tan to white to pink Texture can vary from velvety to verrucous (wartlike)
Verrucous, tan
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Seborrheic keratoses
Though harmless, SKs can occasionally become irritated or can be cosmetically bothersome When necessary, SKs may be curetted, lightly frozen or electrodessicated If picked off or curetted, SKs will leave a pink moist base with minimal bleeding
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Seborrheic keratoses
This SK has been partially picked off
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This woman had SKs frozen off and now has permanent dyspigmentation
Even with electrodessication, a test spot is in order to determine how the patient is likely to react
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Case Two
Doc, these moles keep getting caught on my necklaces. Can you remove them?
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Occasionally skin tags will outgrow their blood supply or become torsed such that they necrose and fall off on their own
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Case Three
A 45-year-old white male presents with a red mole which appeared 6 months ago and has increased in size. It is not tender and has not bled.
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Cherry angiomas
Cherry angioma Majority of people get these starting around age 30 Highest concentration on the trunk
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Traumatized cherry
Occasionally cherry angiomas may bleed or thrombose, thereby mimicking melanoma When in doubt, cut (or refer) it out
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Case Four
A 24-year-old female reports developing a new growth on her leg 6 months ago. She sometimes nicks it when shaving. Its gotten darker around the edges over the past few months. On palpation, you notice that it feels firm, like scar tissue.
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Dermatofibroma
Dermatofibroma This benign spindle cell dermal proliferation looks like wad of scar tissue under the microscope hmm, just like it feels Firm, scar-like texture, in combination with history, is the give-away clue to diagnosis Peripheral rim of darkening pigment is common
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Dermatofibroma
If you pinch on either side of a dermatofibroma, it tends to dimple down due to that scar-like tethering of the dermis - the dimple sign
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Case Five
A 65-year-old woman complains of ugly brown spots on her face and dorsal hands which she feels makes her look old
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Solar Lentigines
Although no treatment is required, there are a variety of cosmetic treatments available (bleaching creams, liquid nitrogen, chemical peels, lasers) The first step is always sun protection
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Doc, how can I tell the difference between one of these lentigines and melanoma?
Look for the ugly duckling Consider biopsy or referral to a dermatologist for any lesion that stands out as different Recall the ABCDEs
Asymmetry Border (irregular) Color (multiple, variegated) Diameter (>6mm) Evolving
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Case Six
A 57-year-old female presents with numerous, asymptomatic bumps on her face, slowly arising over the past 5 years
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Skin Exam
How would you describe these lesions?
a) Erythematous eczematous plaques b) Erythematous edematous plaques c) Pigmented waxy papules d) Skin-colored smooth papules
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Skin Exam
How would you describe these lesions?
a) Erythematous eczematous plaques b) Erythematous edematous plaques c) Pigmented waxy papules d) Skin-colored smooth papules
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Diagnosis
You observe numerous skin-colored or slightly yellow, umbilicated (i.e. have a central dell) papules on forehead and central face. What is the diagnosis?
a) b) c) d) Basal cell carcinomas Nevi Sebaceous hyperplasia Seborrheic keratoses
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Diagnosis
You observe numerous skin-colored or slightly yellow, umbilicated (i.e. have a central dell) papules on forehead and central face. What is the diagnosis?
a) b) c) d) Basal cell carcinomas Nevi Sebaceous hyperplasia Seborrheic keratoses
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Sebaceous hyperplasia
Sebaceous hyperplasia Sebaceous gland (i.e. oil gland) overgrowth
Hence the yellow color Umbilication due to gland growth around a central hair follicle
Case Seven
A healthy 24-year-old African American male presents with an itchy, firm growth on the shoulder, which arose (gradually increasing in size) over several months after receiving the smallpox vaccine at this site
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Keloids
Keloid: overgrowth of scar tissue beyond the original scar site Genetic influence (most common in AfricanAmericans), also more common on upper trunk and earlobes
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Keloids
Can be itchy or tender Can be cosmetically disfiguring Doc, cant you please just cut this off?
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Keloids
Excision alone is a bad idea!
Expect the keloid to recur, even larger
Case Eight
A 35-year-old male presents with a 1.5 cm nodule on the upper back and the chief complaint, Doc, my wife keeps trying to pop this sebaceous cyst, but it just refills with nastysmelling white material.
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Case Nine
Doc, this white bump on my cheek came up a few months ago and wont go away. Is it cancer?
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Diagnosis
Milia = tiny epidermoid cyst Often on the face and therefore cosmetic concern
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Case Ten
Doc, my wife says Im growing horns. What are these things? Slowly enlarging over months to years Firm, mobile subcutaneous nodules, lacking punctum Do not discharge any material
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Pilar cysts
Pilar cysts Compared to an EIC, less likely to rupture or get inflamed Nearly always on the scalp
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Case Eleven
This lump has been slowly enlarging for years. It doesnt bother me, but my wife wants it checked out. You palpate a mobile, soft, subcutaneous nodule, lacking any overlying skin change On exam, he has a few other similar soft to rubbery mobile subcutaneous nodules on his arms and legs
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Lipoma
Texture is your clue lipomas feel like what they arecollections of fat under the skin Growth usually stabilizes at a few cm diameter
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Lipoma
Often solitary, frequently on the trunk and proximal extremities When familial (autosomal dominant), lipomas tend to be multiple and begin in early adulthood Occasionally lipomas can be tender
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Acknowledgements
This module was developed by the American Academy of Dermatology Medical Student Core Curriculum Workgroup from 2008-2012. Primary author: Rebecca B. Luria, MD, FAAD. Peer reviewers: Susan K. Ailor, MD, FAAD; Jennifer Swearingen, MD, Timothy G. Berger, MD, FAAD. Revisions: Rebecca B. Luria, MD, FAAD; Sarah D. Cipriano, MD, MPH. Last revised August 2011.
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Suggested Readings/References
Berger T, Hong J, Saeed S, Colaco S, Tsang M, Kasper R. The Web-Based Illustrated Clinical Dermatology Glossary. MedEdPORTAL; 2007. Available from: www.mededportal.org/publication/462. Habif TP. Clinical Dermatology: a color guide to diagnosis and therapy, 4th ed. New York, NY: Mosby; 2004. Wolff K, Goldsmith LA, Katz SI, Gilchrest B, Paller AS, Leffell DJ: Fitzpatrick's Dermatology in General Medicine, 7th ed. New York, McGraw-Hill; 2008. Marks, JG., Miller, JJ. Lookingbill and Marks' principles of dermatology. Philadelphia, PA: Saunders Elsevier; 2006. Frankel DH Field Guide to Clinical Dermatology. 2nd ed. Philadelphia, PA : Lippincott Williams & Wilkins; 2006. 88