Epidermal New Growths

Diana Jean D. Del Rio, M.D. F.P.D.S

Seborrheic Keratosis Dermatofibroma

Multiple, oval, slightly raised, light brown to black,
sharply demarcated papules or plaques, rarely >3cm
in diameter
Nummular warty lesions often become crumbly, like
a crust that is loosely attached raw, moist base
Sites: chest, back, scalp, feet, neck and extremities,
genital area
A single round or ovoid papule or nodule about 1 cm
in diameter, with a reddish brown, sometimes
yellowish hue
Adherent to the overlying epidermis → dell-like
depression
Dimple sign
o Depression over dematofibroma when it
is grasped gently between the thumb and forefinger

(+) itching
Onset; fourth to fifth decade
Sites: lower extremities, above elbow, sides of trunk
Result from a local arrest of maturation of
Initiated by injuries to the skin, such as insect bites
keratinocytes that are normal in all aspects
or blunt trauma
Usually originate de novo but may involve from
Size: 4-20mm (>5cm)
lenitigines
Progressive enlargement to >2-3 cm suggest a
Increase in number when a patient is gaining weight
malignant fibrous histiocytoma or dermatofibroma
Sudden eruption of may seborrheic keratosis →
sarcoma protuberans
inflammatory cutaneous disorder such as exfoliative
dermatitis
Treatment and Prognosis:
Rarely, SCC and BCC may arise
Excisional biopsy
Spontaneous involution may occur
Sign of Leser-Trelat
Sudden appearance of numerous itchy seborrheic
Keloid and Hypertrophic Scar
keratoses in an adult may be a sign of internal
malignancy Both are usually caused by trauma
60%- adenocarcinoma (stomach) Firm irregularly-shaped thickened, hypertrophic
Others- lymphoma, breast, SCC of lung, melanoma fibrous, pink or red excrescence
Arises as a result of cut, laceration, burn or acne
Differential Diagnosis: pustule on the chest or upper back
Melanoma Keloid: spreads beyond the limits of original injury
Actinic keratosis often sending out claylike (cheloid) projections
Nevi Overlying epidermis is smooth, glossy and thinned
from pressure
Treatment: Early lesion: red, tender, rubbery, surrounded by an
Liquid nitrogen and curettage erythematous halo, may be telangiectatic
Liquid fulguration Chronic: brown, tender, painful, pruritic, hard and
stationary
Carbon dioxide laser
Electrocautery
This lesion is usually removed without any
Scarring

Achrochordon
“kuntil” is it’s Tagalog
term
Small, flesh colored to
Keloid usually grows beyond the original trauma. There are
dark-brown, pinhead
claw like projections. Skin is smooth, glossy and thin as seen in
sized and large, sessile
the picture. In a more chronic keloid, there is pain and
and pedunculated
tenderness on slight touch. The right picture is a scar after an
papillomas on the
ear piercing.
neck, axilla and eyelids
Trunk and groins: soft,
Differential Diagnosis:
pedunculated growths hangs on thin stalks
Hypertrophic scar
Onset 10-50 years old
o No clawlike projections and does not
Increase in number during pregnancy and weight
extend beyond the original wound
gain
o Spontaneous improvement during the
Appear to be more prevalent in those with colonic
first 6 months
polyps
It is usually electrocauterized at the stalk
Twisting of the stalk would create pain

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Epidermal New Growths
Diana Jean D. Del Rio, M.D. F.P.D.S
Hypertrophic Scar
Treatment:
Usually treated by the use of steroids
IL triamcinolone every 6-8 weeks
Flashlamp pulsed dye laser
Excision followed by IL
Silicone sheet
o you can put this on the scar and leave it
for 8 hours
Keratoacanthoma
4 types:
1. Solitary KA
2. Multiple KA
3. Eruptive KA
4. Keratoacanthoma centrifugum marginatum
Sunlight appears to play an important role in the
etiology
o So the sun exposed areas are the ones that are
affected
Isomorphic phenomenon may occur
o Isomorphic is also known as the lines of trauma
Muir-Torre Syndrome
Sebaceous tumors and KA occur in association with
multiple low grade malignancies
Solitary Keratoacanthoma
Rapidly growing papule that enlarges to as much as
25mm in 5-8 weeks
Hemispheric, dome shaped, skin colored nodule with
a smooth crater filled with a central keratin plug
Sites: central part of the face, back of hands, arms,
less frequent buttocks, thighs, penis, ears and scalp
Seen mostly in middle-aged and elderly
Solitary Keratoacanthoma
What is the difference between a keratoacanthoma and a
dermatofibroma? Keratoacanthoma has a scaly surface while
a dermatofibroma has a smooth surface.
KA centrifugum/KA centrigugum marginatum: may
have a nodule vegetative appearance some with
craterlike depression
Giant KA: more than 2 cm, on the nose and eyelid
Coral-reef KA: multiple lesion extend from the
original central lesion
KA dyskeratoticum et segregans: coalescing plaque
or nodules on the forehead
Subungual KA: tender with a destructive crater in the
center → bony destruction
Most interesting feature: rapid growth for 2-4
weeks, stationary period for 2-6 weeks and
spontaneous involution for 2-6 weeks → slightly
depressed scar
Multiple Keratoacanthoma (Ferguson Smith type of multiple
self-healing KA)
Identical clinically and histologically to the solitary
type
Generally only 3-10 lesions on one site
Sites: face, trunk, genitalia
Young men frequently affected
Eruptive Keratoacanthoma
Generalized eruption of multiple dome-shaped skin
colored papules, from 2-7mm in diameter
Spares the palms and soles
Severe pruritus in some patients plus bilateral
ectropion and narrowing of the oral aperture
Associated with higher incidence of
immunosuppresion (LE, leukemia, leprosy, kidney
transplant, photochemotherapy, thermal burn and
radiotherapy)
Keratoacanthoma Centrifugum Marginatum
Progressive peripheral expansion with concomitant
central healing leaving atrophy
Involving dorsum of hands and pretibial region
No tendency for spontaneous involution
Associated with central healing
Etiology of KA:
A variant of regressing SCC [squamous cell
carcinoma] (DDx)
Treatment:
Observation then perform a biopsy
Biopsy excision or curettage and fulguration of lesion
<2cm
IL injection of 5 FU
IL methotrexate (0.5-1ml of 25mg/ml) +IM
methotrexate
IL bleomycin
Oral and topical retinoids and cyclophosphamide:
large and recalcitrant lesions and eruptive forms
Radiotherapy: giant KA and subungual KA
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Epidermal New Growths
Diana Jean D. Del Rio, M.D. F.P.D.S

Epidermal Cyst (Keratin cyst, Sebaceous Cyst,

Epidermoid Cyst) Familial presenile sebaceous hyperplasia
Benign growth Extensive sebaceous hyperplasia on the face, neck
Movable if large and upper thorax with onset at puberty and worsen
with age
Central is shyny
Autosomal dominant
Fluctuant tense swelling
Surface of the skin is smooth and shiny from the
Treatment:
upward pressure
Electrodessication
Freely movable and attached to the normal skin
above them by the remains of the expanded gland Curettage
duct, the opening of which frequently shows a Shave biopsy
central point on the surface as a Lasers
comedo Isotretinoin
o Usually has a central blackhead
The pasty contents are formed of macerated keratin Syringoma
and cheesy, fatty material
Small
transluscent
yellowish,
brownish or
pinkish globoid
papules 1-3mm
in diameter that
develop slowly
and persists
without symptoms
Sites: more common on the eyelids and upper
cheeks, rarely on the axilla, abdomen, forehead and
penis and vulva
Sites: face, neck and trunk Familial patterns may occur
Penetrating injuries may result to epidermoid cysts Occur in 18% of adults with down’s syndrome,
growing within the bone especially females
It is a keratizing cyst lined by stratified squamous Histologic: dilated sweat ducts, some of which have
epithelium containing keratohyalin granules small comma-like tails resembling tadpoles
Probably represent adenomas of intradermal eccrine
Differential Diagnosis ducts
Pilar cyst
Lipoma Treatment:
o Involves subQ fat Electrodessication
Brachial cleft cyst Laser ablation
Nodular fibroma Cryotherapy

Treatment:
Excision
Enucleation

GOD bless!
Sebaceous Hyperplasia (Senile Sebaceous
Hyperplasia, Senile Sebaceous Adenoma)
Wart-like but with yellowish with a central
depression
Small, cream-colored or yellowish umbilicated
papules, 2-6 mm in diameter
Sites: face, forehead, infraorbital area, temples
Age of onset: >40 years old
Histologically: hypertrophied sebaceous glands,
multilobulated, each dividing into other lobules to
produce a cluster resembling a bunch of grapes

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