Dermatology - Common Lumps And Bumps

Front 1

An older, obese person with T2DM develops a skin coloured polyp in the skin folds of the neck. What is this?

Back 1

Fibroepithelial polyps - skin tags, acrochordon, benign squamous papilloma, soft fibroma.

Benign skin overgrowth, pedunculated soft fibroma, increase with age, commonest neck, axillae trunk, groin. No malignant potential.

Mx - leave or remove - snip off with scissors or bone forceps OR tie base with fine cotton or suture material OR diathermy OR apply liquid nitrogen

Front 2

A patient presents with this firm, fixed, fluctuant lump. What is it?

Back 2

Epidermoid (sebaceous) cyst - firm to soft regular lump, fixed to skin, moves with the skin, found in hair bearing skin mainly on scalp, contains sebaceous material, usually fluctuant, may be a central punctate, tendency to inflammation.

Mx - leave or surgical removal.

If infected - incise + drain purulent material, when inflammation is resolved, remove.

Front 3

A patient presents with a lump on their lip, which appeared post traumatically biting their lip. What is it?

Back 3

Mucocoele - form when mucus or saliva escapes into surrounding tissues and a lining of granulation or connective tissue is formed to create a smooth, soft round fluid-filled lump. They most commonly occur on the inner surface of the lower lip (75% ) but may also appear on the floor of the mouth, gums, buccal mucosa and tongue.

Mx- spontaneously resolve, or surgical removal

Front 4

A patient has a small suspicious mole removed from their leg, and returns for ROS, the wound looks like this. What is it?

Back 4

Keloid - hyperplastic scar that extends beyond the margins of the wound. Hypertrophic scars - lumpy scar caused by a nodular accumulation of thickened collagen fibres.

Firm, raised, red-purple, skin overgrowth, common ear, chin,neck,shoulder,trunk. Hereditary predisposition. Follows trauma, even minor.

Mx: prevention, compression, silicone dressings, intradermal steroid infection, +/- re-excision

Front 5

A child present with a skin coloured lump which has a rough surface on their knee. What is this condition?

Back 5

Warts - skin tumours caused by HPV, virus invades the skin, through a small abrasion, causes abnormal skin growth, transmitted by direct contact. More in children, adolescents. Occurs in all ethnicities, 50% resolve spontaneously in 6/12, 90% in 2yrs.

Mx - wart paints (salicyclic acid), cryotherapy, curettage, electrodesiccation, retinoids.

Front 6

A 5 year old child, living in a warm climate, appears with multiple lumps on their back after swimming in the local pool. What is this condition?

Back 6

Molluscum contagiosum - pox virus infection spread readily by direct contact, including sexual contact. Incubation period 2-26wks. Common in children, singles or multiple, shiny, round, pink-white papule, central punctum, spread by scratching. Mx - difficult to treat, avoid using bath, spontaneous resolution, cryo + dry dressing for 2/52, pricking the lesions, apply podophyllin or imiquimod, diathermy.

Front 7

A sheep handler presents with a single papule on his hand. What is this condition?

Back 7

Orf - viral infection of the skin, parapox virus, spread from sheep, presents as a single papule or group of papules on the hands. The papules change into pustular like nodules or bullae.

Mx - clears spontaneously in about 3-4 weeks without scarring and usually no treatment is necessary.

Front 8

1 week after handling cows, a farmers presents with multiple papules on the hands. What is this condition?

Back 8

Milkers nodules - pseudo cowpox - in humans 2-5 nodules appear on the hands about 1/52 post handling cows udders or calves mouths. Caused by a parapoxviurs. Papules enlarge to become tender, grey nodules with a necrotic centre and surrounding inflammation.

Mx: self limiting, spontaneous remission in 5-6wks without scarring. 1 infection = lifelong immunity

Front 9

A 40 year old presents with a new warty spot on their back. What is this lesion?

Back 9

Seborrhoeic kertosis - very common, variey of subtypes, increase >40yrs, well defined border, pitted surface, solitary or multiple, common on face and trunk, occurs anywhere, usually asymptomatic, causes patients alarm (?melanoma).

Mx: reassurance, excision for cosmetic reasons, cryotherapy decolors tumour, curette, laser, if dx uncertain excise for histopathology.

Front 10

A diabetic patient develops lumps on the sides of their fingers, they are firm papules in a string of pearls pattern. What is this condition?

Back 10

Granuloma annularae - common benign group of smooth discoloured plaques arranged in an annular fashion. Most common children, young adults, firm papules grouped in string of pearls pattern, dermal nodules, associated with minor trauma. Mx: screen for diabetes, reassurance, subside in 1 year or so, cosmetic reasons - topical steroid, intradermal steroid injection.

Front 11

A female presents with this firm nodule that is tethered to the skin on her lower legs. The skin dimples when pinching the nodule. What is this condition?

Back 11

Dermatofibroma - common pigmented nodule arising in the dermis, proliferation of fibroblasts, abnormal response to minor trauma including insect bites. Usually multiple, firm well circumscribed nodules, freely mobile over deeper structures. May itch, mainly women, mainly limbs, characteristic dimple sign on pinching margins.

Mx: reassurance, simple excision if requested.

Front 12

An elderly patient presents with this dry, rough, scale on her hand. What is this condition?

Back 12

Solar keratosis - reddened, adherent, scaly hyperkeratotic thickenings occurring on sun exposed areas. Potential for malignant change. Sun exposed fair skin, mainly face, ears, scalp, forearms, dorsum of hands, dry, rough, adherent scale, usually asymtpomatic.

Mx: reduce exposure to sun, disappear spontaneously, cryotherapy if superficial (if inflamed)

Front 13

Starts at the site of a minor injury to sun damaged and hair-bearing skin. Initially like a boil, but then grows rapidly and it may be up to 2cm in diameter. What is this?

Back 13

Keratoacanthoma - rapidly evolving tumours of keratinocytes, that occur singly on sun exposed areas. Low risk variant of SC. Raised crater with central keratin plug, grows 2cm or more, arises over a few weeks, remains static, then spontaneously disappears after about 4-6months, can leave a big scar. Confused with SCCs.

Mx: remove by excision, curettage, diathermy.

Front 14

An elderly patient presents with small, yellow bumps on his forehead, a central hair follicle with yellow lobules surrounding. What is this condition?

Back 14

Sebaceous hyperplasia - single or multiple nodules on the face, especially in older people. The nodules are small, yellow-pink, slightly umbilicated. Can be mistaken as BCCs.

Mx: no need for surgical excision, cryotherapy, or diathermy achieves good results.

Front 15

An elderly male, with fair skin and blue eyes, who has been a farmer for many years presents with this lesion on his face. What is this lesion?

Back 15

Basal cell carcinoma (BCC) - 80% of skin cancers

>35yrs, M>F, sun exposed areas, ulcerate easily, slow growing over years, stretching the skin demarcates the lesion, highlights pearliness and distinct margin, local spread is problem, can spread deeply if around nose, eye, ear. Various forms: nodular, pigmented, ulcerated.

Mx: elliptical excision, radiotherapy is an option, photodynamic therapy, cryotherapy, imiquimod

Front 16

An elderly man, who is a smoker, and has spent a lot of time outdoors, presents with this scaly, crusted lump on his lip, what is it?

Back 16

Squamous cell carcinoma (SCC) - malignant tumour of the epidermis, sun exposed areas, in fair skinned people, tends to arise in premalignant areas e.g. solar keratoses, burns, ulcers. >50yrs, firm thickening skin, surrounding erythema, ulcerates, everted edge, mets to LNs. SCCs lip + ear increased malignant potential.

Mx: early excision, refer if large.

Front 17

An elderly patient presents with irregular scaly plaques of up to several centimetres in diameter, on his ear.

What is this condition?

Back 17

Bowen disease - intra-epidermal carcinoma SCC in situ of the skin. Slowly enlarging demarcated, thickened, red plaque, esp on lower legs in females. Remains unchanged for months-years. May become very crusty and ulcerate, bleed. Potential for malignant change. Ddx: psoriasis, dermatitis, solar keratosis.

Mx: biopsy for dx, then wide surgical excision.

Front 18

What are the common causes of ear lumps?

Back 18

Solar keratosis

BCC

SCC - up to 17x ability to metastasis, early wedge resection.

Keratoacanthoma

Gouty tophi

Chondrodermatitis nodularis helicis

Front 19

An elderly man presents with a tender lump in the cartilaginous portion of his ear which has persisted for years. What is this condition?

Back 19

Chondrodermatitis nodularis helicis - benign lump, painful nodule on the most prominent part of the helix or antihelix of the ear. Caused by sun damage. It is tender and can affect sleep.

Mx: cryotherapy, intralesional steroid injection, sleep on alt ear may resolve, if fails wedge resection.

Front 20

A HIV infected patient presents with a purplish spots on the ankle. Initially, the lesion was small and painless but it then ulcerated and become painful. What is this condition?

Back 20

Kaposi sarcoma - tumour of vascular and lymphatic endothelium that is related to human herpes virus type 8. 3 types: classic form seen in elderly men of central/eastern europena origin, endemic form seen in males from central africa, immunosuppressed relative assoc with AIDs. Brownish-purple papules on skin/mucosa.

Mx: radiotherapy, immunotherapy or chemo.

Front 21

A middle age female presents with this lump on her back, it has been slowly getting bigger and feels soft, smooth and is easily moved. What is this?

Back 21

Lipoma - non-cancerous tumour that is made up of fat cells. It slowly grows under the skin in the subcutaneous tissue. A person may have a single lipoma or may have many lipomas. They are very common.Soft and may fluctuate, well defined, lobulated, rubbery, 1 or many, painless, most common on limbs. Ix: U/S

Mx: reassurance, removal for cosmetic reasons

Front 22

A patient presents with this firm, painless lump. What is the lump?

Back 22

Neurofibroma - benign tumours are firm, painless, s/c lumps often aligned lengthwise in the long axis of a limb in relation to peripheral nerves. More mobile from side-side along the long axis. Superficial neurofibromas are soft button-like tumours with no malignant potential.

Mx: excise if becomes large or painful.

Front 23

A patient presents with this firm, cystic lump in his wrist. What is the lump?

Back 23

Ganglion - firm cystic lumps associated with joints or tendon sheaths. Deep s/c lumps, mostly at wrists, fingers, feet. Immobile, fixed to deep tissues, translucent, contain viscid gelatinous fluid. May disappear spontaneously, recurrences are common.

Mx: wait and see, needle aspiration and steroid injection or surgical excision (can be difficult)