Benign Skin Lesions

Front 1

Ephelids (Melanocytic Lesions)

Back 1

Freckles

Lighten in winter and darken in summer

Increased pigment at basal layer

Front 2

Melasma (Melanocytic Lesions)

Back 2

Mask of pregnancy

Diffuse patchy pigment on face

Pigment in epidermis and/or dermis

Hormonal.

Front 3

Vitiligo (Melanocytic Lesions)

Back 3

White patches

Complete loss of pigment

Loss of melanocytes and pigment

Front 4

Albinism (Melanocytic Lesions)

Back 4

Absence of pigment in skin, hair, and nails

Autosomal recessive

Loss of pigment with normal appearing melanocytes

Front 5

Mongolian Spot (Melanocytic Lesions)

Back 5

Bluish-gray lumbosacral patch in newborns

More common in pigmented races

Resolves in early childhood (Present in neonates and then fades clinically).

Sparse deep dendritic melanocytes (in dermis)

Front 6

Cafe au Lait (Melanocytic Lesions)

Back 6

Light brown patches

6 or more 0.5 cm in child --> neurofibromatosis

6 or more 1.5 cm in adolescence --> neurofibromatosis

Increased pigment in basal layer

Front 7

Lentigo (Melanocytic Nevus)

Back 7

Macular pigmented lesions on sun exposed skin

Indication of photodamage

Microscopic:

Increased melanocytes at Dermal-Epidermal (DE) junction without nest formation.

Front 8

Junctional Nevus (Melanocytic Nevus)

Back 8

Macular pigmented lesion

Microscopic:

Nests of melanocytes along the DE junction

Front 9

Compound Nevus (Melanocytic Nevus)

Back 9

Slightly raised pigmented plaque

(Macular and Papular lesions clinically)

Microscopic:

Nests of melanocytes at DE junction and within the dermis

Front 10

Intradermal Nevus (Melanocytic Nevus)

Back 10

Papular lesions

Microscopic:

Nests of melanocytes within the dermis

Front 11

Spitz's Nevus (Melanocytic Nevus)

Back 11

Papular regions of children

Histologically "benign juvenile melanoma" -- NOT!

Microscopic:

Epitheliod and spindle cell melanocytes can look atypical

Nests often vertically oriented

(Often confused with melanoma)

Front 12

Blue Nevus (Melanocytic Nevus)

Back 12

Bluish papule or macule

Deeper melanin appears blue due to Rayleigh scattering

Microscopic:

Heavily melanized dendritic melanocytes within the mid to deep dermis

Front 13

Halo Nevus (Melanocytic Nevus)

Back 13

Depigmented zone around a nevus

Common (okay) in children
Bad in elderly

Microscopic:

Lymphocytes surround benign nests of melanocytes

Front 14

Congenital Nevus

Back 14

Large "bathing trunk nevus" has increased risk of melanoma

Small form not strongly associated with melanoma

Microscopic:

Benign melanocytes extend more deeply into dermis and even subcutaneous tissues.

Front 15

Dysplastic Nevus (Melanocytic Nevus)

Back 15

Larger irregular morphology (often larder than most moles -- can be confused with melanoma)

Heritable Melanoma Syndrome (sparse and low risk)

Controversial Diagnosis (could be atypical nevus or Clark's nevus)

Microscopic:

Atypical melanocytes (in junctional nests with disordered organization)

Nests steam horizontally

Severely atypical treated as melanoma in situ

Front 16

Nevus

Back 16

Slightly irregularity of border and color

Dermoscopy reveals a fine reticular pigment network without atypical features.

Front 17

Actinic Keratosis

Back 17

Scaly/hyperkeratotic lesions on sun exposed skin--(hard and spiny feel it)

Considered pre-cancerous, but only about 1% evolve to SCC.

Microscopic:

Atypical keratinocytes in lower epidermis

Underlying solar elastosis (bluish dermis)

Overlying parakeratosis (retained nuclei)

Treatment:

cryogenic surgery (liquid nitrogen)

fluorouracil cream

Front 18

Seborrheic Keratosis (treatment is unnecessary, they just look gross)

Back 18

Appear as one gets older -- most commonly in elderly

Can show in younger if there is a strong genetic tendency in family

Stuck on lesions -- keratotic with varying shades of brown, but can be skin colored or even erythematous

Can be rough or smooth surface and be large or small

May have keratotic pores or pseudocysts

Sometimes inflamed or bleeding from picking

Not limited to sun exposed surfaces

(Feel "velvety" when compared to actinic keratosis)

Microscopic:

Epidermal hyperplasia
Orthokeratosis (no retained nuclei)
Horn pseudocysts -- cysts connect to the surface like this

Front 19

Acanthosis Nigricans (need to treat the internal disease or obesity)

Back 19

Most common in obesity but rarely associated with internal tumors (or diabetes, auto-immune diseases, familial, and medication reactions)

Clinically velvety brown plaques -- usually in the axillae.

(Sometimes associated with skin tags-acrochordons)

Microscopic:

papillomatosis and orthokeratosis

Front 20

Fibroepithelial Polyps

Back 20

Also known as acrochordons

Skin tags

More common in obesity involving neck, axillae, and groin areas.

Can be associated with Acanthosis Nigricans.

Microscopic:

epidermis covering an polypoid fibrovascular core


Can be treated with cyrogenics

Front 21

Epidermoid Cysts

Back 21

Sometimes referred to as "sebaceous cysts"--NOT!

Expansion of hair follicle forms epithelial lining. Also forms EICs from trauma

Pilar cysts has trichilemmal keratinization arises from the lower region of the hair follicle

Acne cyst results from follicular rupture

Front 22

Sebaceous Hyperplasia

Back 22

Common in middle and elderly men.

Umbilicated pale yellowish papules

Benign tumor of sebaceous glands

Front 23

Syringoma

Back 23

Seen under the eyes of women

Small skin colored papules

Benign tumor of eccrine sweat glands

Front 24

Nevus Sebaceous

Back 24

Birthmark lacking hair when on scalp

Prepubertal may appear smooth yellow/orange

Adolescent has cobblestone surface

Adult form in prone to basal cell carcinoma.

Front 25

Adenoma Sebaceum

Back 25

Central facial papules

One manifestation of Tuberous Sclerosis

Angiofibromas, histologically.

Front 26

Neurofibroma

Back 26

Von Recklinghausen's

Solitary lesion more commonly

Spindle cell tumor of Schwann cells and fibroblasts

Front 27

Xanthelasma

Back 27

Yellowish plaques on eyelids

Not strongly associated with increased lipids -- other xanthomas associated with increased lipids (associated with lipid disorders)

Foamy histiocytes contain the lipid.

Front 28

Trichilemmona

Back 28

Indicative of Cowden Syndrome/ Breast Carcinoma

Front 29

Sebaceous Adenoma

Back 29

Multi-Torre Syndrome/mult CA

Front 30

Dermatofibroma

Back 30

Common in the legs of women, most common growth in the knee in young adults, may arise from former arthropod bite

Brownish papule with "dimple sign"

Benign fibrohistiocytic tumor

Microscopic:

bland fibrohistiocystic dermal proliferation; histiocytes may contain hemosiderin pigment from ingestion of hemoglobin

Front 31

Keratoacanthoma (GET RID OF THIS)

Back 31

Rapidly growing "volcanoe-like" lesion with keratin center

Sometimes resolve spontaneously

Rare metastasis -- take it out immediately?

Resembles squamous cell carcinoma histologically

Microscopic:

Glassy well differenciated keratinocytes form a cup-like depression

Front 32

Angiomas (Mesenchymal Tumors)

Back 32

Capillary blood vessels in the dermis

Cherry angiomas most common

Strawberry angiomas in children often resolve spontaneously

Pyogenic granuloma is a traumatic variant

Port wine stains are very common in the form of a "stork bite" on posterior neck

Venous lakes occur on lips and ears

Telangiectasia of face is more commonly due to sun damage than rosacea

Front 33

Keloid (Tumor-Like Lesions)

Back 33

Hypertrophic scars that extend beyond initial injury

More common in African-American

Microscopic:

broad bands of collagen

Can be treated with corticosteroids

Front 34

Lipoma (Mesenchymal Tumors)

Back 34

Expanded fat lobules below the dermis encapsulated within a thin fibrous capsule

Soft mobile subcutaneous mass

Solitary or multiple

Stable size

When tender = angiolipoma

Front 35

Verruca (Warts)

Back 35

Verruca -- common warts; seeds = microhemorrhage

Plantar warts -- common warts "pounded inward"

Verruca plana -- flat warts

Condyloma accuminatum -- gential, STD, HPV 6, 11 most common

Molluscum Contagiosum -- pox virus, not HPV -- children and STD in adults

Mosaic warts -- extensive plantar involvement

Front 36

Heritable Melanoma Syndrome (Melanocytic Nevus)

Back 36

Associated with Dysplastic Nevus

But actually:

100 nevi, large and irregular

Associated of family history