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DermNet NZ


Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



Dermal & subcutaneous lesions

Learning objectives
Vascular tumours
Neural tumours
Fibrous tumours
Metastatic tumours
Miscellaneous tumours
Activity

Learning objectives

Vascular tumours

Angiokeratoma

Angiokeratoma is a scaly vascular papule due to epidermal proliferation encircling dilated vessels. Angiokeratoma may be solitary or diffuse. Diffuse lesions may be genital (Fordyce), acral (Mibelli) or rarely, generalised (Fabry's disease: deficiency of ceramide trihexosidase resulting in deposition of glycosphingolipids).

angiokeratoma
Solitary angiokeratoma
angiokeratoma
Scrotal angiokeratoma
Fordyce
angiokeratoma
Vulval angiokeratoma
angiokeratoma
Diffuse angiokeratoma
Mibelli ©R Suhonen
Angiokeratoma

Pyogenic granuloma

Pyogenic granulomas are formed of granulation tissue (vascular proliferation with inflammatory infiltrate). There is a characteristic collarette of skin around a juicy or friable red nodule that bleeds easily. Pyogenic granulomas may be due to minor trauma plus Staphylococcal infection. They are particularly common on lips and fingers, and during pregnancy and childhood.

Pyogenic granuloma
©R Suhonen
Pyogenic granuloma Pyogenic granuloma Pyogenic granuloma
Pyogenic granuloma

Cherry angioma

Cherry angiomas are extremely common benign red, blue, purple or almost black lesions occurring in middle age on the trunk. They can readily be distinguished from melanocytic lesions by dermoscopy, which shows red, blue or purple lacunes. Occasionally they become thrombosed and may fall off or persist as a firm bluish papule.

Cherry angioma Cherry angioma Cherry angioma Cherry angioma
Cherry angiomas: clinical and dermoscopic images
Cherry angioma Cherry angioma Cherry angioma
Thrombosed cherry angiomas: clinical and dermoscopic images

Glomus tumour
Glomus tumor presents most often as a painful subungual papule.

Glomus tumour
Glomus tumour
©R Suhonen

Malignant vascular lesions

Angiosarcoma usually arises on the head and neck, or arise in areas of chronic lymphoedema. It presents as an advancing area of purpura and ecchymosis, usually in an elderly person. Prognosis is poor as the tumour is often multifocal so difficult to excise, and only partially sensitive to radiation.

Kaposi sarcoma (KS) is a low grade vascular malignancy related to human herpesvirus 8. There are four types.

Angiosarcoma
Angiosarcoma
Angiosarcoma
Angiosarcoma
Kaposi sarcoma
Kaposi sarcoma

Acquired telangiectasia

Acquired telangiectasia is common and affects vessels of various size. Some examples are illustrated.

Spider naevus
Spider naevus
Rosacea
Rosacea
Acquired telangiectatic naevus
Acquired telangiectatic naevus
Systemic sclerosis (CRST syndrome): telangiectasia
Systemic sclerosis (CRST syndrome)
Hereditary telangiectasia (Osler-Rendu-Weber)
Hereditary telangiectasia (Osler-Rendu-Weber)
©R Suhonen
Hereditary telangiectasia
Hereditary telangiectasia
Benign hereditary telangiectasia
Benign hereditary telangiectasia
Telangiectasia eruptiva macularis perstans (mastocytosis)
Telangiectasia eruptiva macularis perstans (mastocytosis)
Oestrogen-induced telangiectasia during pregnancy
Oestrogen-induced telangiectasia (pregnancy)
Essential telangiectasia
Essential telangiectasia
Telangiectasia due to potent topical steroids
Telangiectasia due to potent topical steroids
Thread veins / venulectasia
Thread veins / venulectasia (venous disease)
Photodamage: telangiectasia
Photodamage
Basal cell carcinoma
Basal cell carcinoma
Venous lake
Venous lake
Telangiectasia of unknown origin
Telangiectasia of unknown origin

Acquired lymphangiectasia

Acquired lymphangiectasia usually follows lymph node dissection, or traumatic injury interrupting lymphatic drainage, usually in the axilla or genital area. Frogspawn-like clear or haemorrhagic papules develop some time later and tend to cause distressing ooze.

Acquired lymphangiectasia Acquired lymphangiectasia Acquired lymphangiectasia
Acquired lymphangiectasia following lymph node clearance for cancer

Neural tumours

Neurofibroma

Neurofibromas are spindle cell tumours and present as soft to firm, single or multiple dermal nodules that may be pedunculated. Sometimes it is possible to invaginate the lesions because there is a defect in the dermis. There are diffuse, pigmented and plexiform variants. Plexiform neurofibroma is pathognomonic of NF1 neurofibromatosis; these may rarely undergo malignant transformation. Neurofibromatosis may also present with café au lait macules (>6), which are present at birth; axillary freckling; and other types of cutaneous neurofibroma, which arise later in childhood and adult life.

Neurofibroma Neurofibroma Neurofibroma
Neurofibroma Neurofibroma Neurofibroma
Neurofibromatosis

Other neural tumours include neurilemmoma, neuroma, granular cell tumour and neurofibrosarcoma (malignant schwannoma).

Merkel cell carcinoma

Merkel cell carcinoma (primary neuroendocrine carcinoma of the skin) is rare. It presents as a rapidly growing violaceous nodule that can ulcerate. It frequently recurs after excision; distant metastases develop in about 40% and 30% die of their disease within 5 years.

Merkel cell carcinoma
Merkel cell carcinoma

Fibrous tumours

Dermatofibroma

Dermatofibromas (histiocytomas) are common firm dermal papules caused by a proliferation of fibroblasts. They often follow insect bites, so most frequently arise on lower legs. They dimple on lateral compression.

Dermatofibroma Dermatofibroma
Dermatofibroma

Scar

Keloids are scars with excessive bands of collagen.

Keloid
Traumatic keloid
Keloid
Keloid due to burns
Keloid
Surgical keloid
Keloids

Angiofibroma

A solitary angiofibroma may also be called fibrous papule or perifollicular fibroma. These are very common the nose and look like intradermal naevi. They can be removed by shave excision or electrodessication. Multiple angiofibromas around the nose and cheeks are associated with tuberous sclerosis, which appear during childhood and become increasingly prominent. These patients may also have periungual fibromas.

Fibrous papule
Fibrous papule of nose
Angiofibroma
Early lesions
tuberous sclerosis
Angiofibromatosis
Pronounced lesions
tuberous sclerosis
Fibroma
Periungual fibromas
Angiofibromas

Acrochordon

Skin tags are pedunculated papillomas filled with loose collagen.

Skin tag Skin tag
Skin tags

Other fibrous lesions include:

Infantile digital fibromatosis
Infantile digital fibromatosis

Metastatic tumours

Cutaneous lesions due to distant primaries are most often due to:

Adenocarcinoma
Adenocarcinoma

Miscellaneous tumours

Lipoma

Lipomas are very common. They are due to a proliferation of adipose tissue and present as solitary or multiple asymptomatic soft subcutaneous nodules. Multiple lesions are seen in association with various syndromes and may be familial.

Lipoma Lipoma
Lipomas

Leiomyoma

Leiomyoma includes multiple piloleiomyomas, genital leiomyoma and angioleiomyoma. They usually present in young adults and may be painful.

Leiomyoma
Piloleimyomas

Uncommon skin tumours include:

Activity

Look for the skin lesions described in this section in the next twenty or so patients you see.

 

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Author: Clin Assoc Prof Amanda Oakley

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