Transcript Dermatology Board Review

 Infantile Hemangiomas
 Most common vascular tumor of
infancy
 10%
 More common in
 Caucasians
 Females
 Premature infants
 Placental abnormalities
 Location
 >50% head and neck
 25% trunk
 Rest on extremities
 Timing
 Several days to weeks after
delivery
 Infantile Hemangiomas
 Description
 Reddening or bluish
discoloration of skin
 Bright red nodule or plaque with
elevation
 Types
 Superficial (epidermal)
 “Strawberry” or bright red
 Well demarcated
 Elevated
 Soft compressible
 Few mm to 5cm
 Deep (dermis or subq fat)
 Bluish hue
 Indistinct borders
 Doughy consistency
 Enlarge when dependent
 Mixed
 Most hemangiomas
 Infantile Hemangiomas
 Course
 Grow and peak by 6-9
months
 Stabilization
 Involution
 10% per year
 Graying out of surface
 40% with residual skin
changes
 Telangiectasias
 Fibro-fatty tissue
 Hemangiomatosis
 Multiple hemangiomas
 Benign
 Limited to the skin
 Not benign
 Numerous small (<2cm), widely
dispersed cutaneous lesions
 Internal or visceral lesions
 Liver
 May have AV shunts and precipitate highoutput CHF
 6-12 weeks of age
 GI tract
 Bleeding
 CNS
 Mass effect
 Lungs
 When to worry?
 Lower face
 Lower lip, chin,
preauricular, neck
 “beard” distribution
 Airway involvement
 Midline lumbosacral
 Spinal dysraphism
 PHACES syndrome
 Posterior fossa malformations
 Hemangiomas
 Plaque-like segmental
hemangioma of the face
 May initially be confused with
port-wine stain
 Often ulcerate and proliferate
rapidly
 Arterial anomalies
 Carotid
 Cardiac defects
 Eye anomalies
 Sternal clefting
 Complications
 Periorbital and lid lesions
 Occlusion of the visual axis
 Corneal compression
 Must be treated
aggressively
 Amblyopia, strabismus,
astigmatism
 Lips, nose or ears
 High potential for
disfigurement
 High friction areas
 Ulceration
 Secondary infection
 Scarring
 Treatment
 Conservative management for most
 Lesions involving the airway or the eye
 Steroids
 Interferon
 Surgical intervention
 Common benign vascular tumors
 Overgrowth of granulation tissue
 Following minor trauma
 Foreign body
 Timing
 Well after the newborn period
 Location
 Usually face or extremity
 Description




Solitary bright red, soft nodules
Pedunculated
5-6mm
Friable surface
 Treatment
 Excision
 Electrodessication of the “feeder” vessels
 May recur
 Nevus Simplex
 AKA Salmon Patch or “Stork Bite”
 Capillary malformation
 Seen in majority of infants at birth
 Location
 Nape of neck
 Glabella
 Forehead
 Upper eyelids
 Lower back
 Course
 Fade with time
 More apparent when crying or straining
 Nevus Flammeus
 AKA Port-Wine stain
 Congenital capillary/venous
malformation
 Description
 Purple-red
 Location
 Unilaterally on face
 Course
 Do not enlarge or involute
 Sturge-Weber Syndrome
 Port wine stain
 Distribution of the trigeminal nerve
 Vascular malformations of the
ipsilateral leptomeninges and
cerebral cortex
 Glaucoma
 Other
 Seizures, MR, hemiplegia
 Klippel-Trenaunay Syndrome
 Port wine stain
 Over an extremity
 Hemihypertrophy
 Soft tissue and bony overgrowth
A new adolescent patient is seen in your office for a sports
physical. He points out a hairless, well-circumscribed,
yellowish waxy plaque located on his scalp. He says its
been there since birth but has recently become more
raised. He wants to know what it is?
A. Epidermal nevi
B. Congenital
nevomelanocytic nevi
C. Halo nevus
D. Nevus sebaceous
E. Ash-leaf spot
 Congenital Nevomelanocytic
Nevi
 Description
 Pigmented plaques often
associated with dense hair
growth
 Course
 Birth
 Tan or light pink with soft vellus
hairs
 Infancy and childhood
 Darkening with small dark
macules or nodules within the
plaque and prominent hair
 Congenital Nevomelanocytic
Nevi
 Size
 Small <1.5cm
 Medium 1.5-20cm
 Large or Giant >20cm
 Prognosis
 All have potential for malignant
transformation
 New, darker and/or bleeding
nodules
 Sudden growth
 1-4% small to medium
 10-30% Giant
 Congenital Nevomelanocytic Nevi
 Management
 Small to medium
 Yearly follow-up with derm
 Excision if atypical or difficult to monitor
 Giant
 Early, full thickness excision followed by grafting
OR
 Close observation every 6 months
 Acquired Nevomelanocytic Nevi
 Timing
 Early childhood
 Description
 Small, flat, pigmented macules
 1-2mm
 Location
 Sun-exposed areas
 Course
 Junctional nevi
 Limited to epidermal-dermal junction
 Compound nevi
 Papular or pedunculated
 Proliferation into the dermis
 Change slowly over months and only
warrant observation
 Acquired Nevomelanocytic
Nevi
 Halo nevus
 Hypopigmented or
depigmented ring associated
with mild local pruritus around
a benign nevus
 Caused by cytotoxic Tlymphocyte reaction
 Course
 Eventual resolution and nevus
disappears
 Childhood
 De novo
 Within giant congenital nevus or
other nevus
 Transplacental transfer
 Red Flags
 Change in size, shape or outline
 Scalloped, irregular borders
 Change in surface characteristics
 Small, dark, elevated papule or
nodule within a flat plaque
 Flaking, scaling, ulceration or
bleeding
 Change in color
 Different shade or to a mixture of red,
white or blue
 Development of burning, itching or
tenderness
 Blue nevus
 Small, firm, blue papule
 Deep nevus cells
 Traumatic hemorrhage
 Under the nails or in mucous
membranes
 Vascular lesions
 Pyogenic granuloma or
angiokeratoma
 Spitz nevus
 Red and rapidly growing nevus
 Composed of spindle and
epithelial cells
 Confused histologically with
melanoma
 Epidermal Nevi
 Epidermal structures only
 Timing
 Birth or childhood
 Description
 Slightly hyperpigmented
papillomatous or verrucous growth
 Increases in verrucous changes are
common at puberty
 Small and localized, linear,
dermatomal or generalized
 Other associations if extensive
 Seizures, MR, ocular and skeletal
defects, hypophosphatemic
vitamin D-resistant rickets
 Nevus sebaceous of Jadassohn
 Epidermal proliferation, abortive hair
follicles, sebaceous glands and apocrine
structures
 Timing
 Present at birth
 More verrucous, raised and nodular at
puberty
 Description
 Hairless, well-circumscribed, skin-colored
or yellowish waxy plaque
 Linear or round
 Location
 Scalp, face or neck
 Course
 Routine excision not recommended in
childhood
 Malignancy risk is low
 May excise in adolescence or adulthood