Ddx Chart Part 2

BENIGN NEOPLASMS Acrochordon Presentation

(skin tag) familial tendency M/C in Females and obese

Xanthoma cholesterol related lipid deposits occur in response to

Lipoma benign subcutaneous

axilla, neck

of lipid cells

develop after puberty

common epidermal tumor

incorrectly labelled as

occurs in ppl >50+yoa

abnorm lipid concn's

below mammary inguinal areas

eruptive: sddn, discrete,

Seb. Keratosis benign prolif of immature

orginate from hair follicle

or lipoprotein abnorms

Distribution

Pilar Cyst keratin filled cysts that

neoplasms, composed

subaceous cysts

keratinocytes

but also young adults

single or multiple

90% found on scalp

trunk, face, upper extrem's

benign subcutaneous

firm, mobile, keratin cysts

papules and plaques

yellow pap's with red halo, on extensor surfs and prssure sites tuberous: sm, soft, yellworg plaques, on elbows, knees, digits tendinous: firm, irreg, slow growing nodules, on achilles, ext. tendon of digits planar: palms, hands, or feet, periorbital

Lesions

soft papules

firm macules, papules,

and nodules

nodules or plaques

(Dx) pedunculated, on

(lipid deposits)

narrow stalks

orginate from epithel cells

keratin plug in centre

soft, rounded, or lobulated

neoplasms

of outer root sheath of

appear warty, well circumscribed

moveable against overlying

hair follicle

scaly and hyperpigmented

slow growth until stabilize

upclose have horns, cysts

site

and then rupture

or dark keratin plugs

inflammatory rxn follows (PAINFUL)

Colour

hyperpigmented or skin coloured

DDx

yellow-brown, pinkish or orange

secondary lesion is hyperpig and scale Nevus: no stuck on or warty appearance no scale Melanoma: not stuck on appearance assymmetry and blurring of borders of changing mole/skin Basal Cell CA: usually Hx of slowly chngng

IMAGE

lesns, with waxy apprnce dilated BV's and ulceratn to suspect BCC

PRE MALIGNANT NEOPLASMS Leukoplakia Presentation

Act. Keratosis

kertinization of muc. mem, premalignt lesions small white patches, occasnlly ulcerated

Keratoacanthoma "crateriform ulcers

M/C in white, fair haired ppl

of the face" epithelial tumours, suddn

Hairy lesion are keratin growths

onset, growing

Basal Cell CA malignancy of basal cells of epiderm

Squam Cell CA 2nd M/C skin CA malignant tumor of

M/C human malignancy

epithelial keratinocytes

M/C in men, whites, 40-80yrs

MC in males, white, 55 yrs

85% on head and neck

sun exposed areas

Melanoma malignant turmour from melanocytes

tongue, buccal mucosa

back, sh, face

sun exposed areas

sun explosed skin

(cheeks, nose, ears,

(face, dorsa of hands,

doras of hands,

and scalp)

Lesions

small white patches,

papules, plaques with

occasionally ulcerated.

secondary erythema,

secondary erythema

scale, and occasional hyperpigmentation

and crust dome shaped nodule

surface d/t keratin projctns

pigmented areas of skin and muc mems

multiple lesions

with central keratotic core

papule noduel translucnt

exposure

vary in sz, shape, shade

waxy or pearly border

indurated papule, plaque,

most commonly pigmented

nodule, tumor secondary:

TYPES:

pgmented- blue, blck round, oval, umbilicated

lesions assoc with tar "stinging" sensation, sharp, sticking

primary:

ulcer, often crusted pink/red, telagictasea

solitary, rapid growing noninvasive but get v. lrg px's complain of

tumor of lymphathic endothelial cells

identify AIDS

NOSE m/c site

forearms papules, nodules, tumor

Hairy lesion are raised, with corrugated or "hairy"

S's and Sx's

Kaposi's Sarcoma multifocal malig

linked to Herpes 8 sddn epidemic helped

in males, 50-70yoa

Distribution

erythema, scale, erosion, crust, ulcer

lentigo maligna superficial spreading

adenopathy may be presnt in larger lesions, esp in

nodular

flat, macular, red or indurated plaques central clearning irreg border

mouth locally invasive/aggrssve

extremely aggressive

but limited matastizising

biopsy needed

often fatal within months of recognition danger: change in assym, border, colour, diamter, elevation, enlargement …etc.

Dx

based on clin appearnce Hx of rapidly growing lesn & palpatn

excisional biopsy rules

papation is hard firm but

any slowly evolving,

cystic lesions may occur

isolated keratotis or

out Squ. Cell CA sun exposure

eroded papule or

d/t chronic sun exposure

some progress to Squ

and imm compromised

cell CA (not invasive

theory that HPV involved.

plaque in suspect px, that persists over a mnth

unless on lip)

DDx

Candida: K0H test req'd

Squ Cell CA: shave biopsy rules out Seb. Keratosis:

red, erythroplastic lesion when dry appr more

Squ. Cell CA

plaque or papule indurated slower growing and no

co-ixn common Oral Cancer

central karatotic plug

pigmented, "stuck on"

Squ. Cell CA no waxy, thready border or telagiectasia biopsy confirms Scar

of Sq Cell CA Basal Cell CA

Hx: trauma? Not umbilicatd waxy border more stable lesion

coin shaped, erythematous lesions with scaling

Eczema no pearly borders

biopsy needed to confirm Keratocanthoma

located on trunk and prox. extremeties

or telangiectasia erythmatous scaling plque

classic Hx of rapid grwth vs. squ. Cell CA

granular and slightly

lips and tongue

esp on trunk

can look v. sim if ulcerated

central keratotic plug

Frictional hyperker

dermal nevus (mole)

from surface trauma (dental appliances)

firm, flesh-coloured papule Actinic Keratosis that does not gradually not indurated enlarge

IMAGE

Eczema respnds to corticoster'ds induration is more indicate

no "stinging" Nummular Eczema

abraded Apthae (cankers) recurrent lesn's, usually ulcerated, usually affects

bopsy required

precursor to sq. cell CA

Bruise

DISORDERS OF BLOOD VESSELS Strawberry Nevus Vascular Malform Cherry Ang common bright Presentation capillary hemangioma "port wine stain" benign vasc prolif of endothelial lining apprs within 1st few

Spider Ang focal telengiec netwrk

Erythema Nodosum acute inflamm rxn pattern

Salmon Patch "stork bite"

(PWS)

red tiny spots

of dilated capillaries

in thin sheet of tissue

very common

present at birth, embryo

numerous

radiating from a central

(panniculus), around BV

present at birth

no regression!

dilated capillaries

arteriole

in septum CT and adjcnt

mature, dilated dermal

days or mnths of life

lined by flat endo

regress with time

fat of cut tissue

cells

M/C in females 15-30 yrs

capillaries that resolve spontaneously

arises from various ixn's

Distribution

post. neck, glabella, upper eyelids

unilat face, neck M/C

trunk, in middle age and elderly

usually solitary

post. neck, glabella, upper

trunks, legs, forarms

bilateral, not symmetrical

ie. women get on legs

predilection for lower legs,

eyelids

knees, arms rarely face

Lesions

more comm in whites soft bright-red/deep

irreg shaped, red,

nodular vascular

telangectasia of capilarries

bright red, later violaceous

violaceous, macular,

myriad of tiny red

network….

purple vascular nods

vascular formation of

spots stimulating

Spider like arrangement

or plaques

BV's of dermis

petechiae

Indurated

(broken BV's)

tender and warm to

with age, develop into papules or nods

bleed profusefly if

nodules: oval and arciform not sharply marginated

touch

ruptured.

S's and Sx's

Sturge-Weber Synd

Metastatic CAR

PWS involves opthalmic br of CV5 and assoc calcifications of brain eye mvment assoc

may be assoc with hyper estrogenic states

Nodular Melanoma biopsy req'd

(eg. Pregnancy, HRT, or chronic viral heptatitis,

fever, malaise arthraligia in 50% px's spontaneous redxn in 6 weeks

alcholic cirrhosis

with glaucoma

DDx

Erysipelas no nodules, unilateral

Image

DDx

macule with irreg borders

CUTANEOUS BACTERIAL INFECTIONS Impetigo Presentation scabby eruption that attacks!

Folliculitis

Abscess

variety of pustular ixn

circumbscribed

of hair follicle/skin

Erysipelas acute well demarcated

mass of several

ixn of suprfcial layrs

acute or chron

interconnctd infected hair

of skin & assoc cut

superficial skin ixn M/C in

localized ixn

follicles, with formation of

aneous lymphatics

destructs assoc

CT

Streptococcus Ixn

preschool children and teens

follculitis

Carbuncle very painful, deep pyogenic

contagious, acute, purulent d/t bacterial, fungal, viral, syphilitic ixn

collctn of pus,

Furuncle evolves from bacterial

tissue

Cellulitis deeper ixn than erysipelas into dermis and subcut aneous tissue

also S. Aureus

S. Aureus & BH Strep

M/C in infants/child

involved

Distribution

face, arms, legs but can be anywhere

M/C on sites of friction (ie. buttocks) can also occur on hair bearing areas

Lesions

primary:

primary:

vesicles, pustules

nodule, pustule, pierced by

secondary:

a hair

honey crusted, erythema

secondary:

and erosions

erythema, eduma, exudate, draining sinuses

S's and Sx's

dermis,

pst neck, areas with beard

sites of chronic edema

subcut fat,

scalp, axillae, buttocks…

old scars, extremities,

muscle or deeper

face

structures starts as tender

nodule or abscess

nodule, later fills firm, red, not, tender with pus

several adjacent coalescing

primary:

furruncles???

erythema, edema, pain

necrotic plug at centre,

regional lymphadenopathy

nodule flucturates with

secondary:

abscess formation

marginated erythema,

underneath the plug,

eduma, vesicles, bullae,

covered by a pustule.

and cut hemorrhage

adenopathy may be presnt

After rupture or drainage

itching

of pus and plug, a nodule extremely tender

throbbing pain

from mild to severe:

scratching spreads ixn

with cavatation remains

chills, headache, fever,

low grade fever, malaise prostration

Dx

finding young child with

systemic signs range

tachycardia & hypotension made from clinical findings

honey coloured crusts

DDx

Tinea

Tinea barbae

Herpes Zoster

central clearng & KOH+

fungal, highly inflamed

pain precedes onset of HZ

Varicella (pox) discrete, sm vesicles on erythematous base and lesions are in various stages, "crops" *may develop into Impetego d/t excoration Herpes Simplex isolated distribution, prodromall illness, postive Tzanck test for multinucleated giant cells Pemph Vulg & B Pemph more in elderly Allergic Contact Derm pruritis v. specific border in area of contact impetigo second d/t excoriation

KOH+

Tzanck smear

Keratosis pilaris

Contact Derm

chronic non bacterial follic

pruritic, not systemic

inflamm

Perianal candidiasis

symmetrical on post-lat

must culture to determine

upper arms, ant thighs

whether cellulitis or cand

and buttocks friction areas