Family physicians at short interva...

Family physicians at short intervals encounter patients with dermatologic diseases, either as the primary complaint or as a "by the way." Therefore, the ability to accurately diagnose and treat benign skin lesions is an important skill that family physicians should posses Options for evaluating patients with benign skin tumors can be categorized according to the morphologic characteristics of each lesion: macular or slightly raised/papular (Figure 1) papular (Figure 2) or subepidermal (Figure 3)

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Cherry Angioma (Campbell de Morgan's spot)

Cherry angiomas are acquired vascular lesions that come into one's head in up to 50 percent of adults. (1) The lesions guard to appear most often onward the trunk and extremities and can be up to several millimeters in diameter. They are globular bright to dark red, nonblanching vascular papules (Figure 4) Cherry angiomas first meet the eye in early adulthood and increase in number with age. They are asymptomatic and have no reported clinical consequences

Cherry angiomas are compos of dilated capillaries and postcapillary venule The etiology is unknown; however, eruption of multiple lesions following front to various chemicals, including mustard gas (2) and 2-butoxyethanol, (3) has been reported. Hormones also may be an etiologic factor; near pregnant women develop lesions that involute after delivery, and couple women with elevated prolactin of the same heights were reported to have disentangleed hundreds of lesions. (4)

Cherry angiomas are treated for cosmesis. Options include laser treatment, electrodesiccation of typical lesions, and excision of larger lesions. Cryotherapy is not effective.

Sebaceous Hyperplasia (Senile Hyperplasia)

Sebaceous hyperplasia is universal in middle-aged and elderly parts In patients with rare familial forms, the condition begins during puberty. Sebaceous hyperplasia consists of easily moulded yellow, dome-shaped papules, some of which are centrally umbilicated (Figure 5) (5) Commonly occurring forward the forehead, cheeks, and nose, in the greatest degree lesions are 2 to 4 mm in diameter, further have been documented up to 5 cm in size. (6) Sebaceous hyperplasia also can flash on the mind on the vulva. Except for cosmesis, the condition has no clinical significance; however, the lesions are sometimes confused with early basal enclosed space carcinomas. With its characteristic mosaic appearance, the surface of sebaceous hyperplasia is generally les uniform than that of basal small cavity carcinomas.

Histologically, sebaceous hyperplasia consists of enlarged lobule of mature sebaceous glands with a central dilated channel Although the etiology is unknown, solid organ transplant recipients taking cyclosporine (Sandimmune) (7) and patients receiving hemodialysis are at increased risk.

Treatment options for sebaceous hyperplasia include electrodesiccation, (5) laser therapy, and topical bichloracetic acid. (8) Oral isotretinoin (Accutane) has prov effective for patients with diffuse multiple lesions. (9) Use of curettage is limited because of scarring. Biopsy may be necessary if there is matter that the lesion is a basal small cavity carcinoma.

Lipoma

Lipomas are the most numerous common subcutaneous soft-tissue tumors, with an estimated annual incidence of common per 1,000 persons. (10) While lipomas are not a tumor of the skin, for practical reasons they are addressed here. Compos of adipocytes, lipomas are generally slow-growing nodules with a firm, rubbery consistency. While about 80 percent of lipomas are les than 5 cm in diameter, (10) near can reach more than 20 cm (11) and weigh several kg chiefly such tumors are asymptomatic on the other hand can cause pain when they compres mights Lipomas tend to occur upon the trunk, shoulders, posterior neck and axillae, although almost all subcutaneous locations have been reported. (12) Solitary lesions are seen about 80 percent of the time, while multiple lesions are in the greatest degree common in young men. (10)

Although the etiology is uncertain, solitary lipomas are associated with rearrangements of chromosome 12 (13) Lipomas can appear following trauma, (14) moreover it is uncertain whether the trauma is causative or if discovery of the lipoma is incidental.

Lipomas are not remov unles there is trouble for cosmesis, compression of surrounding compositions or if the diagnosis is uncertain. Tumors that have characteristics consistent with a malignant liposarcoma include those that are greater than 5 cm in diameter, located forward the thigh, deep (beneath or fixed to superficial fascia), and exhibit malignant behavior (rapid produce or invasion into nerve or bone) (1015) like tumors should be evaluated radiographically, including plain films and comput tomography or magnetic resonance imaging, before excision is performed. (16) Because lipomas generally do not infiltrate into surrounding tissue, they can be shelled on the outside easily during excision.

An alternative to standard excision is to manually oppress the lipoma through a small incision created with a scalpel or 4-mm push (Figures 6 through 8). (17) This technique is especially useful in areas with thin dermis, like as the face and extremities. Liposuction-assisted lipectomy, usually performed by means of a subspecialist, can be prosperous in removing even large lipomas with minimal scarring. (11)