EPIDERMAL NEW GROWTH DERMATOLOGY

Seborrheic Keratosis
• Multiple, oval, slightly raised, light brown to
black, sharply demarcated papules or plaques,
rarely 3cm in diameter (on the surface it is covered by crusting ; scrape the
surface leaves a moist base)
• Nummular warty lesions often become crumbly,
like a crust that is loosely attached raw, moist
base
• Sites: chest, back, scalp, feet, neck and
extremities, genital area

Onset 10-50 years old

• Increase in number during pregnancy and
weight gain
• Appear to be more prevalent in those with
colonic polyps
• It is usually electrocauterized at the staled
• Twisting of the stalk would create pain

Dermatofibroma
• A single round or ovoid papule or nodule about
1 cm in diameter, with a reddish brown,
sometimes yellowish hue
**parang nakapatong lang sa skin ang S.K • Adherent to the overlying epidermis dell-like
depression
• (+) itching • Dimple sign (pinch the lesion to see)
• Onset; fourth to fifth decade o Depression over dematofibroma when it is
• Result from a local arrest of maturation of grasped gently between the thumb and
keratinocytes that are normal in all aspects forefinger
• Usually originate de novo but may involve from
lenitigines (from freckles; kumakapal yung skin)
• Increase in number when a patient is gaining
weight (inc wt gain = inc seborrheic keratosis)
• Sudden eruption of may seborrheic keratoses
inflammatory cutaneous disorder such as
exfoliative dermatitis
• Rarely, SCC and BCC may arise
Sign of Leser-Trelat
• Sudden appearance of numerous itchy
seborrheic keratoses in an adult may be a sign
of internal malignancy
• 60%- adenocarcinoma (stomach)
• Others- lymphoma, breast, SCC of lung, • Sites: lower extremities, above elbow, sides of
melanoma trunk
Differential Diagnosis: (do biopsy to rule out melanoma) • Initiated by injuries to the skin, such as insect
• Melanoma-> () bites or blunt trauma
• Actinic keratosis **common in children(wait nalang na mag involute)
• Size: 4-20mm (>5cm)
• Nevi • Progressive enlargement to >2-3 cm suggest a
Treatment: malignant fibrous histiocytoma or
• Liquid nitrogen and curettage dermatofibroma sarcoma protuberans (needs biopsy)
• Liquid fulguration Treatment and Prognosis:
• Carbon dioxide laser • Excisional biopsy
• Electrocautery (removal is due to cosmetic purposes) • Spontaneous involution may occur
• This lesion is usually removed without any
scarring Keloid and Hypertrophic Scar
• Both are usually caused by trauma
Achrochordon ('skin tags') • Firm irregularly-shaped thickened, hypertrophic
• “kuntil” is it’s Tagalog term fibrous, pink or red excrescence
• Small, flesh colored to dark-brown, pinhead • Arises as a result of cut, laceration, burn or
sized and large, sessile and pedunculated acne pustule on the chest or upper back
papillomas (parang naka hang) on the neck, axilla and eyelids • Keloid: spreads beyond the limits of original
• Trunk and groins: soft, pedunculated growths injury often sending out claylike (cheloid)
hangs on thin stalks (TX: cut lang daw ang stalk then CAUTERIZE hahah projections (may gradual enlargemnt of scar pwedeng tender or itchy and
paborito nya yan) goes beyong boundary of the original skin)
ordinally scar:-> gradually fades and follows the boundary of skin
hyperthropic scar:->skin does not go beyond skin boundary; involutes kapag
mga 6 months
• Overlying epidermis is smooth, glossy and

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 EPIDERMAL NEW GROWTH DERMATOLOGY
thinned from pressure that are affected
• Early lesion: red, tender, rubbery, surrounded by • Isomorphic phenomenon may occur
an erythematous halo, may be telangiectatic o Isomorphic is also known as the lines
Chronic: brown, tender, painful, pruritic, hard of trauma
and stationary Muir-Torre Syndrome
• Sebaceous tumors and KA occur in association
with multiple low grade malignancies
Solitary Keratoacanthoma
• Rapidly growing papule that enlarges to as
much as 25mm in 5-8 weeks
• Hemispheric, dome shaped, skin colored
nodule with a smooth crater filled with a central
keratin plug
• Sites: central part of the face, back of hands,
arms, less frequent buttocks, thighs, penis, ears
and scalp
• Seen mostly in middle-aged and elderly
**in men : common area dorsum of the hands
Keloid usually grows beyond the original trauma. **in women common area: legs
There are claw like projections. Skin is smooth,
glossy and thin as seen in the picture. In a more
chronic keloid, there is pain and tenderness on
slight touch. The right picture is a scar after an
ear piercing.
Differential Diagnosis:
• Hypertrophic scar
o No clawlike projections and does not extend
beyond the original wound
o Spontaneous improvement during the first 6
months

What is the difference between a keratoacanthoma

and a dermatofibroma? Keratoacanthoma has a
scaly surface while a dermatofibroma has a
smooth surface.
• KA centrifugum/KA centrigugum marginatum:
may have a nodulevegetative appearance some
with craterlike depression
Giant KA: more than 2 cm, on the nose and
eyelid
• Coral-reef KA: multiple lesion extend from the
**keloid prones areas: chest, sternum, back and upper arm ((rare: face))
original central lesion
Treatment:
• KA dyskeratoticum et segregans: coalescing
• Usually treated by the use of steroids
plaque or nodules on the forehead
• IL (intralesional)triamcinolone every 6-8 weeks
• Subungual KA: tender with a destructive crater
• Flashlamp pulsed dye laser
in the center bony destruction
• Excision followed by IL
• Most interesting feature (is the course of disease): rapid growth for 2-4
• Silicone sheet
weeks, stationary period for 2-6 weeks and
o you can put this on the scar and leave
spontaneous involution for 2-6 weeks slightly
it for 8 hours
depressed scar
** hypertrophic scar -->> respond to IL unlike sa keloid it will take years bago
Multiple Keratoacanthoma (Ferguson Smith type of
mag flatten ang keloid
multiple self-healing KA)
**for KELOID : Intralesional 2-3 weeks in AND in between apply silicone gel
• Identical clinically and histologically to the
then put silicon sheet for 12 hours to occlude the lesion para mag flat, but
solitary type
difficult to put on curve areas of the body rather put nalang silicone gel
• Generally only 3-10 lesions on one site
(#GANDA NI DOC #DAMINGkuda) ::avoid nalang mga stimulus for strecth sa
• Sites: face, trunk, genitalia
skin or friction
• Young men frequently affected
**yung mga commercially available na scar cream , effective lang kapag bago
Eruptive Keratoacanthoma
palang yung scar as in immediatly after trauma
• Generalized eruption of multiple dome-shaped
skin colored papules, from 2-7mm in diameter
KERATOACANTHOMA
• Spares the palms and soles
4 types:
• Severe pruritus in some patients plus bilateral
1. Solitary KA-classic KA
ectropion and narrowing of the oral aperture
2. Multiple KA
• Associated with higher incidence of
3. Eruptive KA
immunosuppresion (LE, leukemia, leprosy,
4. Keratoacanthoma centrifugum marginatum
kidney transplant, photochemotherapy, thermal
• Sunlight appears to play an important role in the
burn and radiotherapy)
etiology
Keratoacanthoma Centrifugum Marginatum
o So the sun exposed areas are the ones

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 EPIDERMAL NEW GROWTH DERMATOLOGY
• Progressive peripheral expansion with • Brachial cleft cyst
concomitant central healing leaving atrophy • Nodular fibroma
• Involving dorsum of hands and pretibial region Treatment:
• No tendency for spontaneous involution **for small lesion-> prick only, be sure to remove the capsule to prevent
• Associated with central healing recurrence
Etiology of KA: • Excision
• A variant of regressing SCC [squamous cell • Enucleation
carcinoma] (DDx) Sebaceous Hyperplasia (Senile Sebaceous
Treatment: Hyperplasia, Senile Sebaceous Adenoma)
• Observation then perform a biopsy • Parang wart but with yellowish with
Biopsy excision (to rule out ) or curettage and fulguration of a central depression
lesion <2cm • Small, cream-colored or yellowish
• IL injection of 5 FU (for large lesion) umbilicated papules, 2-6 mm in
• IL methotrexate (0.5-1ml of 25mg/ml) +IM (for large lesion) diameter
methotrexate • Sites: face, forehead, infraorbital area,
• IL bleomycin (for large lesion) temples
• Oral and topical retinoids and (for large and eruptive lesion) • Age of onset: >40 years old
cyclophosphamide: large and recalcitrant • Histologically: hypertrophied sebaceous
lesions and eruptive forms glands, multilobulated, each dividing
• Radiotherapy: giant KA and subungual KA into other lobules to produce a cluster
**iso morphormic phenomenon: lesion can arise area of previous trauma eg: resembling a bunch of grapes
psoriasis **seen commonly sa mga oily pesss /faces at large pores

Epidermal Cyst (Keratin cyst, Sebaceous Cyst,

Epidermoid Cyst)
• Benign growth
• Movable if large
• Central is shyny
• Fluctuant tense swelling
• Surface of the skin is smooth and shiny
from the upward pressure
• Freely movable and attached to the
normal skin above them by the remains
of the expanded gland duct, the
opening of which frequently shows a
central point on the surface as a
comedo
o Usually has a central blackhead
• The pasty contents are formed of
macerated keratin and cheesy, fatty
material Familial presenile sebaceous hyperplasia
Extensive sebaceous hyperplasia on
Epidermal Cyst (keratin Cyst, Sebaceous Cyst, the face, neck and upper thorax with
Epidermoid Cyst) onset at puberty and worsen with age
• Autosomal dominant
Treatment:
• Electrodessication
• Curettage
• Shave biopsy
• Lasers
• Isotretinoin
Syringoma
• Small transluscent yellowish, brownish
or pinkish globoid papules 1-3mm in
diameter that develop slowly and
persists without symptoms
• Sites: more common on the eyelids and
upper cheeks, rarely on the axilla,
abdomen, forehead and penis and
vulva (commonly seen at infraorbital area)
• Sites: face, neck and trunk • Familial patterns may occur
**parang may blackhead sa lesion • Occur in 18% of adults with down’s
Penetrating injuries may result to syndrome, especially females
epidermoid cysts growing within the • Histologic: dilated sweat ducts, some of
bone which have small commalike tails
• It is a keratizing cyst lined by stratified resembling tadpoles
squamous epithelium containing • Probably represent adenomas of
keratohyalin granules intradermal eccrine ducts
Differential Diagnosis Treatment:
• Pilar cyst • Electrodessication
• Lipoma • Laser ablation
o Involves subQ fat • Cryotherapy

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 EPIDERMAL NEW GROWTH DERMATOLOGY

**to differentiate ang syringoma sa white heads , ang syringoma kapag prick
mo walang laman sa loob unlike ang whiteheads

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