Dermally-Based Lesions


Fig. 20.1 Similar clinical appearance of two different dermal tumors. A Infantile hemangioma. B Rhabdomyosarcoma. From Eichenfield LF, Frieden IJ, Zaenglein AL, Mathes E. Neonatal and Infant Dermatology, 3e. London: Saunders, 2014.



Table 20.1


Dermally-based lesions










































Entity Classic morphologic clues* Histopathology
Vascular tumors
Infantile hemangioma

• History: Not present at birth, grows rapidly over first couple of months


• Bright red nodule (see Fig. 20.1A)



• Lobules of small capillaries (GLUT-1-positive)


• Often extends into the subcutaneous

Congenital hemangioma

• History: Present at birth


• Site: Predilection for pressure points


• Oval shape


• Blue–red nodule with white–green halo (Fig. 20.2)



• Lobules of small capillaries (GLUT-1-negative)

Tufted angioma

• Mottled to solid red patches and red papules (Fig. 20.3A,B)



• Small lobules (tufts) of small capillaries


• Dilated lymphatic spaces

Glomuvenous malformation (glomangioma)

• May be autosomal dominant inheritance, particularly if multiple lesions


• Clustered blue papules (Fig. 20.3C,D)



• Dilated spaces lined by one to two layers of monomorphous cells with round blue nuclei

Fibrous tumors
Myofibroma

• Site: Often on the head/neck or trunk


• Firm or rubbery nodule or infiltrative plaque


• Skin-colored to red–purple


• May be multiple (see Fig. 20.4)



• Biphasic with increased vascularity and spindle cells (myofibroblasts)

Infantile digital fibroma

• Site: Typically on the 2nd toe


• Firm, pink nodule (Fig. 20.5)



• Elongated spindle cells with cytoplasmic pink inclusions

Hematologic processes
Mastocytoma

• History: Intermittent blistering


• Brown–pink to red papulonodule


• Leathery surface (Fig. 20.6)



• Fried-egg-shaped cells with granular cytoplasm



*Not every case will have these features.



Table 20.2


Characteristic papulonodules in children/adults



































Entity Classic morphologic clues* Histopathology
Adnexal tumors
Pilomatricoma (Fig. 20.7)

• Bluish tinge


• Firm to hard plate-like papulonodule


• Lesion will “teeter-totter” with pressure on one side or another



• Shadow cells within butterscotch-colored keratin

Apocrine hidrocystoma (see Fig. 21.4)

• Site: Eyelid


• Bluish, translucent papule



• Cuboidal cells lining a lumen

Syringoma (see Fig. 2.1D)

• Site: Eyelids


• Flesh-colored papules



• Tadpole-shaped epithelium with clear cells and ductal differentiation

Sebaceous hyperplasia (see Fig. 2.1E)

• Site: Face


• Yellow papule with central dell



• Dilated follicular infundibulum surrounded by sebaceous glands

Vascular tumors
Cherry angioma (Fig. 20.8)

• Bright red papule



• Clusters of dilated spaces lined by endothelial cells

Pyogenic granuloma (Fig. 20.9)

• Site: Predilection for head/neck, fingers


• History of rapid growth


• Eroded red papule, often pedunculated

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Mar 5, 2017 | Posted by in Dermatology | Comments Off on Dermally-Based Lesions

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