Dermal and Subcutaneous Tumors




Vascular tumors range from red to blue, depending on the degree of vascular stasis and deoxygenation of hemoglobin. When associated with thrombosis or consumptive coagulopathy, the lesions often become hard and tender. The clinician should attempt to distinguish vascular proliferative lesions from vascular malformations, as the former tend to respond to beta blockers, whereas the latter do not. Malformations include nevus flammeus, salmon patch, nevus anemicus, and cutis marmorata telangiectatica congenita. Some vascular malformations are associated with overgrowth of surrounding tissues and can lead to considerable morbidity. This portion of the atlas will focus on the clinical findings of dermal tumors, including fibrous and vascular proliferations, as well as growths, in addition to those composed of muscles, nerves, and fatty tissue.


A biopsy may be required for the definitive diagnosis of dermal neoplasms, but the color, morphology, and distribution of the lesions can often lead to an accurate clinical diagnosis. Dermatofibromas present as firm, pink-to brown dermal nodules with overlying epidermal acanthosis imparting a dull or velvety appearance to the skin. A characteristic dimpling sign occurs when the surrounding skin is compressed laterally. Granular cell tumors tend to be larger, but are accompanied by a similar velvety or verrucous appearance of the overlying skin. In contrast, dermatofibrosarcoma protuberans presents with a multinodular appearance with overlying epidermal atrophy imparting a taught, glossy appearance to the skin. All of these tumors are quite firm to palpation in contrast to the soft rubbery or gelatinous feel of a neurofibroma.


Fig. 28.1


Phacomatosis pigmentovascularis.

Courtesy Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.



Fig. 28.2


Phacomatosis pigmentovascularis.



Fig. 28.3


PIK3CA-related segmental overgrowth syndrome.



Fig. 28.4


PIK3CA-related segmental overgrowth syndrome.



Fig. 28.5


Nevus anemicus.



Fig. 28.6


Nevus anemicus.



Fig. 28.7


Cutis marmorata telangiectatica congenita.

Courtesy Paul Honig, MD.



Fig. 28.8


Nevus simplex.

Courtesy Steven Binnick, MD.



Fig. 28.9


Nevus simplex.



Fig. 28.10


Nevus simplex.



Fig. 28.11


Capillary malformation (port-wine stain) with Sturge-Weber syndrome.



Fig. 28.12


Capillary malformation (port-wine stain) with Sturge-Weber syndrome.



Fig. 28.13


Capillary malformation (port-wine stain).



Fig. 28.14


Capillary malformation (port-wine stain).



Fig. 28.15


RASA1-associated capillary malformation-arteriovenous malformation syndrome.



Fig. 28.16


Cavernous venous malformation.



Fig. 28.17


Cavernous venous malformation.



Fig. 28.18


Cavernous venous malformation.



Fig. 28.19


Venous malformation.



Fig. 28.20


Blue rubber bleb syndrome.



Fig. 28.21


Maffucci syndrome.



Fig. 28.22


Klippel-Trenaunay syndrome.



Fig. 28.23


Arteriovenous fistula.



Fig. 28.24


Microcystic lymphatic malformation.



Fig. 28.25


Oral lymphatic malformation.



Fig. 28.26


Superficial lymphatic malformation.



Fig. 28.27


Venolymphatic malformation.

Courtesy Ken Greer, MD.



Fig. 28.28


Acquired lymphangiectasia after surgery and radiation therapy for breast cancer. Redness is irritation from chylous discharge.



Fig. 28.29


Deep lymphatic malformation.



Fig. 28.30


Spider angioma.

Courtesy Steven Binnick, MD.



Fig. 28.31


Venous lakes.

Courtesy Ken Greer, MD.



Fig. 28.32


Generalized essential telangiectasia.

Courtesy Steven Binnick, MD.



Fig. 28.33


Unilateral nevoid telangiectasia.



Fig. 28.34


Angiokeratoma circumscriptum.

Courtesy Steven Binnick, MD.



Fig. 28.35


Angiokeratoma circumscriptum.

Courtesy Steven Binnick, MD.



Fig. 28.36


Angiokeratoma of Mibelli.



Fig. 28.37


Angiokeratoma of Fordyce.



Fig. 28.38


Angiokeratoma of Fordyce.



Fig. 28.39


Angiokeratoma of Fordyce.



Fig. 28.40


Angiokeratoma of Fordyce.



Fig. 28.41


Angiokeratoma of Fordyce.



Fig. 28.42


Angiolymphoid hyperplasia with eosinophilia.



Fig. 28.43


Pyogenic granuloma.

Courtesy Steven Binnick, MD.



Fig. 28.44


Pyogenic granuloma.

Courtesy Steven Binnick, MD.



Fig. 28.45


Pyogenic granuloma.

Courtesy Steven Binnick, MD.



Fig. 28.46


Pyogenic granuloma.

Courtesy Steven Binnick, MD.



Fig. 28.47


Recurrent pyogenic granulomas with satellite lesions.



Fig. 28.48


Angioma serpiginosum.



Fig. 28.49


Infantile hemangioma.

Courtesy Steven Binnick, MD.



Fig. 28.50


Infantile hemangioma.



Fig. 28.51


Infantile hemangioma with ulceration.



Fig. 28.52


Infantile hemangioma with ulceration.



Fig. 28.53


Involuting infantile hemangioma.

Sep 3, 2019 | Posted by in Dermatology | Comments Off on Dermal and Subcutaneous Tumors
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