Session 9-Sebaceous Cyst and haemangioma.pptx

Knowledge about sebaceous Cyst

1. CMT06207 Sebaceous cyst and Haemangioma Session By Dr. Stephen S. Kasaizi

2. Learning Objectives By the end of this session, students are expected to be able to: Define sebaceous cyst and haemangioma Describe classification of Hemangioma Describe clinical features of Sebaceous cyst and haemangioma Describe the management of Sebaceous cyst and haemangioma

3. Sebaceous cyst on the skin overlying the scapula

4. Activity :Brainstorming What is sebaceous cyst?

5. Introduction of Sebaceous cyst Sebaceous cyst is a retention cyst due to blockage of the duct of sebaceous gland, causing a cystic swelling. Sebaceous glands are present in the skin. These glands secrete sebum which keeps the skin soft and oily.

6. Introduction cont… Most accurately called 'epidermoid cyst' since such cyst is lined by superficial squamous cells. Sebaceous cyst is lined by squamous epithelium and contains sebum which is yellowish fluid material with unpleasant smell. Such material contains sebum, fat and desquamated epithelial cells.

7. Introduction cont… A sebaceous cyst can be seen anywhere in the body but most commonly seen in those parts where there are plenty of sebaceous glands. Such sites are the scalp, face and the scrotum. The characteristic feature here is that the cysts are multiple and when well formed they feel solid. There is no sebaceous gland in the palm or sole, so sebaceous cyst is never seen in these areas

8. Figure A and B: Large sebaceous cyst in the face and scalp. Note the hair loss on the surface.

9. Clinical features Painless swelling which is spherical in shape; Smooth, soft, nontender, freely mobile Adherent to skin especially over the summit, fluctuant(positive Paget’s test) Non- transilluminating with punctum over the summit It moulds on finger indentation Hair loss over the surface is common due to constant pressure over the roots of the hair follicles. Unpleasant odour of sebum content is typical.

10. Clinical features The surface is smooth and there is a bluish or blackish spot or punctum which indicates the blocked opening of the duct. If the cyst is a big one, fluctuation test may be positive otherwise it is difficult to perform. This cyst is free from underlying structures and it can be moved easily with the skin.

11. Activity: Brainstorming What are clinical presentation of sebaceous cyst

12. Treatment Total excision of the cyst is the treatment of choice. If the cyst is infected, preliminary antibiotic treatment should be given and the excision is only possible when the infection has subsided. If the cyst is a small one it can be excised under local anaesthesia . If capsule is not removed properly the cyst will recur.

13. Complications of sebaceous cyst Infection and abscess formation. Surface gets ulcerated leading to formation of a painful,fungating mass with discharge called as— Cock’s peculiar tumour —often resembles epithelioma It is a misnomer as it is not a tumour. Sebaceous horn results from hardening of slowly discharged sebum through the punctum.

14. Hemangioma

15. Activity :Brainstorming What is haemangioma?

16. Definition Haemangioma is a developmental malformation of blood vessels and not a typical tumour. Example; Hamartoma Haemangioma is often present since birth and it never turns malignant .

17. Classification A.Depend on origin Capillary Cavernous Arterial

18. Classification cont… B. Depend on behavior of lesion 1.Involuting haemangioma-Strawberry naevus Superficial -Capillary haemangioma Deep ----Cavernous Combined (superficial +deep)-Strawberry naevus , Capillary haemangioma, Cavernous haemangioma Strawberry naevus

19. Classification cont… 2. Non involuting Portwine stain;- Capillary haemangioma, Naevus flammeus Cavernous haemangioma Arteriovenous fistula Ports wine stain

20. Types of Haemangioma There are mainly three types of haemangioma Capillary haemangioma, arising from capillaries. Venous or cavernous haemangioma, arising from the veins. Arterial or plexiform haemangioma , arising from arteries. Haemangioma may occur anywhere in the body though it is more common in the skin and subcutaneous tissues.

21. Strawberry angioma (Strawberry naevus) The typical history is that the red mark is noticed after 1 to 3 weeks of birth. This red mark gradually increases in size for a few months After the first birthday the angioma gradually regresses in size and involusion may be completed by the age of 7 to 8 years. The subcutaneous tissue as well as the skin is often involved. Sometimes muscles may be affected. Clinically the swelling is compressible diagnostic Haemangioma.

22. Port-wine stain It is usually present since birth and does not show any change for the rest of the life. It is common on the face and at the shoulders, neck and buttock. This is deep purple-red in colour which may become paler in later life. There is no definite swelling but it is a diffuse vascular deformity.

23. Salmon patch It is present since birth and it usually disappears before the first birthday. It is mostly seen over the forehead or occiput or anywhere in the midline of the body. Treatment Wait and watch policy should be adopted, as majority of the capillary haemangiomas disappear on their own. If the lesion exists even after 8 years and the patient and the parents insist on cosmetic treatment, excision of the lesion with skin grafting or Injection of steroids

24. Cavernous Haemangioma It consists of multiple dilated venous channels. It is a spongy swelling. Treatment This is more often required which will include injection of sclerosing agent into the lesion or Cautery treatment may be applied to the haemangioma. Surgery is a better treatment if the swelling is small and localized.

25. Cavernous Haemangioma

26. Arterial Or Plexiform Haemangioma Introduction ( cirsoid aneurysm) It is a type of congenital arteriovenous fistula. There is pulsatile swelling of arteries and the veins become arterialized i.e. tortuous and thick walled and pulsatile-feeling like a bag of pulsating earthworms. Commonly seen on the forehead or in the scalp over the temporal region.

27. Activity:Brainstorming Mention three (3) differential diagnosis of haemangioma

28. Differential diagnosis Lymphangioma Lipoma Cold abscess Branchial cyst

29. Treatment Conservative treatment like Injection of sclerosing agent into lesion like 3% sodium morrhuate Cautery treatment Surgery Ligation of feeding vessels. Therapeutic embolisation of the feeding artery. After ligation of feeding vessels excision of the lesion with diathermy

30. Complication of Haemangioma The following are likely complications; Ulceration and bleeding: Commonly occurs with capillary haemangioma Infection: Septicaemia usually precipitated by a small ulcer High output cardiac failure Other complication depend on the site.

31. Key points Sebaceous cyst is a retention cyst due to blockage of the duct of sebaceous gland, causing a cystic swelling. Sebaceous cyst contains sebum, fat and desquamated epithelial cells. Its treatment of choice is total excision Haemangioma is a developmental malformation of blood vessels and not a typical tumour Treatment of haemangioma can be conservative or surgical treatment.

32. Evaluation Mention three clinical features of sebaceous cyst What is the treatment of sebaceous cyst? Mention three clinical features of haemangioma Classify haemangioma

33. Reference Somen Das (2008) concise textbook of Surgery (5 th edition). Kolkata-Dr Somen Das K.Rajgopal Shenoy, Anitha shenoy (2016) Manipal Manual of surgery (4 th edition). CBS New Delhi F.Charles Brunkardi (2019) Schwartz’s principles of surgery (11 th edition). McGraw-Hill Education Russell R.C.G., Norman S.W. & Bulstrode C.J.K. (2006). Bailey and Love’s Short Practice of Surgery (25 th edition.). London: Hodder Arnold