skin swelling.pptx

skin lumps

1. Superficial swellings

2. Objectives At the end of this presentation students will be able to : Name the common causes of superficial swellings Describe clinical presentation, treatment, examination, management of most common superficial swellings

3. Superficial swellings Swelling denotes enlargement or protuberance in any part of the body Can be called ‘’mass’’ or ‘’lump’’

4. History Duration Mode of onset & progress (trauma or spontaneous; rate of progression) Pain Fever Other lumps or swellings Other features (movements, secondary changes loss of weight or appetite)

5. Inspection of a superficial swelling Site Size Shape Surface (smooth : epidermoid cyst, lobular or irregular) Skin (tense, glossy with prominent veins) Surrounding area (changes, pigmentation/ edema , wasting, discoloration) Others (number, colour, edges, extent, movements)

6. Superficial swellings : Most common causes Swellings or lumps which are superficial to the underlying muscle and fascia are commonly caused by: S ebaceous cysts ( epidermoid cysts) L ipoma Neurofibroma C arbuncle Ganglion

7. 1- S ebaceous cysts Also called Epidermoid cysts Most common cutaneous cysts Can occur anywhere on the body and typically present as a skin- colored dermal nodules, often with a clinically visible central punctum . Epidermoid cysts unusual in number and location (on extremities rather then face, base of ears and trunk) may be seen in the setting of Gardner syndrome, a rare inherited condition characterized by familial adenomatous polyposis of the colon associated with a number of extracolonic abnormalities.

8. 1- Epidermoid cyst : skin- colored subcutaneous nodule Central punctum corresponding to the follicular opening

9. 1- Epidermoid cyst : Diagnosis Diagnosis usually clinical, based upon the clinical appearance of a discrete nodule or cyst, often with a central punctum freely movable on palpation. Cyst wall consists of squamous epithelium similar to skin surface. Cavity filled with laminated layers of keratinous material.

10. 1- Epidermoid cysts: Differential diagnosis 1- Pilar cysts 2- Lipoma 3- Pilomatricoma 4- Ganglion cyst 5- Abscess

11. 1- Epidermoid cyst :Treatment Inflamed uninfected epidermoid cysts may resolve spontaneously without therapy, although they tend to recur. Treatment not necessary unless desired by patient. Injection of Kenalog ® into the inflamed lesion can hasten the resolution of inflammation in uninfected epidermoid cysts.

12. 2- Lipoma Superficial subcutaneous lipomas are the most common benign soft-tissue neoplasms. Consist of mature fat cells enclosed by thin fibrous capsules Can occur on any part of the body Develop superficially in the subcutaneous tissue Rarely, they may involve fascia or deeper muscular planes

13. 2- Lipoma : presentaiton Soft, painless subcutaneous nodules ranging in size from 1 to > 10 cm Occur on the trunk and upper extremities and can be round, oval or multi-lobulated Patients may have more than one lipoma , occasionally patients can have genetic condition : development of multiple lipomas in several family members Malignant transformation of a lipoma into a liposarcoma is rare

14. 2- Lipoma : Diagnosis Made clinically If suspected lipoma causes symptoms (pain or restriction of movement), if it is rapidly enlarging , or is firm, then a biopsy is indicated

15. 2- Lipoma : Treatment Treatment indicated if pain or for cosmetic purposes or concerns over diagnosis Surgical removal of the fat cells and fibrous capsule Recurrence of an excised lipoma is not common Side effects of surgery includes : scarring, seroma , and hematoma formation. Surgical technique with segmental extraction and minimal surface incision may limit the scar size.

16. 3- Neurofibroma Cutaneous neurofibromas are benign nerve tumors composed of cells of neuromesenchymal origin. Cutaneous neurofibromas occur as sporadic, solitary lesions in healthy adults. Asymptomatic, soft, flesh- colored or hyperpigmented papules or nodules that are <2 cm in diameter. Multiple cutaneous neurofibromas and their variants ( plexiform , dermal) may occur in the setting of neurofibromatosis.

17. 3- Cutaneous neurofibroma Soft, flesh- colored papules or nodules. Applying direct pressure to some neurofibromas may make them seem to retract into the skin, a finding that has been described as the ‘’button-hole’’ sign.

18. 3- Neurofibroma : Differential diagnosis Acrochorda Melanocytic Nevi (intradermal nevus)

19. 3- Neurofibroma : treatment Treatment is not necessary for solitary cutaneous neurofibromas . Surgical excision can be used to remove lesions when the diagnosis is in question or when removal is desired due to discomfort or cosmetic concerns.

20. 4- Carbuncle Coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles Series of abscesses in the subcutaneous tissue that drain via hair follicles.

21. GANGLION CYSTS

22. What is a ganglion cyst? A ganglion cyst is the most common soft tissue mass in the hand and wrist. These cysts are sacs that arise from a joint or tendon sheath and become filled with a gelatinous fluid. It is believed the cysts are a result of a weak spot or degeneration of tissue lining a joint or tendon sheath.

23. Common types of ganglions DORSAL CARPAL GANGLION CYST Most common location of a ganglion cyst. Often arises from a weak spot in the scapholunate ligament on the back of the hand.

24. VOLAR GANGLION CYST 2 nd most common location of a ganglion cyst of the wrist. Often arises from a weak spot in either the radiocarpal joint or STT joint

25. RETINACULAR CYST This variant of a ganglion cyst occurs on the palm side of the hand at the joint where the fingers join the palm. These cysts arise off the A1 or A2 pulley of the flexor tendon sheath.

26. MUCOUS CYST These are ganglions that occur on the back of the finger at the DIP (distal interphalangeal ) joint, the joint closest to the fingernail. Most often are associated with underlying osteaoarthritis at this joint.

27. Treatment options Splints M ay be used to provide pain relief by resting the offending joint or tendon sheath Anti-inflammatory medications Can be taken orally to reduce swelling and relieve pain Try to modify or avoid activity that causes pain

28. Aspiration of the cyst In the office, it can be attempted to puncture the cyst with a needle and aspirate the fluid from it. This may eliminate the cyst completely, but there is a high rate of recurrence following this procedure.

29. Surgical options Ganglion cysts are often removed for a variety of reasons, inluding : Pain relief If causing limitations to range of motion Aesthetically unpleasing Specifically in the case of mucous cysts, it is important to surgically remove them if they rupture. This is to prevent infection of the underlying joint. Sometimes an MRI is ordered to confirm origin of the stalk of the cyst so we can ensure this area is addressed intraoperatively .

30. Surgical treatment Surgical treatment for this involves removing the cyst sac and addressing the underlying cause, such as ablating the weak spot in the ligament or removing the bone spurs from an arthritic joint. This is an outpatient procedure and takes about 15-20 minutes to perform.

31. Surgery details D orsal carpal ganglion cysts: This procedure is performed under regional anesthetic, which involves a nerve block at the shoulder. Near the location of these cysts there is a nerve called the PIN (posterior interosseous nerve). Its function is to provide pain fibers to the wrist capsule and can be a contributing factor to pain in this location. It is also removed during the procedure. Volar carpal ganglion cysts: This procedure is performed under regional anesthetic, which involves a nerve block at the shoulder .

32. Surgery details Retinacular cysts: This procedure is performed under local anesthetic, involving an injection near the site of the cyst. Mucous cysts: This procedure is performed under local anesthetic, involving an injection that will the numb the finger. These cysts can thin the skin and sometimes require transfer of nearby skin to cover the defect . In all situations, we are able to give you some sedative medication through an IV to keep you comfortable.

33. Risks Anesthetic Infection Numbness Recurrence

34. Post-operative care A soft dressing is applied after surgery. You will be able to use your hands for light activity later that day. K eep the surgical dressing and incision clean and dry. After 48 hours you may remove the soft dressing and your incision may get wet in the shower, but no soaking. Apply a band-aid to keep the incision clean if necessary. Approximately 10-14 days post-operatively for a follow-up visit and suture removal .