A Few Lumps and Bumps of the Dermatologic Kind

November 9, 2017

An up-close look and a short lesson on each of 7 dermatologic lumps and bumps. Would any of them give you cause for alarm?

Lumps and Bumps of the Dermatologic Kind

This picture of a 5-year-old boy's lip shows a cystic appearing lesion at the left lower lateral vermilion. It had been present for months and was asymptomatic. It was elliptically excised in the office under local anesthesia and healed without complication. Pathologic diagnosis was verruca vulgaris. Differential diagnosis includes mucocele and inclusion cyst.

This 2.5-cm diameter rounded yellow cyst had been present on the right neck of a 33-year-old man for 3 years. It had gradually enlarged and was asymptomatic. A similar lesion at the same spot was incompletely excised just prior to the onset of the present lesion. He plans to have the mass removed in the near future.

This is an inclusion cyst, diagnosed from its clinical appearance.

Differential diagnosis includes abscess and nodular basal cell carcinoma.

An 83-year-old man presented with a cystic area at the acromioclavicular joint of the right shoulder; it had been present for several years, and was asymptomatic. He could not recall any injury. It was an incidental finding on an examination prior to cataract surgery.

Plain film x-ray of the right shoulder revealed migration of the humeral head into the
subacromial space and indicated chronic rotator cuff disease. He required no treatment.

Differential diagnosis includes fracture of the distal clavicle and shoulder dislocation.

This picture of a 68-year-old man's left thumb shows a cystic lesion at the distal interphalangeal joint dorsum. It had been present for 1-2 months and was asymptomatic.

Clinical diagnosis is digital mucous cyst. They are benign ganglion cysts that usually arise from the distal interphalangeal joints of the fingers, and rarely the toes. The cysts are typically seen in adults aged 50 to 70 years and are associated with osteoarthritis. Treatments vary and include expression by pressure of the viscous fluid through needle holes, cryotherapy, and steroid injection. Recurrence is not uncommon regardless of type of treatment.

Differential diagnosis of digital mucous cyst includes digital mucous pseudocyst and bone tumor.

A slightly raised, light tan, 0.5 x 1.5-cm oblong lesion is noted on the post-auricular area of the left ear of a 58-year-old man. He stated it had been present for one month. He thought he had possibly scratched the area and it felt a little swollen compared with the right ear. It is located at the superior part of the ear. The lesion was removed in the office with elliptical incisions under local anesthesia and healed well.

Pathologic diagnosis was Jessner's lymphocytic infiltrate (benign cutaneous lymphocytosis) completely excised. Stains for acid fast bacteria (Fite), fungus (GMS), and PASH were negative.

Differential diagnosis includes skin cancers, lupus erythematosus and other connective tissue diseases, mycosis fungoides, and leprosy.

This picture of a 13-year-old boy shows a rounded swelling, 1.5-cm in diameter, on the upper left eyelid. There are no signs of inflammation. This "bump" developed one week prior to this picture. He was asymptomatic.

Clinical diagnosis is chalazion. He was treated with hot compresses and it resolved over 2 weeks.

A chalazion, (aka internal hordeolum or meibomitis) is a lipogranulomatous cystic lesion of meibomian glands, usually at the upper eyelid. It is typically sterile, but can become secondarily infected (usually staphylococcal).

Differential diagnosis includes stye, which is usually a bacterial; infection of the ciliary follicles or accessory glands of the eyelids (aka external hordeolum); orbital cellulitis; dacrocystitis; sebaceous cell carcinoma; basal cell carcinoma; squamous cell carcinoma, and other infectious etiologies.

Dermatologic lumps and bumps appear in myriad forms and comprise hundreds of diagnoses. This short slide show offers a primer on a small sampling. Find brief history and differential below each slide.