Lump, Bump, Groin Tutorials with Mr Nazli

Try to grab the histological structure of the skin with the appendages. Usually if the pathology occurs within the dermis, the lump or bump should be attached to the skin. For example sebaceous cyst, carbuncle, boil, dermoid (positive transluminance test). Not attached to the skin, you can actually pinch the skin, for example lipoma.

In examining the lesion, As usual we go with inspection, palpation, percussion if needed, auscultation, and some special test in distinguishing the lesions.

LIPOMA

http://www.lipoma.net/wordpress/wp-content/uploads/lipoma4-e1355211534412.jpg

• It is a benign tumor consist of mature fat cells, it is the most common for of soft tissue tumor
• mostly in upperlimbs, chest, neck, shoulder with size smaller than 1 cm commonly. It will have hemispherical or discoid shape, with smooth/ lobulated, may fluctuate with soft of firm in consistency. The edges usually irregular 
• most of the time painless, free mobility of overlying skin with normal temperature
• slips sign test should be positive
• transluminence test usually negative but can be positive if liquified
• it is not a precancerous lesion - less likely to develop into liposarcoma. But if there is liposarcoma, usually it develop de novo ( by its own)
• Prognosis of it 
• 2/3 not growing
• 1/3 growing
• Rx : excision

SEBACEOUS CYST

http://i.ytimg.com/vi/9xKYKyn3oMM/maxresdefault.jpg

http://health.tipsdiscover.com/healme/wp-content/uploads/2013/07/Sebaceous-cyst-%E2%80%93-Causes-Symptoms-Diagnosis-Treatment-and-Ongoing-care.jpg

• arise from hair follicle consisting keratin. If oily, sebum secreted by sebaceous glands.
• Usual sites are the hair bearing sites like scalp, shoulder, neck, scrotum, back
• Usually hemispehrical, with smooth surface, hard and solid, well defines. Attached to the skin hence not mobile
• Usually have one punctum or fistula
• can be complicated with infection, ulceration, calcification, so observe the skin changes suggestive of inflammation
• Rx : excision

DERMOID CYST

http://byebyedoctor.com/wp-content/uploads/2011/05/epidermoid-cyst-3.jpg

• It is "skin lined cyst" deep in the skin in subcutaneous tissue (attached to the skin)
• usually the site is central part of the body 
• shape usually is pherical, smooth surface and may fluctuate, 
• congenital : usually central part of body
• acquired : due to fusion of 2 abnormal layers
• positive transluminance test,
• painless unless infected
• Rx : excision

CARBUNCLE

http://www.millerfamilydermatology.com/wp-content/uploads/2013/05/carbuncle.jpg

• necrotizing infection in the subcutaneous tissue, with pus and slough formation
• multiple punctum
• can be widespread
• lost of skin appendages
• Rx : antibiotic, saucerization(remove layer by l;ayer)
• for saucerization, do dressing for wound healing and prepare blood transfusuion

GANGLION

http://vipplasticsurgery.com/wp-content/uploads/2014/01/ganglion.jpg