Clinical images: Lumps and bumps

Dr Phil Marazzi shares some interesting cases involving lumps and bumps.

Stasis dermatitis

This elderly woman was living in a rest home, where she sat in a chair all day, rarely getting out to walk. She had long-standing varicose veins and gross oedema. These nodules developed over her lower legs over a long period. There were more than 20 of them. An excision biopsy was undertaken, but histology revealed non-specific features, which the pathologists were reluctant to define in a diagnosis. After discussion with the patient, no further treatment was undertaken.

Cyst

This young man presented with a rapidly enlarging, tender swelling on his pinna. He was treated with flucloxacillin and the cyst reduced in size. Sebaceous or epidermoid cysts can occur in a variety of sites and this is one of the less commonly seen lesions, although when they do appear near the ear, it is often in the skin immediately adjacent to the ear. There is often a family history because the tendency to develop them may be carried genetically in an autosomal dominant manner.


Fibrolipoma

This large, pedunculated lesion had been present for a long time in this 56-year-old man, and would catch on his clothing. It was removed easily under a local anaesthetic. Histology revealed it to be a fibrolipoma. It was benign and needed no further treatment.

 


Xanthelasma

This patient presented with fatty lumps under each eye. Xanthelasmata are fairly common and are caused by deposits of cholesterol in subcutaneous tissue. They may be associated with underlying hyperlipidaemia, although this is often not the case. However, they do demonstrate a slightly higher risk of serious cardiovascular disease. They can be removed by a plastic surgeon if necessary. This man has a total cholesterol of 6.4mmol/L, but no other risk factors, and remains well.


Branchial cyst

This 71-year-old woman presented with a swelling in her neck. The worry was that this might be a secondary deposit in a cervical lymph node. She was referred for an ENT opinion and the diagnosis was subsequently confirmed as a branchial cleft cyst. Branchial cleft cysts are congenital epithelial cysts, which develop on the side of the neck as a result of failure of the second branchial cleft to seal off in embryonic development. The cyst was excised.


Abdominal hernia

Inguinal hernias are very commonly seen in practice, but are not the only type of hernia. This 50-year-old man had a large swelling that developed in the middle of his abdomen just above the umbilicus. This is a supra-umbilical hernia. Although unlikely to strangulate, it was uncomfortable, so he elected to have it surgically repaired.

Tick

This elderly man presented with a tick. It had been present for a couple of days and did not trouble him. He had been protecting it with a homemade dressing. There is some erythema around the area where the tick has attached itself. There were no symptoms suggestive of Lyme disease. These would include fever, arthralgia, headache and the classic erythema migrans rash. The tick was removed with a useful hook obtained from a local pet shop, which allows the tick to be ‘unscrewed’ without leaving any of the mouth parts in situ.


 

Keratoacanthoma

This swelling developed on the forearm of an 80-year-old woman. The relatively rapid growth, with a characteristic appearance, made it easy to diagnose. The outer part of the lesion surrounds a keratinised central core. These lesions may represent low-grade squamous cell carcinomas, so should not be ignored and must be managed accordingly. The patient was referred and the lesion excised.

  • Dr Marazzi is a GP in East Horsley, Surrey

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