Differential diagnoses - Benign skin lesions

Diagnose a cyst, ganglion, lipoma and dermatofibroma. Dr Nigel Stollery highlights the differences in presentation

Epidermoid cyst

Presentation

  • Occurs more commonly in hair-bearing areas
  • Lesion varies in size from a few millimetres to many centimetres
  • Punctum may be visible
  • Secondary bacterial infection may occur
  • Contents can usually be expressed
  • Contains sebum which has characteristic odour
  • Multiple lesions may be present

Management

  • Treatment not always required
  • Excision can be undertaken, but recurrence may occur
  • Secondary infection may require oral antibiotics

Ganglion

Presentation

  • Fluid-filled cyst that may fluctuate in size
  • Occurs over joints
  • Common at any age
  • Firm to the touch, but not bony hard
  • -Radiolucent

Management

  • Typically ruptures after trauma
  • Aspiration with a large-bore needle possible
  • Recurrence common
  • In persistent cases, surgical excision can be undertaken

Dermatofibroma

Presentation

  • Common on limbs
  • Occurs secondary to foreign body, such as an insect bite or ingrowing hair
  • Typically dimples when pinched
  • May be pigmented
  • A malignant variant, dermatofibrosarcoma protuberans, is very rare

Management

  • Treatment usually not required
  • Rarely resolves without treatment
  • If treatment is necessary, formal excision is the treatment of choice

Lipoma

Presentation

  • Occurs anywhere on the body
  • May be multiple and some can be very large
  • Located below the skin with normal skin overlying
  • Smooth but irregular surface
  • Non-tender and often asymptomatic

Management

  • Treatment not usually required for smaller lesions
  • Excision is treatment of choice
  • Recurrence may occur
  • Dr Stollery is a GP in Kibworth, Leicestershire

This is an updated version of an article that was first published in January 2014.

Click here to take a test on this article and claim a certificate on MIMS Learning

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

30,000 GPs face uncertainty over pension tax risk for 2017/18

30,000 GPs face uncertainty over pension tax risk for 2017/18

More than 30,000 GPs do not know if they will face pension tax charges for 2017/18...

NHS 'rapid response' teams must not drive up GP workload, warns BMA

NHS 'rapid response' teams must not drive up GP workload, warns BMA

NHS 'rapid response' teams being rolled out from April to help older people avoid...

Councils demand transformation of London's ageing GP surgeries

Councils demand transformation of London's ageing GP surgeries

Council leaders in London are calling for a transformation of the capital’s 'ageing...

GP demand greater focus on underdoctored areas as access inequalities grow

GP demand greater focus on underdoctored areas as access inequalities grow

GP leaders have called for a greater focus on recruitment to underdoctored areas...

Draft PCN plans put practices' financial stability at risk, say London GPs

Draft PCN plans put practices' financial stability at risk, say London GPs

Draft service specifications for primary care networks (PCNs) threaten the stability...

One in six GP practices linked to parkrun events

One in six GP practices linked to parkrun events

More than 1,350 GP practices across the UK have linked up with a local parkrun event...