Nodular lesions
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.
Overview
A nodular lesion that is > or equal to 1 cm is referred to as a nodule. There are many differential diagnoses for nodules as they can be subcutaneous, intraepidermal, dermal or exophytic. To obtain the correct diagnosis it is importnat to observe the growth rate, color, symptoms and any underlying conditions that may have caused the nodules.
Causes
Life Threatening Causes
- Apocrine hidrocystoma
- Basal cell papilloma
- Granular cell tumor
- Melanoma
- Squamous cell carcinoma of skin
- Stomach cancer
Common Causes
- Actinic keratosis
- Angiocentric immunoproliferative lesion
- Blue nevus
- Calcinosis cutis
- Cold panniculitis of haxthausen
- Cutaneous abscess
- Cutaneous metastasis
- Cutaneous nodules
- Dermatofibroma
- Dermatofibrosarcoma protuberans
- Desmoid
- Enchondromatosis
- Eosinophilic cellulitis
- Epidermal inclusion cyst
- Erythema elevatum diutinum
- Erythema induratum
- Erythema nodosum
- Familial cutaneous collagenoma
- Focal dermal hypoplasia
- Follicular infundibulum tumor
- Garrod pads
- Granular cell tumor
- Granuloma annulare
- Granuloma faciale
- Juvenile xanthogranuloma
- Kaposiform hemangioendothelioma
- Keloid
- Keratoacanthoma
- Lipoid dermatoarthritis
- Lobomycosis
- Lymphocytoma cutis
- Malakoplakia
- Merkel cell carcinoma
- Microcystic adnexal carcinoma
- Necrobiosis lipoidica
- Panniculitis
- Pigmented naevus
- Spitz nevus
- Squamous cell carcinoma of skin
- Subcutaneous nodules
- Tendon nodules
- Tophus
- Trichofolliculoma
- Xanthomata
Causes by Organ System
Causes in Alphabetical Order
- Actinic keratosis
- Amyloidosis
- Angiocentric immunoproliferative lesion
- Angiolymphoid hyperplasia with eosinophilia
- Apocrine hidrocystoma
- Apolipoprotein c-ii deficiency
- Apoprotein e deficiency
- Balamuthia mandrillaris
- Basal cell papilloma
- Benign cystic mucinous tumor
- Blau syndrome
- Blue nevus
- Botryomycosis
- Breast cancer
- Bronchogenic carcinoma
- Calcinosis cutis
- Calcinosis-raynaud-sclerodactyly-telangiectasia syndrome
- Cholestanol storage disease
- Cold panniculitis of haxthausen
- Cole disease
- Colorectal cancer
- Cutaneous abscess
- Cutaneous metastasis
- Cutaneous nodules
- Cysticercosis
- Dermatofibroma
- Dermatofibrosarcoma protuberans
- Desmoid
- Eccrine porocarcinoma
- Eccrine poroma
- Eccrine spiradenoma
- Enchondromatosis
- Endovascular papillary angioendothelioma
- Eosinophilic cellulitis
- Epidermal inclusion cyst
- Erythema elevatum diutinum
- Erythema induratum
- Erythema nodosum
- Familial cutaneous collagenoma
- Familial hypertriglyceridaemia
- Farber lipogranulomatosis
- Focal dermal hypoplasia
- Follicular infundibulum tumor
- Garrod pads
- Glycogenosis type 1b
- Granular cell tumor
- Granuloma annulare
- Granuloma faciale
- Graves' disease
- Heberden nodes
- Hereditary leiomyomatosis
- Hidradenoma
- Infantile digital fibromatosis
- Juvenile xanthogranuloma
- Kaposiform hemangioendothelioma
- Keloid
- Keratoacanthoma
- Ldl receptor deficiency
- Leukemia cutis
- Lipoid dermatoarthritis
- Lipoid proteinosis
- Lipoma
- Lipoprotein lipase deficiency
- Lobomycosis
- Lymphocytoma cutis
- Malakoplakia
- Melanoma
- Merkel cell carcinoma
- Microcystic adnexal carcinoma
- Mycobacterium abscessus
- Mycobacterium marinum
- Mycobacterium ulcerans
- Myiasis
- Nakajo-nishimura syndrome
- Necrobiosis lipoidica
- Neurofibromatosis type 1
- Onchocerciasis
- Osler nodes
- Osteopoikilosis
- Otulin related autoinflammatory syndrome
- Ovarian cancer
- Panniculitis
- Pigmented naevus
- Pilomatrixoma
- Polyarteritis nodosa
- Polymyositis
- Pretibial myxoedema
- Protothecosis
- Pyogenic granuloma
- Renal adenocarcinoma
- Renal failure
- Rheumatic fever
- Rheumatoid disease
- Sister mary joseph nodule
- Sitosterolemia
- Spindle cell hemangioendothelioma
- Spitz nevus
- Sporotrichosis
- Squamous cell carcinoma of skin
- Stomach cancer
- Subcutaneous nodules
- Systemic hyalinosis
- Systemic sclerosis
- Tendon nodules
- Tinea profunda
- Tophus
- Torg-winchester syndrome
- Trichofolliculoma
- Vitamin e deficiency
- Weber-christian disease
- Xanthomata
- Zygomycosis
Differential Diagnosis
In alphabetical order. [1] [2]
- Dermatofibroma
- Dermal/subcutaneous neoplasms
- Epidermoid
- Epidermal inclusion cyst
- Ganglion cyst
- Hypertrophic scars
- Kaposi's sarcoma
- Lipoma
- Nodular melanomas
- Pilar cyst
- Pyogenic granuloma
- Xanthoma
Diagnosis
History and Symptoms
- Note the morphology of the nodule
- size changes
- tenderness
- History
- malignancies/ rheumatoid arthritis
- immunosupression
- family history of melanoma
Laboratory Findings
- Appropriate cultures should taken of suppurative lesions
Other Diagnostic Studies
- Biopsy to determine characteristics of nodule
- Shave
- Punch
- Excisional
Treatment
- Treatment includes excision whether for cosmetic or symptomatic reasons
- Epidermoid cysts:
- Lesions must calm down before excision
- Intralesional steroids
- It must be completely removed to avoid a recurrent lesion