benign lesions, retrorectal cystic hamartomas should be routinely resected in order to confirm diagnosis and avoid malignant transfor- mation or local complications.
Jesús García‐DonasNúria RodríguezCarlos JaraMiguel UriosteM NevadoVictoria CuarteroJ.C. Albillos MerinoDaniel VegaAntonio Quintáns
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Cutaneous cystic lesions have broad differentials ranging from common benign entity to rare malignant lesions. Clinical evaluation of the lesion is the key to differentiation, as some rare malignant entities may simulate benign lesions. A high index of suspicion should be maintained for any aggressive behavior, which may require more thorough evaluation, including histopathology and radiographic imaging studies. We report a rare case of cystic poorly differentiated squamous cell carcinoma (CPDSCC) of the scalp.We report a case of a 37-year-old Filipino expatriate male who presented with a scalp swelling which had been gradually increasing in size for four months and was operated upon with a working diagnosis of sebaceous cyst. On post-op excisional biopsy, it turned out to be poorly differentiated cystic squamous cell carcinoma of the scalp. On further workup, no metastasis or other primary was found. Complete re-excision of the lesion with no evidence of residual tumor was achieved. Long-term follow-up was lost, as the patient left for his native country.Though cystic cutaneous lesions are very commonly encountered in clinical practice, high suspicion for malignancy should be maintained if the lesion shows any aggressive behavior. Prompt investigation should be done before surgery to determine the nature of the disease and the most effective management for the patient. Poorly differentiated cystic squamous cell carcinoma should also be considered in the differential diagnosis of cystic cutaneous lesions show aggressive behavior.
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Benign skin tumors are commonly seen by family physicians. The ability to properly diagnose and treat common benign tumors and to distinguish them from malignant lesions is a vital skill for all family physicians. Any lesions for which the diagnosis is uncertain, based on the history and gross examination, should be biopsied for histopathologic examination to rule out malignancy. Lipomas are technically subcutaneous soft tissue tumors, not skin tumors, and controversy exists about whether keratoacanthomas have malignant potential; however, both are discussed in this article because they are common tumors evaluated by family physicians. Diagnosis usually is based on the appearance of the lesion and the patient's clinical history, although biopsy is sometimes required. Treatment includes excision, cryotherapy, curettage with or without electrodesiccation, and pharmacotherapy, and is based on the type of tumor and its location. Generally, excision is the treatment of choice for lipomas, dermatofibromas, keratoacanthomas, pyogenic granulomas, and epidermoid cysts. Cherry angiomas and sebaceous hyperplasia are often treated with laser therapy and electrodesiccation. Common treatments for acrochordons and seborrheic keratoses are cryotherapy and shave excision. Referral is indicated if the family physician is not confident with the diagnostic evaluation or treatment of a lesion, or if a biopsy reveals melanoma.
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