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Semin Plast Surg 2006; 20(3): 180-191
DOI: 10.1055/s-2006-949121
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Papular and Nodular Skin Lesions in Children

Stephanie K. Fogelson1 , Magdalene A. Dohil1
  • 1Division of Pediatric & Adolescent Dermatology, Children's Hospital and Health Center, University of California, San Diego School of Medicine, San Diego, California
Further Information

Publication History

Publication Date:
18 September 2006 (online)

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ABSTRACT

A child may present to plastic surgery for treatment of a wide range of cutaneous lesions. Accurate clinical diagnosis of any skin lesion prior to considering excision results in an optimal outcome. This review discusses the most common papular and nodular skin lesions in children and addresses indications for removal as well as relative contraindications, alternative treatment options, and necessary further diagnostic work-up. Lesions are classified into five categories: expected spontaneous regression without treatment intervention; elective surgical removal guided by clinical circumstances, with a subgroup of these indicating possible underlying syndromes; further diagnostic imaging indicated prior to treatment intervention; and malignancy requiring complete surgical removal or adjuvant therapy (Fig. [1]).

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Figure 1 Factors to consider in the evaluation of papular and nodular skin lesions in children.

KEYWORDS

Pediatric skin tumor - spontaneous regression - elective surgical removal - underlying syndrome - further diagnostic imaging

REFERENCES

  • 1 Burgert S, Jones D H. Recurring digital fibroma of childhood.  J Hand Surg “Br”. 1996;  21 400-402
    PubMedGoogle Scholar
  • 2 Ishii N, Matsui K, Ichiyama S, Takahashi Y, Nakajima H. A case of infantile digital fibromatosis showing spontaneous regression.  Br J Dermatol. 1989;  121 129-133
    CrossrefPubMedGoogle Scholar
  • 3 Azam S H, Nicholas J L. Recurring infantile digital fibromatosis: report of two cases.  J Pediatr Surg. 1995;  30 89-90
    CrossrefPubMedGoogle Scholar
  • 4 Oh C K, Son H S, Kwon Y W, Jang H S, Kwon K S. Intralesional fluorouracil injection in infantile digital fibromatosis.  Arch Dermatol. 2005;  141 549-550
    CrossrefPubMedGoogle Scholar
  • 5 Albertini J G, Welsch M J, Conger L A, Libow L F, Elston D M. Infantile digital fibroma treated with Mohs micrographic surgery.  Dermatol Surg. 2002;  28 959-961
    CrossrefPubMedGoogle Scholar
  • 6 Hernandez-Martin A, Baselga E, Drolet B A, Esterly N B. Juvenile xanthogranuloma.  J Am Acad Dermatol. 1997;  36 355-367
    CrossrefPubMedGoogle Scholar
  • 7 Janssen D, Harms D. Juvenile xanthogranuloma in childhood and adolescence: a clinicopathologic study of 129 patients from the Kiel pediatric tumor registry.  Am J Surg Pathol. 2005;  29 21-28
    CrossrefPubMedGoogle Scholar
  • 8 Dehner L P. Juvenile xanthogranulomas in the first two decades of life: a clinicopathologic study of 174 cases with cutaneous and extracutaneous manifestations.  Am J Surg Pathol. 2003;  27 579-593
    CrossrefPubMedGoogle Scholar
  • 9 Chang M W, Frieden I J, Good W. The risk of intraocular juvenile xanthogranuloma: survey of current practices and assessment of risk.  J Am Acad Dermatol. 1996;  34 445-449
    CrossrefPubMedGoogle Scholar
  • 10 Zvulunov A, Barak Y, Metzker A. Juvenile xanthogranuloma, neurofibromatosis, and juvenile chronic myelogenous leukemia. World statistical analysis.  Arch Dermatol. 1995;  131 904-908
    CrossrefPubMedGoogle Scholar
  • 11 Heide R, Tank B, Oranje A P. Mastocytosis in childhood.  Pediatr Dermatol. 2002;  19 375-381
    CrossrefPubMedGoogle Scholar
  • 12 Ben-Amitai D, Metzker A, Cohen H A. Pediatric cutaneous mastocytosis: a review of 180 patients.  Isr Med Assoc J. 2005;  7 320-322
    PubMedGoogle Scholar
  • 13 Bukhari I A. Solitary mastocytoma successfully treated with a moderate potency topical steroid.  J Drugs Dermatol. 2004;  3 309-310
    PubMedGoogle Scholar
  • 14 Mateo J R. Mastocytoma: topical corticosteroid treatment.  J Eur Acad Dermatol Venereol. 2001;  15 492-494
    CrossrefPubMedGoogle Scholar
  • 15 Kacker A, Huo J, Huang R, Hoda R S. Solitary mastocytoma in an infant-case report with review of literature.  Int J Pediatr Otorhinolaryngol. 2000;  52 93-95
    CrossrefPubMedGoogle Scholar
  • 16 Pearson I C, Harland C C. Epidermal naevi treated with pulsed erbium:YAG laser.  Clin Exp Dermatol. 2004;  29 494-496
    CrossrefPubMedGoogle Scholar
  • 17 Boyce S, Alster T S. CO2 laser treatment of epidermal nevi: long-term success.  Dermatol Surg. 2002;  28 611-614
    CrossrefPubMedGoogle Scholar
  • 18 Sugarman J L. Epidermal nevus syndromes.  Semin Cutan Med Surg. 2004;  23 145-157
    CrossrefPubMedGoogle Scholar
  • 19 Lee B J, Mancini A J, Renucci J, Paller A S, Bauer B S. Full-thickness surgical excision for the treatment of inflammatory linear verrucous epidermal nevus.  Ann Plast Surg. 2001;  47 285-292
    PubMedGoogle Scholar
  • 20 Sidwell R U, Syed S, Harper J I. Pulsed dye laser treatment for inflammatory linear verrucous epidermal naevus.  Br J Dermatol. 2001;  144 1267-1269
    CrossrefPubMedGoogle Scholar
  • 21 Wienecke R, Klemm E, Karparti S, Swanson N A, Green A J, DeClue J E. Reduction of expression of tuberin, the tuberous-sclerosis-complex-gene-2 product in tuberous sclerosis complex associated connective tissue nevi and sporadic squamous and basal cell carcinomas.  J Cutan Pathol. 2002;  29 287-290
    CrossrefPubMedGoogle Scholar
  • 22 Kopec A V, Levine N. Generalized connective tissue nevi and ichthyosis in Down's syndrome.  Arch Dermatol. 1979;  115 623-624
    CrossrefPubMedGoogle Scholar
  • 23 Twede J V, Turner J T, Biesecker L G, Darling T N. Evolution of skin lesions in Proteus syndrome.  J Am Acad Dermatol. 2005;  52 834-838
    CrossrefPubMedGoogle Scholar
  • 24 Woodrow S L, Pope F M, Handfield-Jones S E. The Buschke-Ollendorff syndrome presenting as familial elastic tissue naevi.  Br J Dermatol. 2001;  144 890-893
    CrossrefPubMedGoogle Scholar
  • 25 Cigliano B, Baltogiannis N, De Marco M et al.. Pilomatricoma in childhood: a retrospective study from three European paediatric centres.  Eur J Pediatr. 2005;  164 673-677
    CrossrefPubMedGoogle Scholar
  • 26 Pirouzmanesh A, Reinisch J F, Gonzalez-Gomez I, Smith E M, Meara J G. Pilomatrixoma: a review of 346 cases.  Plast Reconstr Surg. 2003;  112 1784-1789
    PubMedGoogle Scholar
  • 27 Demircan M, Balik E. Pilomatricoma in children: a prospective study.  Pediatr Dermatol. 1997;  14 430-432
    PubMedGoogle Scholar
  • 28 Geh J L, Moss A L. Multiple pilomatrixomata and myotonic dystrophy: a familial association.  Br J Plast Surg. 1999;  52 143-145
    CrossrefPubMedGoogle Scholar
  • 29 Pujol R M, Casanova J M, Egido R, Pujol J, de Moragas J M. Multiple familial pilomatricomas: a cutaneous marker for Gardner syndrome?.  Pediatr Dermatol. 1995;  12 331-335
    CrossrefPubMedGoogle Scholar
  • 30 Cambiaghi S, Ermacora E, Brusasco A, Canzi L, Caputo R. Multiple pilomatricomas in Rubinstein-Taybi syndrome: a case report.  Pediatr Dermatol. 1994;  11 21-25
    CrossrefPubMedGoogle Scholar
  • 31 Matsuura H, Hatamochi A, Nakamura Y, Endo H, Shinkai H. Multiple pilomatricoma in trisomy 9.  Dermatology. 2002;  204 82-83
    CrossrefPubMedGoogle Scholar
  • 32 Noguchi H, Kayashima K, Nishiyama S, Ono T. Two cases of pilomatrixoma in Turner's syndrome.  Dermatology. 1999;  199 338-340
    CrossrefPubMedGoogle Scholar
  • 33 Hamilton K S, Johnson S, Smoller B R. The role of androgen receptors in the clinical course of nevus sebaceus of Jadassohn.  Mod Pathol. 2001;  14 539-542
    CrossrefPubMedGoogle Scholar
  • 34 Coban Y K. Hereditary inheritance of nevus sebaceus.  Dermatol Surg. 2005;  31 1444
    PubMedGoogle Scholar
  • 35 Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: a study of 596 cases.  J Am Acad Dermatol. 2000;  42 263-268
    CrossrefPubMedGoogle Scholar
  • 36 Davison S P, Khachemoune A, Yu D, Kauffman L C. Nevus sebaceus of Jadassohn revisited with reconstruction options.  Int J Dermatol. 2005;  44 145-150
    CrossrefPubMedGoogle Scholar
  • 37 Margulis A, Bauer B S, Corcoran J F. Surgical management of the cutaneous manifestations of linear nevus sebaceus syndrome.  Plast Reconstr Surg. 2003;  111 1043-1050
    CrossrefPubMedGoogle Scholar
  • 38 Dasgupta N R, Bentz M L. Nasal gliomas: identification and differentiation from hemangiomas.  J Craniofac Surg. 2003;  14 736-738
    PubMedGoogle Scholar
  • 39 Rahbar R, Resto V A, Robson C D et al.. Nasal glioma and encephalocele: diagnosis and management.  Laryngoscope. 2003;  113 2069-2077
    CrossrefPubMedGoogle Scholar
  • 40 Hanikeri M, Waterhouse N, Kirkpatrick N, Peterson D, Macleod I. The management of midline transcranial nasal dermoid sinus cysts.  Br J Plast Surg. 2005;  58 1043-1050
    CrossrefPubMedGoogle Scholar
  • 41 Pensler J M, Ivescu A S, Ciletti S J, Yokoo K M, Byrd S E. Craniofacial gliomas.  Plast Reconstr Surg. 1996;  98 27-30
    CrossrefPubMedGoogle Scholar
  • 42 Agirdir B V, Derin A T, Ozbilim G, Ozcaglar H. Endoscopic management of the intranasal glioma.  J Pediatr Surg. 2004;  39 1571-1573
    CrossrefPubMedGoogle Scholar
  • 43 Pryor S G, Lewis J E, Weaver A L, Orvidas L J. Pediatric dermoid cysts of the head and neck.  Otolaryngol Head Neck Surg. 2005;  132 938-942
    CrossrefPubMedGoogle Scholar
  • 44 Rahbar R, Shah P, Mulliken J B et al.. The presentation and management of nasal dermoid: a 30-year experience.  Arch Otolaryngol Head Neck Surg. 2003;  129 464-471
    CrossrefPubMedGoogle Scholar
  • 45 Weiss D D, Robson C D, Mulliken J B. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base.  Plast Reconstr Surg. 1998;  102 2119-2123
    CrossrefPubMedGoogle Scholar
  • 46 Zvulunov A, Rotem A, Merlob P, Metzker A. Congenital smooth muscle hamartoma. Prevalence, clinical findings, and follow-up in 15 patients.  Am J Dis Child. 1990;  144 782-784
    PubMedGoogle Scholar
  • 47 Gualandri L, Cambiaghi S, Ermacora E, Tadini G, Gianotti R, Caputo R. Multiple familial smooth muscle hamartomas.  Pediatr Dermatol. 2001;  18 17-20
    CrossrefPubMedGoogle Scholar
  • 48 Sato M, Ishikawa O, Miyachi Y, Aoki T, Tomomasa T, Nagashima K. Michelin tire syndrome: a congenital disorder of elastic fibre formation?.  Br J Dermatol. 1997;  136 583-586
    CrossrefPubMedGoogle Scholar
  • 49 McDowell H P. Update on childhood rhabdomyosarcoma.  Arch Dis Child. 2003;  88 354-357
    CrossrefPubMedGoogle Scholar
  • 50 Suita S, Noguchi S, Takamatsu H et al.. Clinical characteristics and the prognosis of rhabdomyosarcoma-a report from the Study Group for Pediatric Solid Malignant Tumors in the Kyushu Area, Japan.  Eur J Pediatr Surg. 2005;  15 409-413
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Punyko J A, Mertens A C, Baker K S, Ness K K, Robison L L, Gurney J G. Long-term survival probabilities for childhood rhabdomyosarcoma. A population-based evaluation.  Cancer. 2005;  103 1475-1483
    CrossrefPubMedGoogle Scholar
  • 52 Stevens M C. Treatment for childhood rhabdomyosarcoma: the cost of cure.  Lancet Oncol. 2005;  6 77-84
    CrossrefPubMedGoogle Scholar
  • 53 Cecchetto G, Carli M, Alaggio R et al.. Fibrosarcoma in pediatric patients: results of the Italian Cooperative Group studies (1979-1995).  J Surg Oncol. 2001;  78 225-231
    CrossrefPubMedGoogle Scholar
  • 54 Loh M L, Ahn P, Perez-Atayde A R, Gebhardt M C, Shamberger R C, Grier H E. Treatment of infantile fibrosarcoma with chemotherapy and surgery: results from the Dana-Farber Cancer Institute and Children's Hospital, Boston.  J Pediatr Hematol Oncol. 2002;  24 722-726
    CrossrefPubMedGoogle Scholar
  • 55 Wesche W A, Khare V K, Chesney T M, Jenkins J J. Non-hematopoietic cutaneous metastases in children and adolescents: thirty years experience at St. Jude Children's Research Hospital.  J Cutan Pathol. 2000;  27 485-492
    CrossrefPubMedGoogle Scholar
  • 56 Lukens J N. Neuroblastoma in the neonate.  Semin Perinatol. 1999;  23 263-273
    CrossrefPubMedGoogle Scholar
  • 57 Brodeur G M. Neuroblastoma: biological insights into a clinical enigma.  Nat Rev Cancer. 2003;  3 203-216
    CrossrefPubMedGoogle Scholar
  • 58 Escobar M A, Grosfeld J L, Powell R L et al.. Long-term outcomes in patients with stage IV neuroblastoma.  J Pediatr Surg. 2006;  41 377-381
    CrossrefPubMedGoogle Scholar
  • 59 Weinstein J M, Drolet B A, Esterly N B et al.. Congenital dermatofibrosarcoma protuberans: variability in presentation.  Arch Dermatol. 2003;  139 207-211
    CrossrefPubMedGoogle Scholar
  • 60 Mendenhall W M, Zlotecki R A, Scarborough M T. Dermatofibrosarcoma protuberans.  Cancer. 2004;  101 2503-2508
    CrossrefPubMedGoogle Scholar
  • 61 Khatri V P, Galante J M, Bold R J, Schneider P D, Ramsamooj R, Goodnight Jr J E. Dermatofibrosarcoma protuberans: reappraisal of wide local excision and impact of inadequate initial treatment.  Ann Surg Oncol. 2003;  10 1118-1122
    CrossrefPubMedGoogle Scholar
  • 62 Wolfe J. Identifying optimal surgical approaches for dermatofibrosarcoma protuberans.  Practical Dermatology. 2006;  3 52-53
    PubMedGoogle Scholar
  • 63 Bowne W B, Antonescu C R, Leung D H et al.. Dermatofibrosarcoma protuberans: a clinicopathologic analysis of patients treated and followed at a single institution.  Cancer. 2000;  88 2711-2720
    CrossrefPubMedGoogle Scholar
  • 64 Nguyen C M, Burch J M, Fitzpatrick J E, Peterson S L, Weston W L. Giant cell fibroblastoma in a child misdiagnosed as a dermatofibroma.  Pediatr Dermatol. 2002;  19 28-32
    CrossrefPubMedGoogle Scholar
  • 65 Savasan S. An enigmatic disease: childhood Langerhans cell histiocytosis in 2005.  Int J Dermatol. 2006;  45 182-188
    CrossrefPubMedGoogle Scholar
  • 66 Henter J I, Tondini C, Pritchard J. Histiocyte disorders.  Crit Rev Oncol Hematol. 2004;  50 157-174
    CrossrefPubMedGoogle Scholar
  • 67 Gadner H, Grois N, Arico M et al.. A randomized trial of treatment for multisystem Langerhans' cell histiocytosis.  J Pediatr. 2001;  138 728-734
    PubMedGoogle Scholar
  • 68 Ang P, Tay Y K, Walford N Q. Infantile myofibromatosis: a case report and review of the literature.  Cutis. 2004;  73 229-231
    PubMedGoogle Scholar
  • 69 Stanford D, Rogers M. Dermatological presentations of infantile myofibromatosis: a review of 27 cases.  Australas J Dermatol. 2000;  41 156-161
    CrossrefPubMedGoogle Scholar
  • 70 Wiswell T E, Sakas E L, Stephenson S R, Lesica J J, Reddoch S R. Infantile myofibromatosis.  Pediatrics. 1985;  76 981-984
    PubMedGoogle Scholar
  • 71 Ikediobi N I, Iyengar V, Hwang L, Collins W E, Metry D W. Infantile myofibromatosis: support for autosomal dominant inheritance.  J Am Acad Dermatol. 2003;  49(2 Suppl Case Reports) S148-S150
    PubMedGoogle Scholar

Magdalene A DohilM.D. 

Assistant Professor of Pediatrics & Medicine (Dermatology), Division of Pediatric & Adolescent Dermatology, Children's Hospital and Health Center, University of California, San Diego School of Medicine

8010 Frost Street, Suite 602, San Diego, CA 92123

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