Lumps and bumps

A vast majority of them are generally benign, but sadly a small proportion maybe cancerous. They should be examined by a doctor, especially if it develop suddenly, grow rapidly or show a change in characteristic. These are some of the lesions that may need a formal examination:

• Cyst

  Cyst develops from the skin component. They can occur anywhere in the body. It may stay quiescent and remain the same size. However, they can also increase in size, have a smelly whitish discharge or even get infected and discharge pus. If they are bothersome or get infected, they should be removed.

• Nevus Sebaceum

  It is often found at birth, often over the head and neck region and most commonly over the scalp region. It generally starts as a yellowish plaque-like hairless area, that is often ovoid or linear in orientation. This will gradually change in colour to a darker yellow or orange appearance, as well as becoming thicker, more bumpy and warty in appearance.

  They have a classical characteristics, but the final diagnosis is made after the lesion has been removed and studied histologically.

  They can sometimes be associated with sebaceous naevus syndrome, in which there are involvement of the eye, brain and skull.

  There is a risk of about 10-20% of these lesions becoming different types of skin cancer if left untreated over time. The treatment of choice is a complete surgical excision.

• Pilomatrixoma

  These often occur in young children idiopathically. They are often found over the head and neck region. It is a slow growing, usually benign skin tumour that arise from the hair follicles. They are often felt under the skin as a firm lesion, it can be single or sometimes multiple lesions.

  Occasionally multiple pilomatrixoma may be associated with certain syndromes.

  The treatment of choice is a complete excision. The possible recurrence of after a complete surgical excision is extremely low.

• Hemangioma

  These are red patches that occur often at birth or within the first or second week of birth. These lesions are made up of blood vessels and are mostly benign. They generally are found over the head and neck region, but can sometimes be found over other parts of the body.

  There are several types of hemangioma based on its appearance. These include capillary hemangioma, cavernous hemangioma, compound hemangioma as well as lobular capillary hemangioma (pyogenic granuloma).

  In children, they often undergo a classical pattern of growth: an initial rapid growth period during the first 1 to 2 years of life, followed by an involution/regression period of shrinkage. The shrinkage can generally be estimated to be about 50% by 5 year old, 70% by 7 years old and so forth.

  Most of them can be treated conservatively, however if the location involve special parts of the face like the eyes, nose and mouth that can affect functions like vision, breathing or eating, they may require treatment which can be in the form of medical or surgical.

• Pigmented lesions

  There are a wide variety of congenital or acquired pigmented lesion that can occur in children. These are some more common ones that we manage.

• Congenital melanocytic nevus

  They are present at birth. They present in about 1% of all newborn. They can be small in size or can be giant congenital nevus when they involve over 2% of the total body surface area of the children. Sometimes they can also have hair growing over the nevus. These nevi can grow in thickness and extend into the dermis, subcutaneous fatty layer or muscle. The larger the size of the lesions are, the risk of skin cancer developing increases.

  They may not require surgical removal immediately, but would definitely require follow up and monitoring for changes in characteristics.

  There is also a need to rule out neurocutaneous melanosis which is present in children with larger hairy congenital melanocytic nevi. These children may present with seizures and hydrocephalus.

• Acquired melanocytic nevus

  This is the most common type of melanocytic nevus. These develop during childhood, often in sun exposed areas. They can also increase in size as the child grows. There are several types namely junction nevus, dermal nevus and compound nevus.

  They can often be monitored closely without having the need for surgical excision. However should they start to change in characteristics or start to cause irritation of affect psychosocial development, they can be removed surgically.

• Blue nevus

  These are commonly dome shaped, smooth and have well defined edges. It appears bluish as the nevus are present deeper in the dermis.

This is the most common type of melanocytic nevus. These develop during childhood, often in sun exposed areas. They can also increase in size as the child grows. There are several types namely junction nevus, dermal nevus and compound nevus.

• Nevus of Ota and Ito

  These are formed in the dermis of the trigeminal nerve and lateral cutaneous brachial nerves of the shoulder respectively. They are often blue/grey in colour. With Nevus of Ota, there is possible involvement of the eye as the hyperpigmentation is found along the ophthalmic and maxillary region. These pigmentations generally become more intense in colour and darken until adulthood is reached. The risk of developing into skin cancer are rare.

  Most often, these are treated with repeated session of lasers to destroy the pigments. These can either be Q-switched Nd:YAG laser, Alexandrite laser or intense pulsed light laser. The most effective laser is the picosecond laser. Sometimes a combination of various treatment including chemical peel, dermabrasion and surgery maybe required.