Papular and Nodular Skin Lesions in Children

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]).

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
• 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
• 3 Azam S H, Nicholas J L. Recurring infantile digital fibromatosis: report of two cases.  J Pediatr Surg. 1995;  30 89-90
• 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
• 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
• 6 Hernandez-Martin A, Baselga E, Drolet B A, Esterly N B. Juvenile xanthogranuloma.  J Am Acad Dermatol. 1997;  36 355-367
• 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
• 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
• 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
• 10 Zvulunov A, Barak Y, Metzker A. Juvenile xanthogranuloma, neurofibromatosis, and juvenile chronic myelogenous leukemia. World statistical analysis.  Arch Dermatol. 1995;  131 904-908
• 11 Heide R, Tank B, Oranje A P. Mastocytosis in childhood.  Pediatr Dermatol. 2002;  19 375-381
• 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
• 13 Bukhari I A. Solitary mastocytoma successfully treated with a moderate potency topical steroid.  J Drugs Dermatol. 2004;  3 309-310
• 14 Mateo J R. Mastocytoma: topical corticosteroid treatment.  J Eur Acad Dermatol Venereol. 2001;  15 492-494
• 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
• 16 Pearson I C, Harland C C. Epidermal naevi treated with pulsed erbium:YAG laser.  Clin Exp Dermatol. 2004;  29 494-496
• 17 Boyce S, Alster T S. CO₂ laser treatment of epidermal nevi: long-term success.  Dermatol Surg. 2002;  28 611-614
• 18 Sugarman J L. Epidermal nevus syndromes.  Semin Cutan Med Surg. 2004;  23 145-157
• 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
• 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
• 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
• 22 Kopec A V, Levine N. Generalized connective tissue nevi and ichthyosis in Down's syndrome.  Arch Dermatol. 1979;  115 623-624
• 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
• 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
• 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
• 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
• 27 Demircan M, Balik E. Pilomatricoma in children: a prospective study.  Pediatr Dermatol. 1997;  14 430-432
• 28 Geh J L, Moss A L. Multiple pilomatrixomata and myotonic dystrophy: a familial association.  Br J Plast Surg. 1999;  52 143-145
• 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
• 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
• 31 Matsuura H, Hatamochi A, Nakamura Y, Endo H, Shinkai H. Multiple pilomatricoma in trisomy 9.  Dermatology. 2002;  204 82-83
• 32 Noguchi H, Kayashima K, Nishiyama S, Ono T. Two cases of pilomatrixoma in Turner's syndrome.  Dermatology. 1999;  199 338-340
• 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
• 34 Coban Y K. Hereditary inheritance of nevus sebaceus.  Dermatol Surg. 2005;  31 1444
• 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
• 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
• 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
• 38 Dasgupta N R, Bentz M L. Nasal gliomas: identification and differentiation from hemangiomas.  J Craniofac Surg. 2003;  14 736-738
• 39 Rahbar R, Resto V A, Robson C D et al.. Nasal glioma and encephalocele: diagnosis and management.  Laryngoscope. 2003;  113 2069-2077
• 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
• 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
• 42 Agirdir B V, Derin A T, Ozbilim G, Ozcaglar H. Endoscopic management of the intranasal glioma.  J Pediatr Surg. 2004;  39 1571-1573
• 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
• 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
• 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
• 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
• 47 Gualandri L, Cambiaghi S, Ermacora E, Tadini G, Gianotti R, Caputo R. Multiple familial smooth muscle hamartomas.  Pediatr Dermatol. 2001;  18 17-20
• 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
• 49 McDowell H P. Update on childhood rhabdomyosarcoma.  Arch Dis Child. 2003;  88 354-357
• 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
• 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
• 52 Stevens M C. Treatment for childhood rhabdomyosarcoma: the cost of cure.  Lancet Oncol. 2005;  6 77-84
• 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
• 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
• 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
• 56 Lukens J N. Neuroblastoma in the neonate.  Semin Perinatol. 1999;  23 263-273
• 57 Brodeur G M. Neuroblastoma: biological insights into a clinical enigma.  Nat Rev Cancer. 2003;  3 203-216
• 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
• 59 Weinstein J M, Drolet B A, Esterly N B et al.. Congenital dermatofibrosarcoma protuberans: variability in presentation.  Arch Dermatol. 2003;  139 207-211
• 60 Mendenhall W M, Zlotecki R A, Scarborough M T. Dermatofibrosarcoma protuberans.  Cancer. 2004;  101 2503-2508
• 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
• 62 Wolfe J. Identifying optimal surgical approaches for dermatofibrosarcoma protuberans.  Practical Dermatology. 2006;  3 52-53
• 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
• 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
• 65 Savasan S. An enigmatic disease: childhood Langerhans cell histiocytosis in 2005.  Int J Dermatol. 2006;  45 182-188
• 66 Henter J I, Tondini C, Pritchard J. Histiocyte disorders.  Crit Rev Oncol Hematol. 2004;  50 157-174
• 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
• 68 Ang P, Tay Y K, Walford N Q. Infantile myofibromatosis: a case report and review of the literature.  Cutis. 2004;  73 229-231
• 69 Stanford D, Rogers M. Dermatological presentations of infantile myofibromatosis: a review of 27 cases.  Australas J Dermatol. 2000;  41 156-161
• 70 Wiswell T E, Sakas E L, Stephenson S R, Lesica J J, Reddoch S R. Infantile myofibromatosis.  Pediatrics. 1985;  76 981-984
• 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