SKIN & SUBCUTANEOUS TUMORS.

1.DERMOID CYST.Lined by Sq Epithelium.Has Pultaceous tooth paste like material of Desquqmated epithelial Cells.4 Types- 1,Sequestration. 2.Implantation. 3.Tublo Epidermoid. 4.Teratomatous.

1.Sequestration.Congenital.Inclusion of epithelium buried at thgevline of Embryonic Fusion.Sq Epithelim,hair Follicles,Sebacious & Sweat glands.Pasty pultaceous desquamated matrial with or witout Hair.Mixture of Sebum,sweat &desquamated cells.Sites-Midline-neck Ext Angular bove the outer canthus of eye-fusio of Fronto Nasal& Maxillary Process. Post Auricular-Behind ear. On the Skull at Fusion sites. Midline- Root of the Nose. Submental Dermoid.Pathology- Few Ectodermal cells get buried in the deeper Layer-Proliferate & Liquify. Lie near to Mesoderm so Eodes deeper tiussue as Bones. Can also originate in Mesodem & extend further Deep thru Bone into Skull.CLINICALLY ;Starts at birth but seen at later age.No Symptoms.Rarely Infected as got Thick Wall.Slowly groth.Cosmetic disfigurement as canbe large.Ovoid/Sherical.Smooth surface.No punctum.Soft /Indentable/Non Compressible or reducible.Not fixed to kin.BONY EROSION.Non illuminate.Can Have Intra Cranial Extension.

Inx ;1.X-ray to see Bony erosion.

2.CT Scan if Deep. & fixed.

Complication.Rarely- Infection, Suppuration, Ulceration. Local Pressure effect.

TREATMENT.Complete Exicision unde GA.If a gap in te bine wait for the bone Suture to close.If Intracranial deep- Osteoplastic Flap.

SUBMENTAL DERMOID ; Sequestration dermoid . Fusion of 1 & 2nd Branchial Arches.Complication—Infection/Ulceration /prone for Trauma /Cosmetic.

DD.;1.submental Lymph node-septic foci.2.Sebacious Cyst-3.Suprahyoid Thyroglossal Cyst.4.Ectopic Thyroid. Rx-Total Exicision.

2.IMPLANTATION DRMOID. ;Acquired indriven Epithelium beneath the skin due to puncture injury-Needle/Thorn prick.Palm of Hand /Finger-Pulp-Tip/Sole.Gardners,Talors /Female.Lined bythik Sq epithelium containing White Cheesy Desquamated epi cells &Sebum but no Hair.Bygone Prick.Painless Swelling.Tense Cystic-Firm-Hard,Globlar /scar +Rx ;Infection.SuppurationRupturePressure Effect on Digital Nerves in Finger.Rx ;Exicision.

3.TUBULO DERMOID CYSTS.Congenital unobliterated ectodermal ducts/tracts.Lining Ectodermal cells of unobliterated ducts with Secretiona.ThyroGlossal Cyst.b.Post Anal Dermoid- remnant of Neuroenteric canal/Postanal gut-teratoma.c.Ependymal Cyst of Brain.-infolded Neuroectoderm.

4.TERATOMATOUS DERMOID.Cysts from totipotent cells of Ectodermal preponderance .Also contains mesodermal Cells as Bone/Cartilage/Hairs/Tooth & Cheesy mayerial.AT -Ovary.-Ovarian Cyst. Testis –Teratoma, Mediastinum-mediastinal Cyst, Retroperitoneal-Cyst, Post Anal dermoid

SEBACIOUS CYST.

Sebacious glands in the skin secret Sebum to keep the skin soft & oily.Duct opens into the Hair Follicle & rarely to skin.If the duct opening is blocked it gets DISTENDED with own secretion ---SEBACIOUS CYST –RETENTION cyst-EPENDYMAL CYST ( lined by Superficial Sq cells)Yellowish Pultaceous material of unpleasant smell.In the Dermal level & extends ti subcutaneous plane.Dermis Raised as Firm Elastic Dome shaped swelling.Black punctum of Keratin plug

AT---Any where Except Palm/Sole.Scalp/face/Neck/Shoulders/Chest/Abdomen/Scrotum……CLINICALLY ;Any age-Young-old..Rare in Children.Spherical –few mm to 5 cm>Smooth surface with Punctum.Fixed to skin at Punctum.SoftIndntable mouldable fluctant & movable in Skin if not infected.In SCROTAL seb Cyst ; Multiple, Fells solid like Kachang, Yellowish tallow & no Punctum.

DD-Lipoma/dermoid Cyst/neurofibroma/Fibroma.

COMPLICATIONS ;1.Infection /Suppurtion –can be repeatedly get infected.2.Ulceration- bursts releases contents & covered by granulation tissue & looks as Epithelioma. In Skull lcertes & Excess granulation tissue will form & Appears as “ Cocks Peculiar Tumor”-angry & sore- Granulation tossue arise from the epithelial cella Heaps upthru Skin giving an everted edge.Infection becomes Edematous/ Red/tender & Lymph Nodes +3.Sebacious Horn-slow discharge of sebum-gets dried hardens & hornifies.4.Calcification-inScrotum.5.Malignancy-BCC.

Rx;Exicision.Incision & Avulsion.Wide Exicision & SSG.Wide Exicision of Scrotual Skin/Srotectomy & Implantation of Testis in the Thighs.

LIPOMA.