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  1. Dermoid Cyst
    1. Dermoid cysts a solitary, or occasionally multiple, hamartomatous tumor.
    2. The tumor is covered by a thick dermislike wall that contains multiple sebaceous glands and almost all skin adnexa.
    3. Hairs and large amounts of fatty masses cover poorly to fully differentiated structures derived from the ectoderm.
    4. In addition to the skin, dermoid cysts can be intracranial, intraspinal, or perispinal. Intra-abdominal cysts, such as cystic tumors of the ovary or omentum, occur as well.
    5. Causes:  
      1. Dermoid cysts are true hamartomas.
      2. Dermoid cysts occur when skin and skin structures become trapped during fetal development.
      3. Histogenetically, dermoid cysts are a result of the sequestration of skin along the lines of embryonic closure.
    6. History:  
      1. Dermoid cysts that are congenital and localized on the neck, head, or trunk are usually visible at birth.
      2. Intracranial, intraspinal, or intra-abdominal dermoid cysts may be suspected after specific or nonspecific neurologic or gynecologic symptoms occur.
    7. Treatment: Surgical excision is the treatment of choice in any localization.
    1. Lipomas are adipose tumors that are often located in the subcutaneous tissues of the head, neck, shoulders, and back.
    2. These slow-growing, nearly always benign, tumors usually present as nonpainful, round, mobile masses with a characteristic soft, doughy feel.
    3. Rarely, lipomas can be associated with syndromes such as hereditary multiple lipomatosis, adiposis dolorosa, Gardner's syndrome, and Madelung's disease.
    4. Hereditary multiple lipomatosis, Q  an autosomal dominant condition is found most frequently in men, is characterized by widespread symmetric lipomas appearing most often over the extremities and trunk.
    5. Gardner's syndrome, an autosomal dominant condition involving intestinal polyposis, cysts, and osteomas.
    6. Madelung's disease, or benign symmetric lipomatosis, refers to lipomatosis of the head, neck, shoulders, and proximal upper extremities.
    7. Persons with Madelung's disease, often men who consume alcohol, may present with the characteristic "horse collar" cervical appearance.
    8. Dercum's disease, or adiposis dolorosa, which is characterized by the presence of irregular painful lipomas most often found on the trunk, shoulders, arms, forearms, and legs.
    9. Dercum's disease is five times more common in women, is often found in middle age, and has asthenia and psychic disturbances as other prominent features.
    10. There are also variants such as angiolipomas, neomorphic lipomas, spindle cell lipomas, and adenolipomas.
    11. Most lipomas are best left alone, but rapidly growing or painful lipomas can be treated with excision of the tumor.
    1. A haemangioma is a benign (overgrowth of blood vessels in the skin. It is due to proliferating endothelial cells.
    2. Ten percent of babies develop one or more haemangiomas. Over 80% occur on the head and neck area. They can grow for up to 18 months before they start regressing.
    3. This regression is known as involution and can take as long as 3-10 years.
    4. Haemangioma is compressible because it consists of multiple blood-filled vascular spaces.
    5. Other compressible swellings are lymphangiomas, aneurysms, pharyngeal pouch, saphena varix, varicocoele, pneumatocoele, laryngeocoele, tracheocoele and hernias.
    6. The commonest site of a haemangioma is head and neck region.
    7. It affects internal organs also like liver and spleen.  
      1. Different types of haemangioma are:
        1. Capillary Haemangioma :  Port wine stain, Strawberry angioma, Salmon patch, Spider naevi
        2. Venous Haemangioma (Cavernous haemangioma)
        3. Arterial Haemangioma (Circoid aneurysm)
        4. The commonest complication of a haemangioma is Haemorrhage. 
      2. Types of haemangiomas
        There are basically two main types of haemangiomas:
        1. Capillary and cavernous.
          1. Capillary haemangiomas (superficial angiomatous naevi) affect the blood vessels in uppermost   layers of the skin
          2. cavernous haemangiomas (subcutaneous angiomatous naevi) are more deeply set in the dermis and subcutis. In some cases, both types of haemangiomas may occur together (mixed angiomatous naevi).  
        2. Capillary haemangioma
          1. The capillary haemangioma or superficial angiomatous naevus is most commonly known as a strawberry haemangioma (strawberry birthmark, capillary naevus, haemangioma simplex).
          2. It is more common in premature babies and may appear when the baby is a few days or weeks old and rapidly grows over a few months.
          3. The eventual size varies from a tiny dot to several centimetres in diameter. Occasionally haemangiomas bleed or ulcerate, but this is rarely serious.
          4. As most strawberry birthmarks disappear without any treatment by themselves over 5-7 years, treatment is rarely indicated. Q
          5. If the birthmark grows over the eye, nose or mouth it could interfere with the breathing or feeding problems.
          6. Possible treatment includes oral steroids or laser therapy. Q
          7. Interferon is no longer advised because it has been associated with the development of cerebral palsy in a few infants. 
        3. ​​Cavernous haemangioma
          1. This type of birthmark is caused by overgrown blood vessels deep within the skin, resulting in a bluish swollen-up appearance.
          2. They may also grow and then get smaller, sometimes in conjunction with a strawberry mark.
          3. The Kasabach-Merritt syndrome is also known as haemangioma-thrombocytopaenia syndrome. It is a rare complication of a rapidly growing cavernous haemangioma in the first few months of life.
          4. A defect of blood clotting (coagulopathy) is marked by anaemia, low platelet count and prolonged bleeding. The bleeding is thought to result from trapping and destruction of the platelets and depletion of circulating clotting factors.
          5. The coagulopathy is treated with special blood transfusions, and generally oral steroids to reduce the size of the haemangioma.
          6. The rapid growth of the haemangioma may also result in heart failure.  
      3. Other haemangiomas
        The haemangiomas described below are all very rare conditons.



Verrucous haemangioma

Haemangiomas that also show an overgrowth and thickening of skin cells

May be a single lesion or group occurring most often on the legs

Do not resolve spontaneously and may need to be surgically excised

Eruptive neonatal haemangiomatosis

Multiple capillary haemangiomas present at birth or develop with first few weeks of life

If only the skin is involved the disorder is called benign eruptive neonatal haemangiomatosis: these usually resolve spontaneously over time

If lesions are also present on internal organs of the body (e.g. GI tract, lungs, brain, eyes) this is called disseminated eruptive neonatal haemangiomatosis: death generally occurs within the first few months of life

A newborn with multiple haemangiomas present must be investigated thoroughly for haemangiomas on internal organs

Ulcero-mutilating haemangiomatosis

Rare disorder of multiple haemangiomas that form ulcers that lead to severe tissue damage

Acquired multiple haemangiomatosis

Large numbers of haemangiomas appear in childhood or adulthood on the skin and internal organs, particularly the skeleton, brain and liver

Lesions persist indefinitely but are usually free of symptoms or complications

  1. Haemangiomas arising in adults
    1. Small capillary spots are called Campbell de Morgan lesions Q (also known as cherry angiomas), and appear most often around the midtrunk.
    2. They increase in number from about the age of 40. Their cause is unknown.
    3. They can be simply removed by diathermy or laser, but are usually left alone.
    4. Angiomas are common on the face, particularly around the mouth. On the lip they are known as Venous Lakes, and are bluish in colour.
    5. No treatment is generally required.  
  2. Investigations
    Haemangiomas are usually diagnosed clinically and no investigations are necessary.
    1. However, when there is uncertainty about the diagnosis or whether underlying tissues are affected, an ultrasound scan is often performed.
    2. Characteristically, a haemangioma has a firm lobular structure with vessels separating the lobules.
    3. In more complicated cases it may be necessary to perform Magnetic Resonance Imaging (MRI) or angiography to help plan treatment.
  3. Treatment of a cavernous haemangioma Q : Different lines of treatment are:
    1. Injection of a sclerosant material (commonest material used is Ethanolamine oleate.)
    2. Embolization injection (materials used are Gelfoam, alcohol foam & silicon particles)
    3. Surgical excision
    4. Laser radiation 
  4. Treatment
    Several methods for treatment of cancer of the head and neck are acceptable, including surgery, radiotherapy, chemotherapy, and combinations of these.

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