Lesions may be confused with angiolipomas and hemangiomas; however, a distinguishing feature is the tendency of neurofibromas to be especially soft centrally and invaginate with digital
Trang 1painless, though at times can be mildly pruritic Most do not appear until adolescence Multiple neurofibromas should raise the suspicion for neurofibromatosis type I Lesions may be confused with angiolipomas and hemangiomas; however, a distinguishing feature is the tendency of neurofibromas
to be especially soft centrally and invaginate with digital pressure, described as
“button-holing.” Elective excision is indicated only if the lesion is compressing a nerve causing nerve root pain, because excision is often followed by recurrence
of an even larger lesion
Keloid/Hypertrophic Scar
Exaggerated proliferation of fibrous connective tissue in the process of cutaneous
wound healing results in formation of hypertrophic scars and keloids Wounds
involving areas of skin that are thick or under high tension (shoulders, back, chest, or chin) are at greatest risk The ear lobe is another commonly affected site Individuals with dark skin are much more susceptible to abnormal scarring, which has its highest incidence in adolescence and early adulthood Hypertrophic scars remain confined to the area of original injury They are rarely painful and tend to undergo slow regression over 6 to 12 months In contrast, keloids extend beyond the original wound margins and rarely regress spontaneously Initially, keloids may be tender or pruritic They have a rubbery consistency on palpation and a
smooth pink surface ( Fig 120.21 ) Ear piercing, tattooing, and elective cosmetic
procedures should be avoided in persons who tend to form keloids If a family chooses to pursue ear piercing, they should be counseled to complete the procedure in the first decade of life where the risk of keloid is lower, though not absent Keloids can be treated with topical or intralesional steroid injections, laser therapy, cryotherapy, and surgical excision with postoperative pressure dressing Recurrence is common and often difficult to treat Patients with severe keloids should be referred to a dermatologist or plastic surgeon for further treatment