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Head and neck lesions of the infant

by Tara Oetken, MD

Diagnosed by exam and history

Accessory Tragus Skin-colored papule anterior to the Many associated genoderms,
normal tragus. Bilateral in ~10- however most children are
20% of cases. completely normal.
Cephalohematoma Subperiosteal hematoma. More Complications include calcifica-
common after prolonged labor, tions, hyperbilirubinemia, and
instrument assisted deliveries. infection
Develop in the first hours after
birth. Do not cross the midline.
Spontaneous resorption and reso-
lution over several months.
Caput Succedaneum Localized edema. Boggy mass of No treatment needed.
the scalp with varying degrees of Sometimes permanent alopecia
bruising and necrosis. Cross the can occur (halo scalp ring)
midline. Spontaneously resolves
over 48 hours.
Deep Infantile Hemangioma Skin-colored to bluish, soft, freely May be difficult to distinguish
mobile nodule which appears from vascular malformation
weeks to several months after birth (more common on the extremi-
and continues to grow for ~ 1 year. ties), and U/S may be needed.
Encephalocele Soft mass that can enlarge with Often seen with other neu-
crying. May transilluminate. rologic abnormalities. When
Compressible. suspected, imaging and refer-
ral to neurosurgery should be
prompt.
Juvenile Xanthogranuloma Yellow/red/orange papule on the ~20% present at birth. Can
(JXG) head. have extracutaneous involve-
ment, MC is eye, second MC is
lung. If associated with NF-1,
> 20x increased risk of JMML.
Resolve on their own.
Leptomeningeal Cyst Pulsatile non-tender mass at site
of previous head trauma.
Lipoma Skin-colored, soft, rubbery subcu- Can be seen in infancy, but
taneous nodule(s). Most commonly more common after puberty.
on the neck, shoulders, back,
abdomen.
Nasal Glioma Firm, non-compressible, non-pul- Often mis-diagnosed as infan-
satile mass that does not transil- tile hemangioma due to ery-
lumate. thematous color and prominent
telangiectasia.
Pilomatricoma Hard subcutaneous mass, often Cheeks and eyebrows are
skin to bluish in color. May ulcer- common locations. If multiple
Tara Oetken, ate. lesions present, associations
MD, is a PGY-4
include Gardner Syndrome,
dermatology resident
at the University of Myotonic Dystrophy and
Arkansas for Medical Rubenstein-Taybi.
Sciences (UAMS), in Pilar Cyst Slowing growing, skin-colored, Small subset are AD inherited.
Little Rock, Arkansas. mobile subcutaneous mass. Often Lack granular cell layer on
more than one lesion path.

p. 6 • Winter 2019 www.aad.org/DIR

 boards fodder
Head and neck lesions of the infant Boards
by Tara Oetken, MD
Fodders
Diagnosed with imaging and biopsy
online!
Dermoid Cyst Firm, non-compressible, non- Those on the nose or midline
pulsatile subcutaneous lesions. scalp are at higher risk of hav-
MC location is the lateral eyebrow. ing intracranial extension.
Other common locations include Imaging is required prior to
medial eyebrow/nasal bridge. surgical excision.
Eosinophilic Granuloma Focal tender painful swollen mass. Self resolving variant of
Langerhans cell histiocytosis. In addition to this
Infantile Myofibromatosis Firm, skin colored to vascular Most common fibrous tumor issue’s Boards Fodder,
appearing, subcutaneous nodule. of infancy. Lesions w/o visceral please check out the
special edition of our
MC locations are head, neck, trunk involvement tend to involute in
new online Boards
and upper extremities. 1-2 years.
Fodder exclusive.
Melanotic Neuroectodermal Rare. Usually present in the 1st MRI is preferred imaging. Biologics Update 2019
Tumors of Infancy year of life as rapidly growing, Treatment is complete surgical by Elise Craig, DO, is a
non-mobile, non-ulcerative bluish/ resection. comprehensive update
black mass. Most common in the of our former derma-
tology biologics chart
anterior maxilla but cases in the
with several of the lat-
skull and extremities are reported.
est biologics included.
Normally painless and benign, You can view, down-
but malignant transformation is load, or print any of
reported in ~6-7% our Boards Fodder
Neuroblastoma Red to bluish, firm, asymptomatic Skin metastasis are present in charts at www.aad.
org/boardsfodder.
nodules. If rubbed will blanch and ~1/3 of cases.
More than 100 charts
have erythematous rim due to cat- are now available!
echolamine release.
Rhabdomyosarcoma Painful, rapidly growning. Rare in skin but can present as
Appearance can vary from small a metastasis. Head and neck
nodule to large vascular like are the most common sites of
plaque. presentation

References
1. Bansal, Anmol Gupta (07/2018). “US of Pediatric Superficial Masses of the Head and
Neck.” Radiographics (0271-5333), 38 (4), p. 1239. Got Boards?
2. Bolognia, Jean L., Joseph L. Jorizzo, and Julie V. Schaffer. Dermatology. Philadelphia: Elsevier
Saunders, 2012.
3. Bowen, Casey D (03/2015). “Large, exophytic mass on the scalp of a newborn. Solitary infantile
myofibroma.” Pediatric dermatology (0736-8046), 32 (2), p. 281.
4. Ding, AngAng (09/2019). “Role of ultrasound in diagnosis and differential diagnosis of deep
infantile hemangioma and venous malformation.” Journal of vascular surgery. Venous and Directions in Residency
is currently
lymphatic disorders (New York, NY) (2213-333X), 7 (5), p. 715.
accepting
5. Owen, Bryce (11/2018). “Melanotic neuroectodermal tumor of infancy: A rare pediatric head and submissions for new
neck lesion.” Pediatric dermatology (0736-8046), 35 (6), p. e389. Boards Fodder charts
for 2020. Get
6. Paller, Amy, Sidney Hurwitz, and Anthony J. Mancini. Hurwitz Clinical Pediatric Dermatology: A published, impress
Textbook of Skin Disorders of Childhood and Adolescence (Expert Consult Title). 5th ed. N.p.: your friends,
Elsevier Health Sciences, 2015. and help out your
fellow residents.
Contact Dean Monti,
dmonti@aad.org with
your chart ideas.

A Publication of the American Academy of Dermatology | Association Winter 2019 • p. 7