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Nodules on the face are usually due to tumours, the commonest being basal cell skin cancers, squamous cell skin cancers, melanoma and Merkel cell skin cancers and atypical fibroxanthomas.  The benign nodules on the face would be sebaceous or dermoid cysts, the latter particularly occurring around the base of the nose and the eyes, near the embryonic planes. neurofibromas and trichoepitheliomas.  Conditions that cause deposits in the skin can also cause nodules on the face particularly amyloidosis, sarcoidosis and infective disorders such as leishmaniasis,treated leprosy, TB and rarely tertiary syphilis.  Mycosis fungoides or T cell lymphoma of the skin, B cell lymphoma, Granuloma faciale and Lymphocytoma cutis and angiosarcomas could all cause nodules on the face. 

 

Management – generally a biopsy is necessary to establish the diagnosis of the facial nodule and the tissue should be sent for culture for atypical mycobacteria and for deep fungal infections if an infective cause is considered. 

 

SIGN DIP MEN    Nodules Overview

 

S-Squamous   Many of the infective nodules below will have a rough surface 

 

I-Infective          Deep fungal infections particularly Chromoblastomycosis and Sporotrichosis, Tuberculosis, Atypical mycobacterial ,Leishmaniasis, Syphilis, Leprosy, Orf, Milker’s nodules,

 

G-Granulomatous    Sarcoidosis,Granuloma annulare, Foreign body, Erythema elevatum diutinum, Rheumatoid nodule, Granuloma faciale, Panniculitis,

 

N-Neoplastic    Benign Tumours such as sebaceous cysts, dermatofibroma, lipoma. More aggresive tumours such as  Basal cell carcinoma, Squamous cell carcinoma, Keratoacanthoma, Metastases, Merkel cell, Melanoma, Atypical fibroxanthoma, Mycosis fungoides, B cell lymphoma, Lymphocytoma, Angiolymphoid hyperplasia with eosinophilia, Angiosarcoma, Lymphangiosarcoma, Dermatofibrosarcoma protuberans, Cylindroma

 

D-Drugs    Iodides, Bromides, Phenytoin, Dapsone

 

I-Immunological   Erythema nodosum , Sweet’s syndrome, Kimuras disease

 

P-Physical    Prurigo nodularis, Pyogenic granuloma, Digital myxoid cyst, Chilblains(Perniosis)

 

M-Metabolic   Xanthomas, Gouty tophi, Tumoral calcinosis, Mucinoses

 

E-Endocrine    Pretibial myxedema,

 

N-Nutritional

 

Others     Painful nodules   Multiple familial leiomyomas, Spiradenoma, Glomus tumour, Angiolipoma, Blue rubber bleb nevus, Neuroma, Neurilemmoma, Neurofibroma, Keloid, Granular cell tumour, Dermatofibrosarcoma protuberans, Bleeding into a dermatofibroma

 

Yellow Nodules   Xanthomas, Xanthogranuloma, Sebaceous nevi, Histiocytosis,

 

Vascular Looking Nodules    Bacilliary angiomatosis, Kaposi's sarcoma, Pseudo Kaposi's sarcoma, Angiosarcoma, Multiple Glomus tumours, Leukemia cutis, Systemic amyloidosis, Metastatic melanoma, Metastaic Merkels, Sweet's syndrome, Sarcoidosis, Maffucci's syndrome, Angiolymphoid hyperplasia with eosinophilia, Kimura's disease, multiple Clear cell acanthomas

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