Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Accessory tragus – Commonly found on the anterior ear or preauricular skin.
• Trichofolliculoma – A central vellus hair may be seen clinically. Histopathologically, these lesions have a central invagination from which the hair follicles radiate.
• Acrochordon – Lack clustering of vellus hairs seen in hair follicle nevi.
• Adnexal polyp of neonatal skin – A pedunculated polyp that is present at birth and spontaneously separates within the first few days of life. The areola is a common site.
• Nevus sebaceus – These lesions are initially macular and hairless and progress to become more raised and verrucous at puberty. They are typically found on the scalp.
• Trichodiscomas and fibrofolliculomas – Small, dome-shaped papules that are not typically seen in the pediatric population. Occur in the setting of Birt-Hogg-Dubé syndrome.
• Epidermoid cyst – A firm nodule that often has a dilated punctum.
• Intradermal nevus – Not associated with a clustering of vellus hairs that is characteristic of hair follicle nevi.
• Basal cell carcinoma – Pearly papule with raised rolled borders and occasional central ulceration.
• Dilated pore of Winer – Presents as a solitary enlarged pore filled with keratin.
• Pilar sheath acanthoma – Presents as a papule or nodule with a central opening.
• Thyroglossal duct cyst – Presents as a midline neck mass that elevates with protrusion of the tongue and with swallowing.
• Branchial cleft cyst – A skin-colored nodule or cyst, usually on the inferior and lateral neck.

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References

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