Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

882 Jaw Swelling and Masses Keloids

Prognosis

■Varies with the diagnosis. Infectious problems usually have a good

prognosis, whereas malignancies carry a fair mortality risk, depend-

ing on the exact type.

■Congenital lesions like lymphangiomas and vascular malformations

can cause a great deal of morbidity and even mortality if exten-

sive.

Keloids............................................

DAVID OUTLAND, MD and JEFFREY P. CALLEN, MD

REVISED BY JEFFREY P. CALLEN, MD

history & physical

■Usually a history of trauma or injury at site; however, the injury might

have been minor

■Occurs more commonly in dark-skinned individuals

■A genetic predisposition is likely.

■Occurs equally among men and women

■Flesh-colored, pink, purple or hyperpigmented

■Usually painless but can be painful or pruritic

■Extends beyond the site of physical injury

■Most commonly occurs on ears, upper chest, upper back, suprapubic

and shoulders

tests

■None indicated unless diagnosis is questionable

■Biopsy is diagnostic but is rarely indicated.

■Biopsy shows thickened collagen bundles that are whorled, with

occasional increased numbers of mast cells and plasma cells.

differential diagnosis

■Hypertrophic scar

management

■Mostly surgical; however, injection with intralesional corticosteroids

may prove beneficial

specific therapy

■Generally referred to dermatologist, surgeon and/or radiation ther-

apist

■Intralesional corticosteroids such as triamcinolone acetonide