Skin nodules in newborns and infants
- Josie A Pielop, MD
Josie A Pielop, MD
- Memorial Dermatology
- Houston, TX
- Section Editors
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
A variety of cutaneous and subcutaneous nodules may be detected in the newborn. Most are benign and self-limited, such as cysts, subcutaneous fat necrosis, and certain soft tissue tumors. However, some may be because of malignancy or be a marker for other abnormalities, such as neural tube defects.
Cysts, subcutaneous fat necrosis, and tumors that present at birth or in early infancy are reviewed here. Other benign skin lesions, vesiculopustular and bullous disorders, and congenital pigmented and vascular disorders in the newborn are discussed separately. (See "Benign skin and scalp lesions in the newborn and infant" and "Vascular lesions in the newborn" and "Vesiculopustular and bullous lesions in the newborn and infant".)
Common types of cysts include dermoid cysts and epidermal cysts. Other types, such as branchial cleft or thyroglossal duct cysts, may also occur.
Dermoid cysts and sinuses — Dermoid cysts are congenital subcutaneous lesions that are usually distributed along embryonic fusion lines of the facial processes or within the neural axis . The most common locations are overlying the anterior fontanelle, the bregma (junction of the coronal and sagittal sutures), upper lateral region of the forehead, lateral upper eyelid, and submental region, although lesions can occur anywhere on the scalp, face, spinal axis, or other body sites.
Dermoid cysts are almost always present at birth, although subtle lesions may not be noticed until, for example, trauma causes inflammation (picture 1). They present as small (1 to 4 cm in diameter), slow-growing, asymptomatic rubbery subcutaneous nodules that are usually solitary (picture 2 and image 1). They are nonpulsatile, noncompressible, nontender masses that appear skin-colored or blue . The skin overlying the cyst appears normal unless a pit or a sinus is present.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Drolet BA. Cutaneous signs of neural tube dysraphism. Pediatr Clin North Am 2000; 47:813.
- Ackerman LL, Menezes AH. Spinal congenital dermal sinuses: a 30-year experience. Pediatrics 2003; 112:641.
- Guggisberg D, Hadj-Rabia S, Viney C, et al. Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol 2004; 140:1109.
- Douvoyiannis M, Goldman DL, Abbott IR 3rd, Litman N. Posterior fossa dermoid cyst with sinus tract and meningitis in a toddler. Pediatr Neurol 2008; 39:63.
- Brownstein MH, Helwig EB. Subcutaneous dermoid cysts. Arch Dermatol 1973; 107:237.
- Baldwin HE, Berck CM, Lynfield YL. Subcutaneous nodules of the scalp: preoperative management. J Am Acad Dermatol 1991; 25:819.
- Mallory SB. Subcutaneous scalp lesions in children. J Am Acad Dermatol 1993; 28:131.
- Cutaneous tumors and tumor syndromes. In: Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence, 3rd ed, Paller AS, Mancini AJ (Eds), W.B. Elsevier Saunders, Philadelphia 2006. p.205.
- Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol 1999; 16:384.
- Tran JT, Sheth AP. Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature. Pediatr Dermatol 2003; 20:257.
- Hicks MJ, Levy ML, Alexander J, Flaitz CM. Subcutaneous fat necrosis of the newborn and hypercalcemia: case report and review of the literature. Pediatr Dermatol 1993; 10:271.
- Mahé E, Girszyn N, Hadj-Rabia S, et al. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children. Br J Dermatol 2007; 156:709.
- Oza V, Treat J, Cook N, et al. Subcutaneous fat necrosis as a complication of whole-body cooling for birth asphyxia. Arch Dermatol 2010; 146:882.
- Chuang SD, Chiu HC, Chang CC. Subcutaneous fat necrosis of the newborn complicating hypothermic cardiac surgery. Br J Dermatol 1995; 132:805.
- Hoath SB, Narendran V. The skin. In: Neonatal-Perinatal Medicine, 9th ed, Fanaroff AA, Martin RJ, Walsh MC (Eds), Elsevier Mosby, St. Louis 2011. p.1705.
- Walker WP, Smith RJ, Cohen MB. Fine-needle aspiration biopsy of subcutaneous fat necrosis of the newborn. Diagn Cytopathol 1993; 9:329.
- Jardine D, Atherton DJ, Trompeter RS. Sclerema neonatorum and subcutaneous fat necrosis of the newborn in the same infant. Eur J Pediatr 1990; 150:125.
- Zeb A, Darmstadt GL. Sclerema neonatorum: a review of nomenclature, clinical presentation, histological features, differential diagnoses and management. J Perinatol 2008; 28:453.
- Thomsen RJ. Subcutaneous fat necrosis of the newborn and idiopathic hypercalcemia. Report of a case. Arch Dermatol 1980; 116:1155.
- Alos N, Eugène D, Fillion M, et al. Pamidronate: Treatment for severe hypercalcemia in neonatal subcutaneous fat necrosis. Horm Res 2006; 65:289.
- Lombardi G, Cabano R, Bollani L, et al. Effectiveness of pamidronate in severe neonatal hypercalcemia caused by subcutaneous fat necrosis: a case report. Eur J Pediatr 2009; 168:625.
- Karochristou K, Siahanidou T, Kakourou-Tsivitanidou T, et al. Subcutaneous fat necrosis associated with severe hypocalcaemia in a neonate. J Perinatol 2006; 26:64.
- Chen TH, Shewmake SW, Hansen DD, Lacey HL. Subcutaneous fat necrosis of the newborn. A case report. Arch Dermatol 1981; 117:36.
- Oswalt GC Jr, Montes LF, Cassady G. Subcutaneous fat necrosis of the newborn. J Cutan Pathol 1978; 5:193.
- Lewis A, Cowen P, Rodda C, Dyall-Smith D. Subcutaneous fat necrosis of the newborn complicated by hypercalcaemia and thrombocytopenia. Australas J Dermatol 1992; 33:141.
- Sharata H, Postellon DC, Hashimoto K. Subcutaneous fat necrosis, hypercalcemia, and prostaglandin E. Pediatr Dermatol 1995; 12:43.
- Wolach B, Raas-Rothschild A, Vogel R, et al. Subcutaneous fat necrosis with thrombocytopenia in a newborn infant. Dermatologica 1990; 181:54.
- Caple JI, Reyes S. Subcutaneous fat necrosis of the newborn: a case presentation. J Perinatol 1996; 16:140.
- Coffin CM, Dehner LP. Soft tissue tumors in first year of life: a report of 190 cases. Pediatr Pathol 1990; 10:509.
- Wiswell TE, Davis J, Cunningham BE, et al. Infantile myofibromatosis: the most common fibrous tumor of infancy. J Pediatr Surg 1988; 23:315.
- Coffin CM, Dehner LP. Fibroblastic-myofibroblastic tumors in children and adolescents: a clinicopathologic study of 108 examples in 103 patients. Pediatr Pathol 1991; 11:569.
- Chung EB, Enzinger FM. Infantile myofibromatosis. Cancer 1981; 48:1807.
- Zand DJ, Huff D, Everman D, et al. Autosomal dominant inheritance of infantile myofibromatosis. Am J Med Genet A 2004; 126A:261.
- Bracko M, Cindro L, Golouh R. Familial occurrence of infantile myofibromatosis. Cancer 1992; 69:1294.
- Smith A, Orchard D. Infantile myofibromatosis: two families supporting autosomal dominant inheritance. Australas J Dermatol 2011; 52:214.
- Martignetti JA, Tian L, Li D, et al. Mutations in PDGFRB cause autosomal-dominant infantile myofibromatosis. Am J Hum Genet 2013; 92:1001.
- Cheung YH, Gayden T, Campeau PM, et al. A recurrent PDGFRB mutation causes familial infantile myofibromatosis. Am J Hum Genet 2013; 92:996.
- Larralde M, Hoffner MV, Boggio P, et al. Infantile myofibromatosis: report of nine patients. Pediatr Dermatol 2010; 27:29.
- Mashiah J, Hadj-Rabia S, Dompmartin A, et al. Infantile myofibromatosis: a series of 28 cases. J Am Acad Dermatol 2014; 71:264.
- Wyatt AJ, Hansen RC. Pediatric skin tumors. Pediatr Clin North Am 2000; 47:937.
- Briselli MF, Soule EH, Gilchrist GS. Congenital fibromatosis: report of 18 cases of solitary and 4 cases of multiple tumors. Mayo Clin Proc 1980; 55:554.
- Ebert CS Jr, Zdanski C, Ardeshirpour F, et al. Recurrent infantile myofibromatosis: a report of conservative management and discussion of treatment strategies. Ear Nose Throat J 2008; 87:E4.
- Kapur P, Erickson C, Rakheja D, et al. Congenital self-healing reticulohistiocytosis (Hashimoto-Pritzker disease): ten-year experience at Dallas Children's Medical Center. J Am Acad Dermatol 2007; 56:290.
- Bernstein EF, Resnik KS, Loose JH, et al. Solitary congenital self-healing reticulohistiocytosis. Br J Dermatol 1993; 129:449.
- Inuzuka M, Tomita K, Tokura Y, Takigawa M. Congenital self-healing reticulohistiocytosis presenting with hemorrhagic bullae. J Am Acad Dermatol 2003; 48:S75.
- Satter EK, High WA. Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society. Pediatr Dermatol 2008; 25:291.
- Longaker MA, Frieden IJ, LeBoit PE, Sherertz EF. Congenital "self-healing" Langerhans cell histiocytosis: the need for long-term follow-up. J Am Acad Dermatol 1994; 31:910.
- Larsen L, Merin MR, Konia T, Armstrong AW. Congenital self-healing reticulohistiocytosis: concern for a poor prognosis. Dermatol Online J 2012; 18:2.
- Chung EB, Enzinger FM. Infantile fibrosarcoma. Cancer 1976; 38:729.
- Blocker S, Koenig J, Ternberg J. Congenital fibrosarcoma. J Pediatr Surg 1987; 22:665.
- Knezevich SR, McFadden DE, Tao W, et al. A novel ETV6-NTRK3 gene fusion in congenital fibrosarcoma. Nat Genet 1998; 18:184.
- Sebire NJ, Ramsay AD, Levitt G, et al. Aberrant immunohistochemical expression in nonrhabdomyosarcoma soft tissue sarcomas of infancy: retrospective review of clinical material. Pediatr Dev Pathol 2002; 5:579.
- Sandberg AA, Bridge JA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: congenital (infantile) fibrosarcoma and mesoblastic nephroma. Cancer Genet Cytogenet 2002; 132:1.
- Bourgeois JM, Knezevich SR, Mathers JA, Sorensen PH. Molecular detection of the ETV6-NTRK3 gene fusion differentiates congenital fibrosarcoma from other childhood spindle cell tumors. Am J Surg Pathol 2000; 24:937.
- Ferguson WS. Advances in the adjuvant treatment of infantile fibrosarcoma. Expert Rev Anticancer Ther 2003; 3:185.
- Loh ML, Ahn P, Perez-Atayde AR, et al. Treatment of infantile fibrosarcoma with chemotherapy and surgery: results from the Dana-Farber Cancer Institute and Children's Hospital, Boston. J Pediatr Hematol Oncol 2002; 24:722.
- Cecchetto G, Carli M, Alaggio R, et al. Fibrosarcoma in pediatric patients: results of the Italian Cooperative Group studies (1979-1995). J Surg Oncol 2001; 78:225.
- McCahon E, Sorensen PH, Davis JH, et al. Non-resectable congenital tumors with the ETV6-NTRK3 gene fusion are highly responsive to chemotherapy. Med Pediatr Oncol 2003; 40:288.
- Russell H, Hicks MJ, Bertuch AA, Chintagumpala M. Infantile fibrosarcoma: clinical and histologic responses to cytotoxic chemotherapy. Pediatr Blood Cancer 2009; 53:23.
- Megarbane H, Doz F, Manach Y, et al. Neonatal rhabdomyosarcoma misdiagnosed as a congenital hemangioma. Pediatr Dermatol 2011; 28:299.
- Rodriguez-Galindo C, Hill DA, Onyekwere O, et al. Neonatal alveolar rhabdomyosarcoma with skin and brain metastases. Cancer 2001; 92:1613.
- Grundy R, Anderson J, Gaze M, et al. Congenital alveolar rhabdomyosarcoma: clinical and molecular distinction from alveolar rhabdomyosarcoma in older children. Cancer 2001; 91:606.
- Lucky AW, McGuire J, Komp DM. Infantile neuroblastoma presenting with cutaneous blanching nodules. J Am Acad Dermatol 1982; 6:389.
- Schneider KM, Becker JM, Krasna IH. Neonatal neuroblastoma. Pediatrics 1965; 36:359.
- Francis JS, Sybert VP, Benjamin DR. Congenital monocytic leukemia: report of a case with cutaneous involvement, and review of the literature. Pediatr Dermatol 1989; 6:306.
- Dinulos JG, Hawkins DS, Clark BS, Francis JS. Spontaneous remission of congenital leukemia. J Pediatr 1997; 131:300.
- Dermoid cysts and sinuses
- Other cysts
- SUBCUTANEOUS FAT NECROSIS
- Benign tumors
- - Infantile hemangiomas
- - Vascular lesions
- - Infantile myofibromatosis
- - Congenital self-healing reticulohistiocytosis
- - Cutaneous mastocytosis
- Malignant tumors
- - Infantile fibrosarcoma
- - Rhabdomyosarcoma
- - Neuroblastoma
- - Congenital leukemia