Hands and Feet Nodules

Nodules on the hands and feet

You should consider tumours first both benign and malignant but remember ganglion,digital myxoid cyst,rheumatoid nodule,Heberden's nodes and gouty tophus are more common than infected lesions such as atypical mycobacteria from fish ponds,sporotrichosis from rose thorns,orf from feeding lambs,innoculation tuberculosis if you are a pathologist or leishmaniasis from a sand fly bite.Painful nodules in winter suggest perniosis.Rare conditions such as erythema elevatum diutinum have a predelection for the hands and some forms of granuloma annulare on the dorsum of the hands can be nodular rather than papular.

Management   Biopsy and culture for deep fungi and atypical mycobacteria is usually necessary to give a definitive diagnosis.The typical digital myxoid cyst giving a linear groove in the nail does not need a biopsy.

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,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