Differential diagnois of painless nodular lesion in dermatology with famous mnemonic
Reading File
Finding Sources
Searching PubMed
cutaneous nodules AND differential diagnosis
Searching the Web
dermatology painless nodules differential diagnosis mnemonic
Searching the Web
"painless nodules" dermatology mnemonic differential diagnosis
Finding Sources
The famous mnemonic is for painful, not painless, cutaneous nodules:
BENGAL
- B - Blue rubber bleb nevus
- E - Eccrine spiradenoma
- N - Neuroma / neurilemmoma
- G - Glomus tumor
- A - Angiolipoma / angioleiomyoma
- L - Leiomyoma
A broader variant is LEND AN EGG: leiomyoma, eccrine spiradenoma, neuroma, dermatofibroma, angiolipoma, neurilemmoma, endometrioma, glomus tumor, granular-cell tumor. Mnemonic variants exist, so learn the core BENGAL list. Dermatology mnemonic reference
Common differential diagnosis of a painless skin nodule
| Clinical clue | Likely diagnoses |
|---|---|
| Soft, mobile, subcutaneous | Lipoma, neurofibroma |
| Firm nodule with central punctum | Epidermoid cyst |
| Firm, tethered lesion with dimple sign | Dermatofibroma |
| Very hard, calcified, often child or young adult | Pilomatricoma, osteoma cutis, calcinosis cutis |
| Yellow-orange | Xanthoma, juvenile xanthogranuloma |
| Skin-colored, pedunculated or buttonhole sign | Neurofibroma |
| Over a pressure point in rheumatoid arthritis | Rheumatoid nodule |
| Slow-growing, infiltrative plaque/nodules | Dermatofibrosarcoma protuberans |
| Rapid growth, ulceration, bleeding, fixed/hard | Consider keratoacanthoma/SCC, amelanotic melanoma, Merkel cell carcinoma, cutaneous metastasis |
Also consider infective painless nodules when there is travel, trauma, or immunosuppression: sporotrichosis, atypical mycobacterial infection, mycetoma, and Buruli ulcer. Cutaneous metastases often present as firm, painless erythematous nodules.
Exam point: a painful nodule suggests BENGAL, whereas a painless nodule should be approached by consistency, mobility, punctum, color, site, growth rate, and ulceration. A new, enlarging, hard, fixed, ulcerated, or atypically pigmented lesion needs dermoscopic assessment and usually biopsy.
This is a shared conversation. Sign in to Orris to start your own chat.