Differential Diagnosis for the Superficial Ovoid Hypoechoic Lesion

• Single Most Likely Diagnosis
  • Lipoma: This is the most likely diagnosis given the lesion's characteristics, such as being superficial, hypoechoic, and having internal vascularity. Lipomas are common, benign tumors composed of fat tissue and can be found just beneath the skin. They are often partially compressible and can appear solid on ultrasound.
• Other Likely Diagnoses
  • Hemangioma: A benign vascular tumor that could present as a hypoechoic lesion with internal vascularity. It might be partially compressible due to its vascular nature.
  • Neurofibroma: A benign nerve sheath tumor that can appear as a hypoechoic lesion. It might show some vascularity and could be partially compressible.
  • Epidermal Inclusion Cyst: Although typically anechoic or hypoechoic with a hyperechoic rim, an epidermal inclusion cyst could be considered if the lesion's appearance varies. However, internal vascularity would be less common.
• Do Not Miss Diagnoses
  • Soft Tissue Sarcoma: Although rare, sarcomas can present as superficial, solid lesions. Given the potential for malignancy and the significant impact on treatment and prognosis, it's crucial not to miss this diagnosis. The presence of internal vascularity and the lesion being solid in nature warrant careful consideration.
  • Metastatic Lesion: In patients with a history of cancer, a metastatic lesion to the skin or soft tissue should be considered, especially if the lesion has atypical features or grows rapidly.
• Rare Diagnoses
  • Glomus Tumor: A rare, benign tumor arising from glomus cells that can appear as a hypoechoic lesion with significant vascularity. They are typically found under the fingernail but can occur elsewhere.
  • Dermatofibrosarcoma Protuberans (DFSP): A rare, low-grade malignant tumor of the skin that can present as a hypoechoic lesion. It often has a characteristic storiform pattern on histology and can be locally aggressive.