Benign and Pre-malignant Skin Conditions Flashcards
List 6 Benign Skin Lesions:
Seborrhoeic keratoses Viral warts Cysts Dermatofibroma Lipoma Vascular lesions
3 x Clinical features of premalignant skin lesions
- Bowens disease
- Actinic Keratoses
- Melanoma in situ
Seborrhoeic Keratoses
Benign, but commonly referred
Warty growths, “stuck on appearance”
Can have variable appearance
Patients often have multiple +/- cherry angiomas
Generally left untreated, but if troublesome
Cryotherapy
Curettage
Cryotherapy
What does it use? 1
Pros? 2
Cons? 3
Liquid nitrogen
Pros
Cheap
Easy to perform “on the day”
Cons
Can scar
Failure/Recurrence
No pathology result
Sign of Leser-Trelat
Paraneoplastic phenomenon
Abrupt onset of widespread seborrhoeic keratosis, particularly in a younger individual
Seborrhoeic Keratoses remain benign but may indicate underlying solid organ malignancy
GI adenocarcinoma
Viral Warts
Due to Human Papilloma Virus
Rough hyperkeratotic surface
Difficult to treat
Do we need to treat at all?
Will clear when immunity developed to virus
Cryotherapy or wart paints can stimulate immune system slightly
Can curette in severe cases
Cysts
what is it?
who does it affect?
Encapsulated lesion containing fluid or semi-fluid material
Usually firm and fluctuant
Common.
Affect ~20% adults
Multiple different types of cyst exist (6)
- Epidermoid cyst (often wrongly called sebaceous)
- Pilar cyst
- Steatocystoma
- Dermoid cyst
- Hidrocystoma
- Ganglion cyst
Cysts - complications and treatment:
Can rupture and cause inflammation of surround skin
May become secondary infected
Treated with excision If inflammed/infected Antibiotics Intralesional steroid Incision & Drainage
Dermatofibroma
Benign fibrous nodule, often on limbs
Proliferation of fibroblasts
Cause is unknown. They are sometimes attributed to an area of trauma.
Firm nodule, tethered to skin but mobile over fat. Pale pink/brown. Often paler in centre.
Dimple sign positive
Usually asymptomatic. Can be itchy or tender
Excision if concern or symptomatic.
Lipoma
Benign tumour consisting of fat cells Common Cause unknown Smooth and rubbery subcutaneous mass Usually asymptomatic If tender ?angiolipoma ?Liposarcoma – rare malignancy
Vascular Lesions
Presentation:
Cherry angiomas
Spider naevi
Venous lakes – dilated venules
Vascular Lesions - Angioma
Overgrowth of blood vessels in the skin due to proliferating endothelial cells
Generally asymptomatic. Can be unsightly or bleed
Occur in all age groups, both sexes
Pregnancy & liver disease
Excision or laser
Vascular Lesions - Pyogenic Granuloma
Rapidly enlarging red/raw growth, often at a site of trauma. Bleed easily Cause is unknown Occur in up to 5% of pregnancies Common on head and hands Removed by curettage & cautery
Pre-malignant Lesions
Bowen’s Disease
aka Intraepidermal squamous cell carcinoma
Full thickness dysplasia, entirely contained within the epidermis, no metastatic potential
Potential to become malignant (around 5%)
Irregular, scaly erythematous plaque
Treatment of Bowens
Cryotherapy
Curettage
Lesion scraped off and heat applied to seal vessels and destroy residual cancer cells
Photodynamic therapy
Imiquimod
Treatment of Bowens: Photodynamic therapy
Photochemical reaction to selectively destroy cancer cells
Topical photosensitising agent applied
Concentrates in cancerous cells
Red light applied ( light colour dependant on which agent is used)
Photodymanic reaction occurs between light, photosensitiser and oxygen causing inflamation and destruction of cells
Treatment of Bowens: Photodynamic Therapy
+ 3 / - 2
Pros Done for the patient by hospital staff Can treat multiple areas, including those which would be hard to reach by patient 1 or 2 treatments Cons Requires hospital appointments Can be painful and scar
Treatment of Bowens: Imiquimod
Aldara Immune response modifier Stimulates cytokine release Inflammation and destruction of lesion Pros Useful where surgery is undesirable Usually good cosmetic result Large surface area Cons Treatment time is 6 weeks Significant inflammation Failure/recurrence
Actinic Keratoses
Rough scaly patches on sun damaged skin
Low risk of transformation to SCC
If average of 7.7 AK, the probability of developing an SCC within 10 years is 10%
May spontaneously resolve
Actinic Keratoses Treatment
- Cryotherapy
- Curettage
- Diclofenac Gel
- Imiquimod
Melanoma in situ
- Melanoma cells entirely confined to epidermis
- No metastatic potential
- Treated with excision
Lentigo Maligna
- Type of melanoma in situ
- Usually facial
Sun Protection
Cover up Avoid sun at peak hours 10am-4pm Don’t burn and try not to tan Avoid sunbeds Sunscreen UVA & UVB protection At least SPF 30 / 4 Star Need to apply 2 tablespoons every 2 hours
