Benign and Pre-malignant Skin Conditions

Question 1

List 6 Benign Skin Lesions:

Answer 1

Seborrhoeic keratoses
Viral warts
Cysts
Dermatofibroma
Lipoma
Vascular lesions

Question 2

3 x Clinical features of premalignant skin lesions

Answer 2

• Bowens disease
• Actinic Keratoses
• Melanoma in situ

Question 3

Seborrhoeic Keratoses

Answer 3

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

Question 4

Cryotherapy
What does it use? 1
Pros? 2
Cons? 3

Answer 4

Liquid nitrogen

Pros
Cheap
Easy to perform “on the day”

Cons
Can scar
Failure/Recurrence
No pathology result

Question 5

Sign of Leser-Trelat

Answer 5

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

Question 6

Viral Warts

Answer 6

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

Question 7

Cysts
what is it?
who does it affect?

Answer 7

Encapsulated lesion containing fluid or semi-fluid material
Usually firm and fluctuant
Common.

Affect ~20% adults

Question 8

Multiple different types of cyst exist (6)

Answer 8

• Epidermoid cyst (often wrongly called sebaceous)
• Pilar cyst
• Steatocystoma
• Dermoid cyst
• Hidrocystoma
• Ganglion cyst

Question 9

Cysts - complications and treatment:

Answer 9

Can rupture and cause inflammation of surround skin
May become secondary infected

Treated with excision
If inflammed/infected
Antibiotics
Intralesional steroid
Incision & Drainage

Question 10

Dermatofibroma

Answer 10

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.

Question 11

Lipoma

Answer 11

Benign tumour consisting of fat cells
Common
Cause unknown
Smooth and rubbery subcutaneous mass
Usually asymptomatic
If tender
?angiolipoma
?Liposarcoma – rare malignancy

Question 12

Vascular Lesions

Presentation:

Answer 12

Cherry angiomas
Spider naevi
Venous lakes – dilated venules

Question 13

Vascular Lesions - Angioma

Answer 13

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

Question 14

Vascular Lesions - Pyogenic Granuloma

Answer 14

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

Question 15

Pre-malignant Lesions

Bowen’s Disease

Answer 15

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

Question 16

Treatment of Bowens

Answer 16

Cryotherapy
Curettage
Lesion scraped off and heat applied to seal vessels and destroy residual cancer cells

Photodynamic therapy
Imiquimod

Question 17

Treatment of Bowens: Photodynamic therapy

Answer 17

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

Question 18

Treatment of Bowens: Photodynamic Therapy

+ 3 / - 2

Answer 18

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

Question 19

Treatment of Bowens: Imiquimod

Answer 19

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

Question 20

Actinic Keratoses

Answer 20

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

Question 21

Actinic Keratoses Treatment

Answer 21

• Cryotherapy
• Curettage
• Diclofenac Gel
• Imiquimod

Question 22

Melanoma in situ

Answer 22

• Melanoma cells entirely confined to epidermis
• No metastatic potential
• Treated with excision

Question 23

Lentigo Maligna

Answer 23

• Type of melanoma in situ

- Usually facial

Question 24

Sun Protection

Answer 24

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