Benign and Premalignant Skin Lesions Flashcards
Describe seborrhoeic keratoses
Benign but commonly referred
Warty growths - stuck on appearance
Can be variable appearance
Can have multiple cherry angiomas
Generally left untreated
What is the treatment for seborrhoeic keratoses if troublesome?
Cryotherapy
Curettage - scraping off
What is crytotherapy?
Liquid nitrogen
Pros - cheap and easy to perform
Cons - can scar, failure/ recurrence and no pathology result
What is the sign of Leser-Trelat?
Paraneoplastic phenomenon
Abrupt onset of widespread seborrhoeic keratosis, particularly in younger individual
SKs remain benign but may indicate underlying solid organ malignancy
Describe viral warts
Due to human papilloma virus
Rough hyperkeratotic surface
Difficult to treat
Will clear when immunity developed to virus
What is the treatment for viral warts?
Cryotherapy or wart paints can stimulate immune system slightly
Can curette in severe cases
Describe cysts
Encapsulated lesion containing fluid or semi-fluid material
Usually firm and fluctuant
Common and affect around 20% of people
What are the multiple types of cysts?
Epidermoid cysts - puncture
Pilar cyst - hair root sheath
Steatocystoma - sebaceous cyst
Dermoid cyst
Hidrocystoma - around eye
Ganglion cyst - degeneration of mucosal tissue of joint
What is the treatment for cysts?
Excision
If inflamed or infected - antibiotics, intralesional steroid and incision + drainage
What is the risks of cysts?
Can rupture and cause inflammation of surrounding skin
May become secondary infected
Describe dermatofibroma
Benign fibrous nodule and often on limbs - proliferation of fibroblasts
Cause is unknown but sometimes on an area of trauma
Excision if concerned or symptomatic
What are the symptoms of dermatofibroma
Form nodule, tethered to skin but mobile over fat
Pale pink/ brown and often paler in the centre
Dimple sign positive
Usually asymptomatic but can be itchy or tender
Describe a lipoma
Benign tumour of fat cells
Common and cause unknown
Smooth and rubbery subcutaneous mass which is usually asymptomatic
What are the possible diagnosis if the lipoma is tender?
Angiolipoma
Liposacrcoma - rare malignancy
What are some vascular lesions?
Angioma
Pyogenic granuloma
Describe an angioma
Overgrowth of blood vessels in skin due to proliferating endothelial cells
Generally asymptomatic but can slightly bleed
Excision or laser
What groups are at risk of angiomas?
Occurs in all age groups and both sexes
Pregnancy and liver disease
What are some types of angiomas?
Cherry angiomas
Spider naevi
Venous lakes - dilated venules
Describe pyogenic granulomas
Rapidly enlarging red/ raw growth, often at site of trauma
Bleed easily
Cause is unknown
Common on head and hands
How are pyogenic granulomas removed?
Curettage and cautery
What is a risk factors for pre-malignant lesions?
UV radiation - DNA damage and immunosuppression
UVB and UVA can penetrate down into subcutaneous layer
What is Bowman’s disease?
Intraepidermal squamous cell carcinoma
Is full thickness dysplasia, contained in epidermis with no metastatic potential
5% chance of becoming malignant
What is the appearance of Bowman’s disease?
Irregular, scaly erythematous plaque
What is the treatment for Bowman’s disease?
Cryotherapy and curettage - lesion scraped off and heat applies to seal vessels and destroy residual cancer cells
Photodynamic therapy
Imiquimod
Describe photodynamic therapy
Photochemical reaction to selectively destroy cancer cells
Topical photosensitising agent applied
Red light applied
Reaction occurs between light, photosensitiser and oxygen causing inflammation and destruction of cells
What are the pros of photodynamic therapy?
Done for patient at the hospital
Can treat multiple areas, including hard to reach areas
1 or 2 treatments
What are the cons of photodynamic therapy?
Requires hospital appointments
Can be painful and scar
What is Imiquimod?
Aldara
Immune response modifier - stimulates cytokine release leading to inflammation and destruction of lesion
What are the pros of Imiquimod?
Useful where surgery is undesirable
Usually good cosmetic result
Large surface area
What are the cons of Imiquimod?
Treatment time is 6 weeks
Significant inflammation
Failure/ recurrence
Describe actinic keratoses
Rough scaly patches on sun damages skin
Low risk of transformation to SCC
May spontaneously resolve
Not full thickness dysplasia, base is flat and red
What is the treatment for actinic keratoses?
Cryotherapy
Curettage
Diclofenac gel
Imiquimod
What is melanoma in situ?
Melanoma cells entirely confined to epidermis
No metastatic potential
How is melanoma in situ treated?
Excision
What is a type of melanoma in situ?
Lentigo Maligna
Usually facial
What is advised for sun protection?
Cover up
Avoid sun at peak hours
Don’t burn and try to not tan
Avoid sunbeds
Sunscreen
