Benign and Premalignant Skin Lesions

Question 1

Describe seborrhoeic keratoses

Answer 1

Benign but commonly referred
Warty growths - stuck on appearance
Can be variable appearance
Can have multiple cherry angiomas
Generally left untreated

Question 2

What is the treatment for seborrhoeic keratoses if troublesome?

Answer 2

Cryotherapy
Curettage - scraping off

Question 3

What is crytotherapy?

Answer 3

Liquid nitrogen
Pros - cheap and easy to perform
Cons - can scar, failure/ recurrence and no pathology result

Question 4

What is the sign of Leser-Trelat?

Answer 4

Paraneoplastic phenomenon
Abrupt onset of widespread seborrhoeic keratosis, particularly in younger individual
SKs remain benign but may indicate underlying solid organ malignancy

Question 5

Describe viral warts

Answer 5

Due to human papilloma virus
Rough hyperkeratotic surface
Difficult to treat
Will clear when immunity developed to virus

Question 6

What is the treatment for viral warts?

Answer 6

Cryotherapy or wart paints can stimulate immune system slightly
Can curette in severe cases

Question 7

Describe cysts

Answer 7

Encapsulated lesion containing fluid or semi-fluid material
Usually firm and fluctuant
Common and affect around 20% of people

Question 8

What are the multiple types of cysts?

Answer 8

Epidermoid cysts - puncture
Pilar cyst - hair root sheath
Steatocystoma - sebaceous cyst
Dermoid cyst
Hidrocystoma - around eye
Ganglion cyst - degeneration of mucosal tissue of joint

Question 9

What is the treatment for cysts?

Answer 9

Excision
If inflamed or infected - antibiotics, intralesional steroid and incision + drainage

Question 10

What is the risks of cysts?

Answer 10

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

Question 11

Describe dermatofibroma

Answer 11

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

Question 12

What are the symptoms of dermatofibroma

Answer 12

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

Question 13

Describe a lipoma

Answer 13

Benign tumour of fat cells
Common and cause unknown
Smooth and rubbery subcutaneous mass which is usually asymptomatic

Question 14

What are the possible diagnosis if the lipoma is tender?

Answer 14

Angiolipoma
Liposacrcoma - rare malignancy

Question 15

What are some vascular lesions?

Answer 15

Angioma
Pyogenic granuloma

Question 16

Describe an angioma

Answer 16

Overgrowth of blood vessels in skin due to proliferating endothelial cells
Generally asymptomatic but can slightly bleed
Excision or laser

Question 17

What groups are at risk of angiomas?

Answer 17

Occurs in all age groups and both sexes
Pregnancy and liver disease

Question 18

What are some types of angiomas?

Answer 18

Cherry angiomas
Spider naevi
Venous lakes - dilated venules

Question 19

Describe pyogenic granulomas

Answer 19

Rapidly enlarging red/ raw growth, often at site of trauma
Bleed easily
Cause is unknown
Common on head and hands

Question 20

How are pyogenic granulomas removed?

Answer 20

Curettage and cautery

Question 21

What is a risk factors for pre-malignant lesions?

Answer 21

UV radiation - DNA damage and immunosuppression
UVB and UVA can penetrate down into subcutaneous layer

Question 22

What is Bowman’s disease?

Answer 22

Intraepidermal squamous cell carcinoma
Is full thickness dysplasia, contained in epidermis with no metastatic potential
5% chance of becoming malignant

Question 23

What is the appearance of Bowman’s disease?

Answer 23

Irregular, scaly erythematous plaque

Question 24

What is the treatment for Bowman’s disease?

Answer 24

Cryotherapy and curettage - lesion scraped off and heat applies to seal vessels and destroy residual cancer cells
Photodynamic therapy
Imiquimod

Question 25

Describe photodynamic therapy

Answer 25

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

Question 26

What are the pros of photodynamic therapy?

Answer 26

Done for patient at the hospital
Can treat multiple areas, including hard to reach areas
1 or 2 treatments

Question 27

What are the cons of photodynamic therapy?

Answer 27

Requires hospital appointments
Can be painful and scar

Question 28

What is Imiquimod?

Answer 28

Aldara
Immune response modifier - stimulates cytokine release leading to inflammation and destruction of lesion

Question 29

What are the pros of Imiquimod?

Answer 29

Useful where surgery is undesirable
Usually good cosmetic result
Large surface area

Question 30

What are the cons of Imiquimod?

Answer 30

Treatment time is 6 weeks
Significant inflammation
Failure/ recurrence

Question 31

Describe actinic keratoses

Answer 31

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

Question 32

What is the treatment for actinic keratoses?

Answer 32

Cryotherapy
Curettage
Diclofenac gel
Imiquimod

Question 33

What is melanoma in situ?

Answer 33

Melanoma cells entirely confined to epidermis
No metastatic potential

Question 34

How is melanoma in situ treated?

Answer 34

Excision

Question 35

What is a type of melanoma in situ?

Answer 35

Lentigo Maligna
Usually facial

Question 36

What is advised for sun protection?

Answer 36

Cover up
Avoid sun at peak hours
Don’t burn and try to not tan
Avoid sunbeds
Sunscreen