Benign and Premalignant Skin Lesions Flashcards
For a lot of these, probably worth looking them up to get a proper idea what they look like. Remember, all of these are benign.
What does seborrhoeic keratoses look like?
Warty growths, can have a ‘stuck on’ appearance
Seborrhoeic keratoses can generally be left untreated but what can be done to them if they are proving the be troublesome?
Cryotherapy
Curettage
->patients often want them removed but cannot be done on the NHS is not causing any harm. Can be removed if being irritated by a necklace etc
Cryotherapy?
Liquid nitrogen
What are the pros and cons of cryotherapy?
Pros- cheap, easy to perform on the day
Cons- can scar, failure/reoccurrence, no pathology result
What is meant by the sign of Leser-Trelat?
Abrupt appearance of multiple seborrheic keratoses caused by an associated cancer and the rapid increase in their size and number
->important to note that the actual SKs remain benign but can indicate solid organ malignancy
Which virus causes viral warts?
Human Papilloma Virus
What is the treatment for viral warts?
Difficult to treat but do not really need treated as will clear when the patient develops immunity to the virus
Cryotherapy or wart paints can be used to stimulate the immune system slightly
Cyst?
Encapsulated lesion containing fluid or semi-fluid material
They are usually firm and fluctuant
Common
What happens if cysts rupture?
Can cause inflammation of surrounding skin
Can become secondarily infected
How are cysts treated?
With excision
What is the treatment if cysts become inflamed?
Antibiotics
Intralesional steroid
Incision and drainage
What do dermatofibromas look like?
Firm nodule, tethered to skin but mobile over fat
Pale pink/brown, often paler in the centre
Usually asymptomatic but can be itchy or tender
Why are dermatofibromas known as being dimple positive?
If you squeeze the skin around them, there is a dimple in the centre
What causes a dermatofibroma?
Proliferation of fibroblasts
What is a lipoma?
Benign tumour consisting of fat cells
Lipomas are usually symptomatic. What would be queried if they were tender?
If it was an angiolipoma or liposarcoma
Angioma?
Overgrowth of blood vessel in the skin due to proliferating endothelial cells
When are angiomas more commonly seen??
In pregnancy
In liver disease (especially spider naevi)
What is the treatment of angiomas?
Excision or laser
What is a pyogenic granuloma?
Rapidly enlarging red/raw growth, often at the site of trauma
They can bleed easily
->classic exam question is a gardener who has pricked their finger on a rose bush
Where are pyogenic granulomas most commonly found?
Head and heads
How are pyogenic granulomas removed?
Curettage
Cautery
What are some of the risk factors for pre-malignant skin lesions?
UV radiation- causes DNA damage and immunosuppression
There are three types of UV radiation- UV A, B and C.
Which one does not affect us on earth?
UV C
Which type of UV light can cause skin damage even through glass?
UVA
Which layer of the skin does UVB penetrate down to?
Dermis
Which layer of the skin does UVA penetrate down to?
Subcutaneous fat
Which UV gives immediate burning?
UVB
What is Bowen’s disease?
Intraepidermal squamous cell carcinoma
Looks like an irregular scaly erythematous plaque
Can Bowen’s disease plaques become malignant?
Yes- but only about a 5% chance potential
Anything that sits above which layer of the skin is not an invasive malignancy?
Dermal-epidermal junction
What is the treatment of Bowens?
Cryotherapy
Curettage
Photodynamic therapy
Imiquimod
What happens in curettage?
Lesion is scraped off and heat is applied to seal vessels and destroy residual cancer cells
What is photodynamic therapy?
Photochemical reaction to selectively destroy cancer cells
What are the pros and cons of photodynamic therapy?
Pros:
Done for the patient by hospital staff
Can treat multiple areas, including those hard to reach by a patient
1 or 2 treatments
Cons:
Requires hospital appointments
Can be painful and scar
What is Imiquimod (used in treatment of Bowen’s disease)?
Immune response modifier which stimulates cytokine release
What are the pros and cons of Imiquimod?
Pros:
Useful when surgery is undesirable
Usually good cosmetic result
Large surface area
Cons:
Treatment time is 6wks
Significant inflammation
Failure/reoccurrence
What is actinic keratoses?
Rough scaly patches on sun damaged skin
Where on the body is more likely to be affected by actinic keratoses?
Backs of hands
Top of scalps
Ears
Is there a risk of actinic keratoses becoming malignant?
Small chance but low risk
What needs to differentiated against in patients with actinic keratoses/
Squamous cell carcinomas
What are the treatment options of actinic keratoses?
Cryotherapy
Curettage
Diclofenac gel
Imiquimod
What is meant by melanoma in situ?
Skin melanoma is a skin cancer but in this case it is entirely confined to the epidermis so has no metastatic potential
How in melanoma in situ treated?
Excision
->needs to be treated as could penetrate into dermis and then will have metastatic potential
What is the most important factors for patients with pre-malignant skin disease to take into account?
They must have sun protection
What are some of the methods of sun protection?
Cover up
Avoid sun at peak hours 10am-4pm
Don’t burn
Don’t try to tan
Avoid sunbeds
Wear sunscreen with UVA and UVB protection and reapply every 2hrs at least SPF 30
