Benign epidermal tumours and pigmented lesions Flashcards
(25 cards)
What is the other name for a squamous cell papilloma
Fibroepithelial polyp
What is the histology of squamous cell papilloma
Finger like projections of fibrovascular connective tissue covered by irregular acanthotic and hyperkeratotic squamous epithelium
What are the signs of a squamous cell papilloma
- Flesh coloured, narrow based, pedunculated lesion
- Broad based (sessile) lesion with raspberry like surface
- Hyperkeratotic filiform lesion similar to a cutaneous horn
What is the treatment of a squamous cell papilloma
Simple excision
What is the differential diagnosis for a squamous cell papilloma
Viral wart
Seborrheic keratosis
Intradermal naevus
What are some examples of a basal cell papilloma
Seborrhoeic keratosis
Seborrhoeic wart
Senile verruca
What is basal cell papilloma
Common, slow growing condition affecting the face, trunk and extremities of elderly individuals
What is the histology of basal cell papillomas
Expansion of the squamous cell layer of the epidermis and proliferation of the basal cells
The acanthotic epidermis may show keratin filled cystic inclusions; either horn cysts within the mass of invaginations of surface keratin known as pseudohorns
What are the signs of a basal cell papilloma
A discreate, greasy, brown plaque with a friable verrucous surface and a ‘stuck on’ appearance
What is the treatment of basal cell papilloma
Shave excision of flat lesions
Excision of pedunculated lesions
What is the differential diagnosis of a basal cell papilloma
Pigmented basal cell carcinoma
Naevus
Melanoma
What is acitinic keratosis
Slow growing lesion, rarely develops on eyelid
Who is affected by acitinic keratosis
Elderly fair skinned individuals with a history of excessive sun exposure
What does acitinic keratosis occur
Forehead and backs of hand
What is the histology of acitinic keratosis
Irregular dysplastic epidermis, with hyperkeratosis, parakeratosis and cutaneous horn formation
What are the signs of acitinic keratosis
Hyperkeratotic plaque with distinct borders and a scaly surface that may become fissured
Occasionally lesion can be nodular, wart like or give rise to a cutaneous horn
What is the treatment of acitinic keratosis
Biopsy if suspicious, excision or cryotherapy particularly if multiple lesions
What is a freckle
A brown macule due to increased melanin in the basal layer of the epidermis in sun exposed areas
What is the malignant potential for a congenital melanocytic naevus
Larger lesions - 15%
What are the signs of a congenital melanocytic naevus
Small, uniform in colour
Rare type - kissing/split type, involving upper and lower lid and sometimes hairs
Rarely - cover large area of body - giant hairy naevus
What is the treatment of congenital melanocytic naevus
If necessary complete surgical excision
How is the malignant potential for acquired melanocytic naevi determined?
Their histologic location
What are the types of acquired melanocytic
Junctional - uniformly brown macule or plaque occuring in young individuals. The naevi cells are between the epidermis and the dermis. There is low malignant potential
Compound - middle aged individuals, raised papular lesion. Shade of pigment varies from light tan to a dark brown. Naevus cells go from the epidermis into the dermis and there is low potential for malignant transformation related to its junctional component
Intradermal - most common, in elderly patients. Papillomatous lesion, with little if any pigment, may show dilated blood vessels or protruding lashes. Cells are confirmed to the dermis and there is no malignant potential.
What are the histological variations of naevi other than the 3 most common?
Spitz naevi (juvenille melanoma)
Halo naevi
Balloon cell naevi
Dysplastic naevi (atypical moles)
If an individual as multiple dysplastic naevi this comprises the dysplastic naevi syndrome (atypical mole syndrome AMS). Individuals with AMS are more likely to have conjunctival and uveal naevi and more likely to develop cutaneous, conjunctival or uveal melanoma.
