Benign epidermal tumours and pigmented lesions

Question 1

What is the other name for a squamous cell papilloma

Answer 1

Fibroepithelial polyp

Question 2

What is the histology of squamous cell papilloma

Answer 2

Finger like projections of fibrovascular connective tissue covered by irregular acanthotic and hyperkeratotic squamous epithelium

Question 3

What are the signs of a squamous cell papilloma

Answer 3

• Flesh coloured, narrow based, pedunculated lesion
• Broad based (sessile) lesion with raspberry like surface
• Hyperkeratotic filiform lesion similar to a cutaneous horn

Question 4

What is the treatment of a squamous cell papilloma

Answer 4

Simple excision

Question 5

What is the differential diagnosis for a squamous cell papilloma

Answer 5

Viral wart
Seborrheic keratosis
Intradermal naevus

Question 6

What are some examples of a basal cell papilloma

Answer 6

Seborrhoeic keratosis
Seborrhoeic wart
Senile verruca

Question 7

What is basal cell papilloma

Answer 7

Common, slow growing condition affecting the face, trunk and extremities of elderly individuals

Question 8

What is the histology of basal cell papillomas

Answer 8

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

Question 9

What are the signs of a basal cell papilloma

Answer 9

A discreate, greasy, brown plaque with a friable verrucous surface and a ‘stuck on’ appearance

Question 10

What is the treatment of basal cell papilloma

Answer 10

Shave excision of flat lesions

Excision of pedunculated lesions

Question 11

What is the differential diagnosis of a basal cell papilloma

Answer 11

Pigmented basal cell carcinoma
Naevus
Melanoma

Question 12

What is acitinic keratosis

Answer 12

Slow growing lesion, rarely develops on eyelid

Question 13

Who is affected by acitinic keratosis

Answer 13

Elderly fair skinned individuals with a history of excessive sun exposure

Question 14

What does acitinic keratosis occur

Answer 14

Forehead and backs of hand

Question 15

What is the histology of acitinic keratosis

Answer 15

Irregular dysplastic epidermis, with hyperkeratosis, parakeratosis and cutaneous horn formation

Question 16

What are the signs of acitinic keratosis

Answer 16

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

Question 17

What is the treatment of acitinic keratosis

Answer 17

Biopsy if suspicious, excision or cryotherapy particularly if multiple lesions

Question 18

What is a freckle

Answer 18

A brown macule due to increased melanin in the basal layer of the epidermis in sun exposed areas

Question 19

What is the malignant potential for a congenital melanocytic naevus

Answer 19

Larger lesions - 15%

Question 20

What are the signs of a congenital melanocytic naevus

Answer 20

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

Question 21

What is the treatment of congenital melanocytic naevus

Answer 21

If necessary complete surgical excision

Question 22

How is the malignant potential for acquired melanocytic naevi determined?

Answer 22

Their histologic location

Question 23

What are the types of acquired melanocytic

Answer 23

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.

Question 24

What are the histological variations of naevi other than the 3 most common?

Answer 24

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.

Question 25

What is the treatment for acquired melanocytic

Answer 25

Excision - for cosmetic reasons or suspicion of malignancy

Excision must be complete as it can be difficult to differentiate recurrence from melanoma both clinically and histologically