Benign/malignant dermatological lesions

Question 1

Solar keratosis

Answer 1

A: Pre-malignant abnormal skin proliferation due to prolonged UV exposure.

S: Usually multiple, flat or thickened scaly lesions, can be skin coloured or reddened. May be uncomfortable.

D: None-specific, biopsy if concern about progression to SCC

T: Cryotherapy, curettage, 5-fluorouracil or imiquimod

Question 2

Keratocanthoma

Answer 2

A: Sun exposed areas commonly affected, can be triggered by a minor injury. Originates from hair follicle.

S: Dome-shaped, symmetrical lesion, often surrounded by inflamed skin and capped with keratin and debris

D: Difficult to discriminate from malignancy so biopsies are needed.

T: Includes cryotherapy, curettage and surgical excision.

Question 3

Sebaceous cyst

Answer 3

A: Usually caused by blocked sebaceous glands or hair follicles

S: Usually asymptomatic lump, often on face, neck or trunk. The lump may become infected (red, hot and painful).

D: None, unless infection is suspected.

T: Surgical excision, can be removed with applications of heat pad.

Question 4

Dermoid cyst

Answer 4

A: Benign tumours consisting of skin cells, hair follicles and sweat glands. They appear in early childhood due to a defect in skin tissue development.

S: Firm, dough-like lumps, usually 0.5-6cm and often occur on the face, neck or scalp.

D: US scan to plan surgery

T: Surgical removal

Question 5

Lipoma

Answer 5

A: Benign tumours composed of fat cells, they may have a genetic element or arise from trauma.

S: Palpable soft, smooth lump beneath skin that is easily moved. Usually 2-10cm in size but can be bigger. Multiple tender lipomas are know as Dercum’s disease.

D: -

T: Usually none needed but can be removed surgically.

Question 6

Basal cell carcinoma

Answer 6

A: Commonest skin malignancy, genetic susceptibility but it usually occurs with excessive sun exposure (more common in fair skinned individuals).

S: Slow growing, shiny, pearly nodule with ‘rolled edge’ and telangiectasia, commonly not the face. Very rarely metastasises.

D: Skin biopsy

T: Surgical excision, cryotherapy, radiotherapy and 5-fluorouracil. Excellent prognosis.

Question 7

Squamous cell carcinoma

Answer 7

A: Second most common, originating in epidermis. Can be from excessive sun exposure, genetics, smoking, chronic ulceration (Marjolin’s ulcer), infections (HPV).

S: Usually appear on sun-exposed sites and are slow-growing tender, scaly or crusted lumps. May presents as ulcers that don’t heal.

D: Biopsy

T: Surgical excision and radiotherapy.
Good prognosis but 5% of tumours metastasise to local lymph nodes.

Question 8

Bowen’s disease

Answer 8

A: SCC-in-situ, intradermal SCC. Can be from excessive sun exposure, genetics, smoking, chronic ulceration (Marjolin’s ulcer), infections (HPV).

S: Gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling.

T: Cryotherapy, curettage, 5-fluorouracil, imiquimod cream or photodynamic therapy.
Reoccurrence is fairly common, a can progress to SCC.

Question 9

Malignant melanoma

Answer 9

A: Malignant proliferation of melanocytes. Can be from sun damage, genetics, or from other moles. Highest mortality of skin cancers.

S: Common sites are skin, eyes and anus. Worrying features include:

• Asymmetry
• Border irregularity
• Colour variation
• Diameter > 6mm
• Evolving (enlarging/changing).

D: If melanoma is suspected then the lesion should be surgically excised with a 2-3mm margin. The biopsy should then be sent for histological diagnosis and staging.

T: Surgical excision with our without chemotherapy or radiotherapy.
Prognosis related to Breslow thickness (depth of tumour in mm) and Clark’s level (useful if 4mm but 95-100% if

Question 10

Seborrheic keratosis

Answer 10

A: Appear with advancing age

S: Painless, raised lesions with “stuck on” appearance

D: Skin biopsy can confirm if diagnosis is in doubt

T: If needed, can be removed by cryotherapy or curettage