Benign & Premalignant Skin Lesions

Question 1

What lesion is this?

Answer 1

Seborrhoeic keratoses

Question 2

What lesion is this?

Answer 2

Viral Warts

Question 3

What lesion is this?

Answer 3

Cyst

Question 4

What lesion is this?

Answer 4

Lipoma

Question 5

What lesion is this?

Answer 5

Pyogenic Granuloma - type of vascular lesion

Question 6

What lesion is this?

Answer 6

Angioma - type of vascular lesion

Question 7

What lesion is this?

Answer 7

Actinic Keratoses

Question 8

What lesion is this?

Answer 8

Bowen’s Disease

Question 9

How are skin lesions described?

Answer 9

Site
Size
Shape
Colour

Palpate

Check lymph nodes

Question 10

What factors are you checking for when palpating skin lesions?

Answer 10

Mobility

Surface changes

Temperature

Consistency

Question 11

What are Seborrhoeic keratoses?

Answer 11

Warty growths

Often present with cherry angiomas

Question 12

How are Seborrhoeic keratoses treated?

Answer 12

(only if troublesome)

Cryotherapy
Curettage

Question 13

What are the pros of cryotherapy?

Answer 13

Cheap and Easy

Question 14

What are the cons of cryotherapy?

Answer 14

Scars

Can fail

No histology

Question 15

What is the Sign of Leser-Trelat?

Answer 15

Widespread seborrhoeic keratosis in younger individual

Paraneoplastic phenomenon:

GI adenocarcinoma

Question 16

What is the cause of viral warts?

Answer 16

Human Papillomavirus

Question 17

How do viral warts appear?

Answer 17

Rough hyperkeratotic papules

Question 18

How are viral warts treated?

Answer 18

Difficult, will often clear automatically

Cryotherapy

Wart paints

Curettage if severe

Question 19

What factor must you be aware of in patients with new warts?

Answer 19

Immunocompromised?

Question 20

Name 6 types of cyst?

Answer 20

Epidermoid

Pilar

Steatocystoma

Dermoid

Hidrocystoma (eye)

Ganglion

Question 21

How are cysts treated?

Answer 21

Excision

Question 22

How are inflamed/infected cysts treated?

Answer 22

Antibiotics

Intralesional steroids

Incision + Drainage

Question 23

How are dermatofibromas differentated from cysts?

Answer 23

Dimple size

Squeeze:
Dermatofibromas - form dimples

Cysts - Bulge/pucker

Question 24

What is a dermatofibroma?

Answer 24

Benign proliferation of fibroblasts - associated with trauma

Question 25

How do dermatofibromas present?

Answer 25

Firm, pink nodule, mobile over fat Asymptomatic May be itchy

Question 26

How are dermatofibromas treated?

Answer 26

Excision if **symptomatic**

Question 27

What is a lipoma?

Answer 27

Benign tumour of fat cells Smooth rubbery subcutaneous mass

Question 28

When are lipomas removed?

Answer 28

If changing

Question 29

Tender lipoma may be what?

Answer 29

Angiolipoma Liposarcoma

Question 30

Name 2 vascular lesions?

Answer 30

Angioma Pyogenic granuloma

Question 31

What is a pyogenic granuloma?

Answer 31

Rapidly enlarging, red growth Often at site of trauma Bleed easily

Question 32

Where are pyogenic granuloma most common?

Answer 32

5% pregnancies Head and hands

Question 33

How are pyogenic granuloma treated?

Answer 33

Curettage Cautery

Question 34

What are angioma?

Answer 34

Vascular lesion - overgrowth of blood vessels in the skin due to proliferating endothelial cells

Question 35

How do angioma present?

Answer 35

Asymptomatic - may bleed Red, compressable lesions

Question 36

Angioma are more common in what?

Answer 36

Liver disease Pregnancy

Question 37

Name 3 kinds of pre-malignant lesions

Answer 37

Melanoma-in-situ Bowen's disease Actinic Keratoses

Question 38

What are the risk factors for pre-malignant lesions?

Answer 38

UV radiation DNA damage Immunosuppression

Question 39

What do UV A and B do?

Answer 39

UVA - Ages (SPF) UVB - Burns (Star rating)

Question 40

What is the process of cell damage?

Answer 40

Normal ↓ Hyperplasia ↓ Dysplasia ↓ In-situ disease ↓ Invasive malignancy

Question 41

What are Actinic Keratoses?

Answer 41

Pre-malignant lesions Rough scaly patches on sun damaged skin

Question 42

Actinic Keratoses have a risk of what?

Answer 42

Low risk Transformation into Squamous cell carcinoma

Question 43

How are Actinic Keratoses treated?

Answer 43

Cryotherapy Curettage Diclofenac gel Imiquimod

Question 44

What is Bowen's disease?

Answer 44

In-situ squamous cell carcinoma Full thickness dysplasia within epidermis (cant metastasise)

Question 45

How does bowen's disease present?

Answer 45

Irregular, scaly erythematous plaque

Question 46

What proportion of Bowen's disease plaques can become malignant?

Answer 46

5%

Question 47

How is Bowen's disease treated?

Answer 47

Cryotherapy Curettage Photodynamic therapy Imiquimod

Question 48

What is the process of Photo-dynamic therapy?

Answer 48

Photochemical reaction to selectively destroy cancer cells Apply photosensitizing agent Red light applied (reaction)

Question 49

What is Curettage?

Answer 49

Lesion scraped off Heat applied to seal vessels and destroy residual cancer

Question 50

Imiquimod is indicated in what?

Answer 50

Genital warts Actinic Keratoses Bowen's disease

Question 51

How does Imiquimod work?

Answer 51

Modifies immune response Stimulates cytokine response → inflammation and destruction of lesion

Question 52

What are the pros of imiquimod?

Answer 52

Useful when surgery undesirable Good cosmetic result

Question 53

What are the cons of imiquimod?

Answer 53

6 weeks treatment Significant inflammation Can fail - recur

Question 54

What is melanoma in situ?

Answer 54

Melanoma cells confined to epidermis No metastatic potential Treated with excision

Question 55

How can excess sun exposure be avoided?

Answer 55

Avoid sun 10am-4pm Avoid sunbeds Sunscreen - UV A&B SPF 30/4 star 2 tablespoons every 2 hours