BENIGN SKIN DISEASE Flashcards
What is a seborrhoeic keratoses?
A benign, warty, epidermal growth that occurs commonly with skin aging
What age are seborrhoeic keratoses common in?
Patient over 50
How do seborrheic keratoses present?
Usually multiple lesions over the face and trunk
Flat, raised, filiform and pedunculated subtypes
Has a well-defined, “stuck on” appearance with a fissured keratin surface
Variable colours
Surface may have a greasy scale overlying it
Investigating seborrheoic keratoses?
Typically not necessary due to their characteristic appearance
If any uncertainty or concern, a skin biopsy may be performed to rule out other skin conditions
Dermatoscopy can be used to identify the features described above
Management of seborrheoic keratoses?
Removal is not required
If desired due to it being symptmatic - Cryotherapy, curettage, laser ablation
What is a solar lentigo?
A benign patch of darkened skin from exposure to UV radiation
“Senile freckle” or “old age spot”
Common over the age of 40
What is dermatosis papulosa nigra?
The presence of multiple small 1-5mm diameter, smooth, firm, black or dark brown papules on face and neck
More common in females and in people of colour
Usually begins in adolescence and incidence, number, size of lesions increase with age
What is a melanocytic naevi?
A benign skin lesion due to a local proliferation of melanocytes
What are congenital melanocytic naevi?
Melanocytic naevus appear at, or soon after birth
They are usually greater than 1cm diameter
They have an increased risk of malignant transformation
Often quite large and hairy
What are junctional melanocytic naevi?
Circular macules
May have heterogenous colour even within the same lesion
Due to melanocytes at the basal layer of the epidermis
What are compound melanocytic naevi?
Domed pigmented nodules up to 1cm in diameter
They arise from junctional naevi, usually have uniform colour and are smooth
What is a spitz naevus?
An uncommon type of melanocytic naevus
Usually develop over a few months in children
Ckassically a dome-shaped pink/red/brown papule
Most common on face + legs
May grow up to 1cm rapidly
What is atypical naevus syndrome?
Atypical melanocytic naevi that may be autosomally dominantly inherited
Some individuals may have an increased risk of melanoma
What are epidemic cysts also known as?
Sebaceous cyst
What is an epidermoid cyst?
A benign cyst derived from a epidermis (epidermoid cyst) or the outer root sheath of a heair follicle (pilar cyst)
They are typically filled with keratin or lipid-rich debris
Who do epidermoid cysts most commonly occur in?
Adults
More common in men
Those with Gardner syndrome
Where do epidermoid cysts usually occur?
Face and trunk
What do epidermoid cysts look like?
A firm, flesh-coloured or yellowish round papule or nodule fixed to the skin surface but typically mobile over deeper layers
Diameter 1–3 cm
A central punctum
Foul-smelling cheesy debris can be expressed from the central punctum.
What is another term for a dermatofibroma?
A cutaneous fibrous histiocytoma
What is a dermatofibroma?
A common benign fibrous nodule usually found on the skin of the lower legs
They are benign proliferations of fibroblasts
Sometimes they are attributed to minor trauma e.g. insect bites, injections etc
Who do dermatofibromas typically affect?
Young adults
How do dermatofibromas present?
A solitary 7-10mm nodule tethered to the skin surface but mobile over subcutaneous tissue
Positive dimple sign
Colour usually pink-light brown or dark brown-black in dark skin
The lesions usually feel larger than they appear visually
Histology findings of dermatofibroma?
Proliferating fibroblasts merging with sparsely cellular dermal tissues
Medical term for freckle?
Ephilides
What is a lentigo simplex?
A well-circumscribed uniform brown-black macule
Develop during childhood or young adult life
How do junctional naevi present?
Well-circumscribed pigmented macule with regular byt fading borders
How do compound naevi present?
Pink or brown, dome-shaped papule surrounded by macular pigmentation
How do dermal naevi present?
A brown/blue/black/skin coloured elevated papule
What are corns and calluses?
Localised areas of thickened skin induced by pressure
What is the most common benign soft-tissue tumour?
A lipoma
What is a lipoma?
A common, benign tumour of adipocytes
Generally found in subcutaneous tissues. Rarely they can be found in deeper adipose tissue
Who do lipomas most commonly occur in?
Middle-aged adults
Features of a lipoma?
Smooth, mobile and painless
Features of a sarcomatous change of a lipoma i.e. development of a liposarcoma?
Size >5cm
Increasing size
Pain
Deep anatomical location
Medical term for a skin tag?
Acrochordon
Who do skin tags look like?
Soft, fleshy papule that is almost always pedunculated
Biopsy findings of a skin tag?
Fibrovascular core covered by normal squamous epithelium
What causes skin warts?
Certain strains of HPV
They cause too much keratin to develop in the epidermis = produces the rough, hard, texture of a wart
What are verrucas?
Plantar warts - warts that develop on the soles of the feet
They are often white with a black dot in the centre and are flat
How to prevent warts/verrucas?
Dont touch other people’s warts
Dont share towels, flannels or other personal items
Dont share shoes/socks
Don’t scratch or pick a wart or verruca
Keep feet dry
Change socks every day
Take care when shaving
Wear gloves when using shared gym equipment
Wear pool slippers or flip flops in communal changing rooms
Cover wart/verruca with a waterproof plaster or verruca sock when swimming/PE at school
Managing skin cysts?
They do not need to be treated if not causing problems
If infected -> antibiotics
If large and pinaful that interferes with everyday life them it may be removed
What is a pyogenic granuloma?
A relatively common benign skin lesion
It’s a lobular capillary haemangioma
More common after trauma, in pregnancy, in women and young adults
Features of pyogenic granulomas?
Initially a small red/brown spot that rapidly progresses within days-> weeks forming a raised, red-brown lesion that’s often spherical in shape
They may bleed profusely or ulcerate
Where are pyofenic granulomas common?
Head, neck, upper trunk,m hands
In pregnancy - common in oral mucosa
Management of pyogenic granulomas?
lesions associated with pregnancy often resolve spontaneously post-partum
other lesions usually persist. Removal methods include curettage and cauterisation, cryotherapy, excision
What are cherry haemangiomas also known as?
Campbell de Morgan Spots
“Senile haemangiomas”
What are cherry haemangiomas?
Benign skin lesions containing an abnormal proliferation of capillaries
Who gets cherry haemangiomas?
Advancing age - 75% of people >75 have them
Men + women equally
Features of cherry haemangiomas?
Erythematous popular lesions. When thrombosed it can appear black in colour until examined with a Dermatoscope
Often multiple
1-3mm in size
Non-blanching
Not found on mucous membranes
Tx of cherry angioma?
Harmless so no need for Tx
Occasionally they are removed to exclude a malignant skin lesion
What is hereditary haemorrhagic telangiectasia?
Also known as Osler-Weber-Rendu syndrome
Autosomal dominant condition characterised by multiple telangiectasia over the skin and mucous membranes
20% of cases occur spontaneously without prior FHx
4 main diagnostic criteria:
- epistaxis
- telangiectasia
- visceral lesions e.g. GI telangiectasia, pulmonary Arteriovenous malformations
- FHx first degree
What is a strawberry naevi?
A capital,army haemangioma that is not usually present at birth but develops rapidly in the first month of life. They typically increase in size until around 6-9 months before regressing over the next few years
Appears as an erythematous, raised, multilobed tumour
How common is a strawberry naevus?
Present in 10% of white infants
Who is more likely to be affected by a strawberry naevus?
Female infants, premature infants and those of mothers who have undergone chorionic villous sampling
Tx of a strawberry naevus?
If Tx is required e.g. there is a visual field obstruction = propranolol
What is a keratocanthoma?
A benign, epithelial tumour
Who are keratocanthomas most common in?
Older population
Clinical features of keratocanthoma?
Looks like a volcano or crater
Initially a smooth dome-shaped papule which rapidly grows to become a crater centrally-filled with keratin
Management of keratocanthomas?
Usually spontaneously regress within 3 months, leaving a scar
They should be urgently excised as difficult to exclude SCC (removal may also prevent scarring)
At what size lipoma should you USS it for diagnosis rather than making a clinical diagnosis?
> 5cm - as this suggests a sarcomatous change
