Due to Human Papilloma Virus Rough hyperkeratotic surface Difficult to treat Will clear when immunity developed to virus

Encapsulated lesion containing fluid/semi-fluid matter Usually firm and fluctuant Common. Affect ~20% adults Multiple different types of cyst exist

Benign skin lesions Flashcards by Rachel Hughes

Describe Sebborrhoeic keratosis

• Benign, but commonly referred
• Warty growths, “stuck on appearance”
• Can have variable appearance
• Patients often have multiple +/- cherry angiomas
• Generally left untreated, but if troublesome
– Cryotherapy
– Curettage

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How is Sebborrhoeic keratosis treated?

– Cryotherapy
– Curettage

generally left untreated, only removed if troublesome

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What are the pros and cons of cryotherapy?

Pros	
–	Cheap
–	Easy to perform “on the day”
Cons
–	Can scar
–	Failure/Recurrence

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What is cryotherapy?

Liquid nitrogen (extremely cold) is used to destroy abnormal skin lesions

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Describe Leser-Trelat sign

Paraneoplastic phenomenon of abrupt onset of widespread seborrhoeic keratosis, particularly in a younger individual

SKs remain benign but may indicate underlying solid organ malignancy
– GI adenocarcinoma, must always investigate

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What is Leser-Trelat sign often a sign of?

SKs remain benign but may indicate underlying solid organ malignancy
– GI adenocarcinoma, must always investigate

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What virus causes viral warts?

Human Papilloma Virus

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Describe viral warts

Due to Human Papilloma Virus
Rough hyperkeratotic surface
Difficult to treat
Will clear when immunity developed to virus

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How are viral warts treated?

Will clear when immunity developed to virus
Cryotherapy or wart paints can stimulate immune system slightly
Can curette in severe cases

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What is a cyst?

Encapsulated lesion containing fluid/semi-fluid matter
Usually firm and fluctuant
Common. Affect ~20% adults
Multiple different types of cyst exist

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Describe an epidermoid cyst

– Epidermoid cyst (wrongly called sebaceous) – hard lumps under skin, grow slowly

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Describe a pilar cyst

– Pilar cyst – cyst that develops from hair follicle

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Describe a steatocystoma

Steatocystoma – cyst growth from sebaceous glands

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Describe a dermoid cyst

– Dermoid cyst – teratoma containing hair follicles, epidermis and glands from residual embryonic cells

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Describe a hidrocystoma

– Hidrocystoma – adenoma of sweat glands, usually on eyelid

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Describe a ganglion cyst

– Ganglion cyst – spongy swelling on top of joint or tendon

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What are the complications often seen with cysts?

Can rupture and cause inflammation of surrounding skin
May become secondary infected

Treated with excision

If inflammed/infected
– Antibiotics
– Intralesional steroid
– Incision & Drainage

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How are inflamed/infected cysts treated?

– Antibiotics
– Intralesional steroid
– Incision & Drainage

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Describe dermatofibromas

• Benign fibrous nodule, often on limbs
– Proliferation of fibroblasts
• Cause is unknown. They are sometimes attributed to an area of trauma.
• Firm nodule, tethered to skin but mobile over fat. Pale pink/brown. Often paler in centre.
• Dimple sign positive

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What benign skin lesions have positive dimple signs?

Dermatofibromas

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How are dermatofibromas treated?

Usually asymptomatic. Can be itchy or tender

* Excision if concern or symptomatic.

What is classified as a positive dimple sign?

Dimple sign positive – when lateral pressure on the skin causes a depression

If someone presents with a firm nodule found on a limb that is tethered to skin/mobile over fat, and is a pale pink/brown which is paler in the centre, what would you suspect?

Dermatofibroma

What condition is associated with an acute onset of widespread seborrhoeic keratosis, particularly in a younger individual?

Leser-Trelat paraneoplastic syndrome - GI cancer??

Describe a lipoma

* Benign tumour consisting of fat cells * Common * Cause unknown * Smooth and rubbery subcutaneous mass * Usually asymptomatic

If a lipoma is found to be tender, what should be suspected?

angiolipoma | ?Liposarcoma – rare malignancy

What would you suspect if someone presented with a smooth and rubbery asymptomatic non-tender subcutaneous mass?

Lipoma

What is an angioma?

Overgrowth of blood vessels in the skin due to proliferating endothelial cells – Generally asymptomatic. Can be unsightly or bleed – Occur in all age groups, both sexes

What conditions can cause angioma development?

– Pregnancy & liver disease

How are angiomas treated?

– Excision or laser therapy

List 3 types of angioma

* Cherry angiomas * Spider naevi * Venous lakes

What should be suspected if someone presents with a blue papule on a sun exposed region of skin e.g. ear, lips?

Venous lake angioma

What should be suspected if someone presents with a mole like growth that appears red as it is full of blood vessels?

Cherry angiomas

What should be suspected if someone presents with a central red spot with extensions?

Spider naevia angioma Increased in women on OCP or pregnant women due to increased oestrogen levels

Describe a pyogenic granuloma

``` – Rapidly enlarging red/raw growth, often at a site of trauma. – Bleed easily – Cause is unknown – Occur in up to 5% of pregnancies – Common on head and hands ```

What conditions is pyogenic granuloma usually associated with?

Pregnancy | trauma to head or hand

What risk is associated with pre-malignant lesions?

UV radiation – DNA damage and immunosuppression

Describe Bowens disease

Aka Intraepidermal squamous cell carcinoma – Full thickness dysplasia, entirely contained within the epidermis, no metastatic potential – Potential to become malignant (around 5%) Irregular, scaly erythematous plaque

What number of spider naevi is suspicious and should elicit investigations?

> 5 on total body (may be higher in pregnancy/if on OCP)

What is Bowen's disease also called?

Intraepidermal squamous cell carcinoma

How is Intraepidermal squamous cell carcinoma/Bowens disease treated?

– Cryotherapy – Curettage followed by cauterisation – Photodynamic therapy – Imiquimod

What is photodynamic therapy?

``` • Photochemical reaction to selectively destroy cancer cells • Topical photosensitising agent applied – Concentrates in cancerous cells • Red light applied • Photodymanic reaction occurs ```

What is Imiquimod?

• Aldara • Immune response modifier – Stimulates cytokine release to cause inflammation and destruction of lesion

What are the pros and cons of Imiquimod?

Pros – Useful where surgery is undesirable – Usually good cosmetic result Cons – Treatment time is 6 weeks – Significant inflammation – Failure/recurrence

What skin lesions presents as a rough scaly patch on sun damaged skin that is associated with a risk of transforming into squamous cell carcinoma?

Actinic keratoses

How is Actinic keratoses treated?

– Cryotherapy – Curettage – Diclofenac Gel – Imiquimod

What is Actinic keratoses?

* Rough scaly patches on sun damaged skin | * Low risk of transformation to SCC

What is melanoma in situ?

* Melanoma cells entirely confined to epidermis * No metastatic potential * Treated with excision

Describe 3 pre-malignant conditions

Bowen's disease/Intraepidermal squamous cell carcinoma Actinic keratoses Melanoma in situ

What are the recommendations for sunscreen use?

– UVA & UVB protection – At least SPF 30 / 4 Star – Need to apply 2 tablespoons every 2 hours

What are peak hours of sunlight?

10am-4pm