Benign skin lesions Flashcards
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
How is Sebborrhoeic keratosis treated?
– Cryotherapy
– Curettage
generally left untreated, only removed if troublesome
What are the pros and cons of cryotherapy?
Pros – Cheap – Easy to perform “on the day” Cons – Can scar – Failure/Recurrence
What is cryotherapy?
Liquid nitrogen (extremely cold) is used to destroy abnormal skin lesions
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
What is Leser-Trelat sign often a sign of?
SKs remain benign but may indicate underlying solid organ malignancy
– GI adenocarcinoma, must always investigate
What virus causes viral warts?
Human Papilloma Virus
Describe viral warts
- Due to Human Papilloma Virus
- Rough hyperkeratotic surface
- Difficult to treat
- Will clear when immunity developed to virus
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
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
Describe an epidermoid cyst
– Epidermoid cyst (wrongly called sebaceous) – hard lumps under skin, grow slowly
Describe a pilar cyst
– Pilar cyst – cyst that develops from hair follicle
Describe a steatocystoma
Steatocystoma – cyst growth from sebaceous glands
Describe a dermoid cyst
– Dermoid cyst – teratoma containing hair follicles, epidermis and glands from residual embryonic cells
Describe a hidrocystoma
– Hidrocystoma – adenoma of sweat glands, usually on eyelid
Describe a ganglion cyst
– Ganglion cyst – spongy swelling on top of joint or tendon
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
How are inflamed/infected cysts treated?
– Antibiotics
– Intralesional steroid
– Incision & Drainage
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
What benign skin lesions have positive dimple signs?
Dermatofibromas
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
