Benign Skin Lesions

Question 1

What is the appearance of seoborrhoeic keratoses?

Answer 1

Warty growths

Stuck on appearance

Variable appearance

Patients may or may not have several cherry angiomas

Question 2

What is the treatment for seborrhoeic keratoses?

Answer 2

Generally left untreated but if troublesome - cryotherapy / curettage

Question 3

What is cryotherapy?

Answer 3

Liquid nitrogen

Question 4

What are the pros and cons of cryotherapy?

Answer 4

•Pros

–Cheap

–Easy to perform “on the day”

•Cons

–Can scar

–Failure/Recurrence

–No pathology result

Question 5

What condition does a rapid onset of seborrhoeic keratoses indicate? (particularly in a younger individual)

Answer 5

Leser - Trelat

SK’s remain benign but may indicate underlying solid organ malignancy

GI adenocarcinoma

Question 6

What are these?

They have a rough hyperkeratotic surface

Answer 6

They are viral warts (due to the human papilloma virus)

Question 7

What is the treatmet of viral warts?

Answer 7

Tend to be difficualt to treat

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

Question 8

What is this?

(encapsulated lesion containing fluid or semi-fluid material)

Firm and fluctulant

Answer 8

Cysts

Question 9

What are different types of cyst?

Answer 9

Epidermoid

Pilar

Steatocystoma - genetic predisposition - may be treated with isotretinoin

Question 10

What risks are associated with cysts?

Answer 10

Can rupture and cause inflammation of surrounding skin

May become secondary infected

Question 11

What are the treatments of cysts?

Answer 11

Treated with excision

If inflamed / infected:

• Antibiotics
• Intralesional steroid
• Incision and drainage

Question 12

What is this?

(described as a benign fibrous nodule - often on limbs)

Answer 12

Dermatofibroma

Question 13

The proliferation of what type of cell causes dermatofibroma?

Answer 13

Fibroblasts

The cause is unknown, they are sometimes attributed to an area of trauma

Question 14

What are the features of dermatofibroma?

Answer 14

Firm nodule, tethered to skin but mobile over fat

Pale/pink brown

Often paler centre

Dimple sign positive

Usually asymptomatic - can be itch or tender

Excision if concern or symptomatic

Question 15

What is a lipoma?

Answer 15

It is a benign tumour consisting of fat cells

Question 16

What are the features of lipomas?

Answer 16

Common

Smooth and rubbery subcutaneous mass

Usually asymptomatic

Question 17

If the lipoma is tender what might that indicate?

Answer 17

Angiolipoma

Liposarcoma - rare malignancy

Question 18

What is an angioma?

Answer 18

Overgrowth of blood vessels in the skin due to proliferating endothelial cells

Question 19

What are the features of angiomas?

Answer 19

Generally asymptomatic but they may bleed and can be described as unsightly

They occur in liver disease or pregancy

Question 20

What is the treatment for angiomas?

Answer 20

Excsion or laser

Question 21

What is this?

Answer 21

Pyogenic granuloma

Question 22

What are the features of pyogenic granuloma?

Answer 22

Rapidly enlarging

Bleed easily

Occur in 5% of pregnancies

Common on the head and the hands

Question 23

What is the treatment for pyogenic granuloma?

Answer 23

Curettage and cautery

Question 24

So what were the vascular lesions?

Answer 24

Pyogenic granuloma

Angioma

Question 25

What are some pre-malignant skin conditions?

Answer 25

Actinitic keratoses Bowen's disease Melanoma in situ

Question 26

What does actinitc keratoses progress to?

Answer 26

SCC Common in the elderly population Described as a crusty scaly patch - sign of partial thickness epidermal dysplasia

Question 27

If actinitic keratoses is partial thickness epidermal dysplasia - what is full thickness epidermal dysplasia known as?

Answer 27

Bowen's disease It is entirely contained within the epidermis so there is no metastatic potential Potential to become malignant is around 5% It is described as irregular, scaly, erythematous plaque

Question 28

What is the treatment if bowens?

Answer 28

Cryotherapy Curettage - Lesion scraped off and heat applied to seal vessels and destroy residual cancer cells Photodynamic therapy Imiquimod

Question 29

How does photodynamic therapy work?

Answer 29

A topical photosensitising agent causes cancer cells to become sensitised to a specific colour of light - the agent conecntratres in cancer cells A photodynamic reaction occurs between light photosensitiser and oxygen causing inflamation and destruction of cells

Question 30

Pros and cons of photodynamic therapy

Answer 30

•Pros –Done for the patient by hospital staff –Can treat multiple areas, including those which would be hard to reach by patient –1 or 2 treatments •Cons –Requires hospital appointments –Can be painful and scar

Question 31

How does imiquimod work?

Answer 31

Stimulates cytokine release - inflammation and destruction of lesion

Question 32

Pros and cons for imiquimod

Answer 32

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

Question 33

What is treatment of actinitic keratoses?

Answer 33

–Cryotherapy –Curettage –Diclofenac Gel –Imiquimod

Question 34

What is meant by melanoma in situ?

Answer 34

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

Question 35

Give an example of a melanoma in situ

Answer 35

Lentigo maligna Usually facial

Question 36

What are ways to avoid the sun? Actinitic keratoses is described as rough scaly patches on sun damaged skin

Answer 36

* Cover up * Avoid sun at peak hours –10am-4pm * Don’t burn and try not to tan * Avoid sunbeds * Sunscreen –UVA & UVB protection –At least SPF 30 / 4 Star –Need to apply 2 tablespoons every 2 hours