Benign Skin Lesions Flashcards
Describe the appearance of seborrhoeic keratoses?
Warty growths - ‘stuck on’ appearance
Patients often have multiple cherry angiomas
Management for seborrhoeic keratoses?
Generally left untreated
If troublesome - cryotherapy, curettage
What is cryotherapy?
Liquid nitrogen applied to lesion
Pros and cons of cryotherapy?
Pros: cheap, easy to perform on day
Cons: can scar, failure/recurrence, no histology
What is the ‘Sign of Leser-Trelat’? What does it indicate?
Abrupt onset of widespread seborrhoeic keratosis, particularly in youth
SKs remain benign but may indicate underlying solid organ malignancy (GI adenocarcinoma)
What virus causes viral warts? What do they look like?
Human Papilloma Virus
Rough, hyperkeratotic
How are viral warts treated?
Difficult to treat
Will clear when immunity to virus develops
Cryotherapy/wart paints
Curette if severe
What is a cyst?
Encapsulated lesion containing fluid or semi-fluid material; firm + fluctuant
Try to name some types of cyst
Epiermoid cyst Pilar cyst Steatocystoma (genetic; isotretinoin) Dermoid cyst Hidrocystoma Ganglion cyst
What is the risk associated with cysts?
Can rupture and cause inflammation of surrounding skin; may become infected
How are cysts treated?
Treated with excision
If inflamed/infection - abx, intralesional steroid, incision + drainage
What is a dermatofibroma?
Benign fibrous nodule, often on limbs
Cause of dermatofibroma?
Cause unknown; sometimes trauma
Proliferation of fibroblasts
How does a dermatofibroma present?
Firm nodule, tethered to skin but mobile over fat
Pale pink/brown; paler in centre
Usually asymptomatic (can be itchy/tender)
Dimple sign +ve
How is dermatofibroma managed?
Excised if concern or asymptomatic
What is a lipoma?
Benign tumour of fat cells
Cause of lipoma?
Cause unknown, but a common lesion
How does a lipoma present?
Smooth + rubbery subcutaneous mass
Usually asymptomatic
What can it mean if a lipoma is tender?
Possible angiolipoma or liposarcoma (rare malignancy)
What is an angioma?
Overgrowth of blood vessels in the skin due to proliferating endothelial cells
How do angiomas present?
Generally asymptomatic
Can be unsightly/bleed
In what conditions are angiomas more likely to occur?
Pregnancy
Liver disease
How are angiomas dealt with?
Excision or laser
What is a pyogenic granuloma?
Rapidly enlarging red/raw growth, often at site of trauma
What are features of pyogenic granulomas?
Bleed easily Common on head and hands Red/raw Occur ~5% pregnancies Unknown cause
How are pyogenic granulomas dealt with?
Removed by curettage and cautery
Name 3 pre-malignant lesions
Actinic keratoses
Bowen’s disease
Melanoma in situ
What are actinic keratoses?
Rough scaly patches on sun damaged skin
What is there a risk of developing form actinic keratoses?
SCC
How are actinic keratoses treated?
Cryotherapy
Curettage
Diclofenac gel
Imiquimod
What is Bowen’s disease?
SCC in situ
What is the appearance of Bowen’s disease?
Full thickness dysplasia, entirely contained in epidermis
Irregular, scaly erythematous plaque
What is the potential of Bowen’s disease?
Potential to become malignant (~5%)
No metastatic potential
How is Bowens treated?
Cryotherapy
Curettage (lesion scraped off and heat applied to seal vessels and destroy residual cancer cells)
Photodynamic therapy
Imiquimod
What is photodynamic therapy?
Photochemical reaction to selectively destroy cancer cells
Process of photodynamic therapy?
Topical photosensitising agent applied - concentrates in cancerous cells
Red light applied
Photodynamic reaction occurs
What is imiquimod - how does it work? (aka Aldara)
Cream
Immune response modifier which stimulates cytokine release leading to inflammation and destruction of lesion
Pros and cons of imiquimod?
Pros: useful where surgery is undesirable; usually good cosmetic result
Cons: treatment time ~6 weeks; significant inflammation; failure/recurrence
What is melanoma in situ?
Melanoma cells entirely confined to epidermis
No metastatic potential
How is melanoma in situ dealt with?
Excision
What is essential to try and avoid development of these pre-malignant skin lesions?
Sun protection - SPF, cover up, avoid sunbeds etc
