Benign Skin Lesions Flashcards
What are some benign skin lesions?
Seborrhoeic Keratoses Viral warts Cysts Dermatofibroma Lipoma Vascular lesions
Presentation of seborrheic keratoses
Warty growths
“Stuck on appearance”
Variable appearance
Multiple +/- cherry angiomas
Treatment of seborrheic keratoses
Generally left untreated
If troublesome
- cryotherapy
- curettage
What is Leser-Trelat?
Paraneoplastic phenomenon
Abrupt onset of widespread serborrheoic keratoses, particularly in a younger individual
What may SK Leser Trelat sign indicate?
Solid organ malignancy - GI adenocarcinoma
Cause of viral warts
Human papilloma virus (HPV)
Presentation of viral warts
Warts
Rough hyperkeratotic surface
Treatment of viral warts
Cryotherapy / wart paints can stimulate immune system slightly
Curette in severe cases
When will viral warts clear?
When immunity developed t the virus
What are cysts?
Encapsulated lesion containing fluid or semi fluid material
Presentation
Contain fluid / semi fluid
Firm
Fluctuant
What % of the population have cysts?
20%
Different types of cysts
Epidermoid cyst Pilar cyst Steatocystoma Dermoid cyst Hidrocystoma Ganglion cyst
Complications of cysts
Can rupture and cause inflammation of surrounding skin
May become secondary infected
Treatment of cysts
Excision If inflamed/infected - antibiotics - intralesional steroid - incision and drainage
What is a dermatofibroma?
Benign fibrous nodule, often on limbs
Pathology of dermatofibroma
Proliferation of fibroblasts
Cause of dermatofibroma
Unknown
Sometimes attributed to area of trauma
Presentation of dermatofibroma
Often found on limbs Firm nodule Tethered to skin but mobile over fat Pale pink/brown Often paler in the centre Dimple sign positive Usually asymptomatic Can be itchy or tender
When would you excise a dermatofibroma?
If concern or symptomatic
What is lipoma?
Benign tumour consisting of fat cells
Presentation of lipoma
Smooth and rubbery subcutaneous mass Usually asymptomatic If tender - angiolipoma - liposarcoma (rare)
What are the two vascular lesions?
Angioma
Pyogenic granuloma
What is an angioma?
Overgrowth of blood vessels in the skin due to proliferating endothelial cells
Presentation of angioma
Blood vessels
Asymptomatic
Can be unsightly or bleed
Who gets angiomas?
All age groups
Both M and F
Pregnancy
Liver Disease
Treatment of angioma
Excision
Laser
What is a pyogenic granuloma?
Rapidly enlarging red/raw growth, often at a site of trauma
Bleed easily
Pyogenic granulomas occur in 5% of what?
Pregnancies
Where are pyogenic granulomas common?
Head
Hands
Treatment of pyogenic granulomas
Removal by
- Curettage
- Cautery
Risk factors for pre malignant lesions
UV radiation
What does UV radiation cause?
DNA damage
Immunosuppression
What are the pre malignant skin lesions?
Bowen’s disease
Actinic Keratoses
Melanoma in situ
What is Bowen’s disease?
Intraepidermal squamous cell carcinoma
Pathology of Bowen’s disease
Full thickness dysplasia, entirely contained within the epidermis
Can Bowen’s disease metastasise?
No
What is Bowen’s disease potential to become malignant?
5%
Presentation of Bowen’s disease
Irregular, scaly erythematous plaque
Treatment of Bowen’s disease
Cryotherapy
Curettage
Photodynamic therapy
Imiquimod
What is curettage?
Lesion scraped off and heat applied to seal vessels and destroy residual cancer cells
What is actinic keratoses?
Rough scaley patches on sun damaged skin
Risk of actinic keratoses transforming to SCC?
Low risk
Treatment of actinic keratoses
Cryotherapy
Curettage
Diclofenac Gel
Imiquimod
What is melanoma in situ?
Melanoma cells entirely confined to dermis
Has melanoma in situ got metastatic potential?
No
What is melanoma in situ treated with?
Excision
What type of condition is actinic keratoses?
Premalignant
What does acitinic keratoses develop as a consequence of?
Chronic sun exposure
Presentation of actinic keratoses
Small crusty or scaly lesions
Pink, red brown or same colour as skin
Multiple lesions may be present
Where do you find actinic keratoses?
Sun exposed areas e.g. temples of head
Management of actinic keratoses
Prevention of further risk - sun avoidance - sun cream Fluorouracil cream (2 - 3 weeks) - topical hydrocortisone sometimes given to settle inflammation Topical diclofenac (mild) Topical imiquimod Cryotherapy Curettage and cautery
Another name for cherry hemangioma
Campbell de morgan spots
What are cherry hemangiomas?
Benign skin lesions which contain abnormal proliferation of capillaries
Presentation of cherry hemangioma
Erythematous papular lesions
1 -3mm in size
Non blanching
Where are cherry hemangiomas NOT found?
Mucous membranes
Treatment of cherry hemangiomas
No treatment is usually required
What are keloid scars?
Tumour like lesions that arise from connective tissue of a scar and extend beyond the dimensions of the original wound
Predisposing factors for keloid scars
Ethnicity - dark skin
Young adults
Common sites for keloid scars (in order of decreasing frequency)
Sternum Shoulder Neck Face Extensor surface of limbs Trunk
When are keloid scars less likely?
If incisions are made along relaxed skin tension lines
Treatment of keloid scars
Early - intra lesional steroids e.g. triamcinolone
Excision sometimes required
What is a feature of a keratoacanthoma?
They have a rapid growth phase
Describe a keratoacanthoma
Red dome shaped lesion
Central defect that contains keratinous type material
