Benign Skin Lesions

Question 1

What are some benign skin lesions?

Answer 1

Seborrhoeic Keratoses
Viral warts 
Cysts
Dermatofibroma
Lipoma
Vascular lesions

Question 2

Presentation of seborrheic keratoses

Answer 2

Warty growths
“Stuck on appearance”
Variable appearance
Multiple +/- cherry angiomas

Question 3

Treatment of seborrheic keratoses

Answer 3

Generally left untreated
If troublesome
- cryotherapy
- curettage

Question 4

What is Leser-Trelat?

Answer 4

Paraneoplastic phenomenon

Abrupt onset of widespread serborrheoic keratoses, particularly in a younger individual

Question 5

What may SK Leser Trelat sign indicate?

Answer 5

Solid organ malignancy - GI adenocarcinoma

Question 6

Cause of viral warts

Answer 6

Human papilloma virus (HPV)

Question 7

Presentation of viral warts

Answer 7

Warts

Rough hyperkeratotic surface

Question 8

Treatment of viral warts

Answer 8

Cryotherapy / wart paints can stimulate immune system slightly
Curette in severe cases

Question 9

When will viral warts clear?

Answer 9

When immunity developed t the virus

Question 10

What are cysts?

Answer 10

Encapsulated lesion containing fluid or semi fluid material

Question 11

Presentation

Answer 11

Contain fluid / semi fluid
Firm
Fluctuant

Question 12

What % of the population have cysts?

Answer 12

20%

Question 13

Different types of cysts

Answer 13

Epidermoid cyst
Pilar cyst 
Steatocystoma
Dermoid cyst
Hidrocystoma 
Ganglion cyst

Question 14

Complications of cysts

Answer 14

Can rupture and cause inflammation of surrounding skin

May become secondary infected

Question 15

Treatment of cysts

Answer 15

Excision 
If inflamed/infected
- antibiotics
- intralesional steroid
- incision and drainage

Question 16

What is a dermatofibroma?

Answer 16

Benign fibrous nodule, often on limbs

Question 17

Pathology of dermatofibroma

Answer 17

Proliferation of fibroblasts

Question 18

Cause of dermatofibroma

Answer 18

Unknown

Sometimes attributed to area of trauma

Question 19

Presentation of dermatofibroma

Answer 19

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

Question 20

When would you excise a dermatofibroma?

Answer 20

If concern or symptomatic

Question 21

What is lipoma?

Answer 21

Benign tumour consisting of fat cells

Question 22

Presentation of lipoma

Answer 22

Smooth and rubbery subcutaneous mass 
Usually asymptomatic 
If tender
- angiolipoma
- liposarcoma (rare)

Question 23

What are the two vascular lesions?

Answer 23

Angioma

Pyogenic granuloma

Question 24

What is an angioma?

Answer 24

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

Question 25

Presentation of angioma

Answer 25

Blood vessels Asymptomatic Can be unsightly or bleed

Question 26

Who gets angiomas?

Answer 26

All age groups Both M and F Pregnancy Liver Disease

Question 27

Treatment of angioma

Answer 27

Excision | Laser

Question 28

What is a pyogenic granuloma?

Answer 28

Rapidly enlarging red/raw growth, often at a site of trauma | Bleed easily

Question 29

Pyogenic granulomas occur in 5% of what?

Answer 29

Pregnancies

Question 30

Where are pyogenic granulomas common?

Answer 30

Head | Hands

Question 31

Treatment of pyogenic granulomas

Answer 31

Removal by - Curettage - Cautery

Question 32

Risk factors for pre malignant lesions

Answer 32

UV radiation

Question 33

What does UV radiation cause?

Answer 33

DNA damage | Immunosuppression

Question 34

What are the pre malignant skin lesions?

Answer 34

Bowen's disease Actinic Keratoses Melanoma in situ

Question 35

What is Bowen's disease?

Answer 35

Intraepidermal squamous cell carcinoma

Question 36

Pathology of Bowen's disease

Answer 36

Full thickness dysplasia, entirely contained within the epidermis

Question 37

Can Bowen's disease metastasise?

Answer 37

No

Question 38

What is Bowen's disease potential to become malignant?

Answer 38

5%

Question 39

Presentation of Bowen's disease

Answer 39

Irregular, scaly erythematous plaque

Question 40

Treatment of Bowen's disease

Answer 40

Cryotherapy Curettage Photodynamic therapy Imiquimod

Question 41

What is curettage?

Answer 41

Lesion scraped off and heat applied to seal vessels and destroy residual cancer cells

Question 42

What is actinic keratoses?

Answer 42

Rough scaley patches on sun damaged skin

Question 43

Risk of actinic keratoses transforming to SCC?

Answer 43

Low risk

Question 44

Treatment of actinic keratoses

Answer 44

Cryotherapy Curettage Diclofenac Gel Imiquimod

Question 45

What is melanoma in situ?

Answer 45

Melanoma cells entirely confined to dermis

Question 46

Has melanoma in situ got metastatic potential?

Answer 46

No

Question 47

What is melanoma in situ treated with?

Answer 47

Excision

Question 48

What type of condition is actinic keratoses?

Answer 48

Premalignant

Question 49

What does acitinic keratoses develop as a consequence of?

Answer 49

Chronic sun exposure

Question 50

Presentation of actinic keratoses

Answer 50

Small crusty or scaly lesions Pink, red brown or same colour as skin Multiple lesions may be present

Question 51

Where do you find actinic keratoses?

Answer 51

Sun exposed areas e.g. temples of head

Question 52

Management of actinic keratoses

Answer 52

``` 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 ```

Question 53

Another name for cherry hemangioma

Answer 53

Campbell de morgan spots

Question 54

What are cherry hemangiomas?

Answer 54

Benign skin lesions which contain abnormal proliferation of capillaries

Question 55

Presentation of cherry hemangioma

Answer 55

Erythematous papular lesions 1 -3mm in size Non blanching

Question 56

Where are cherry hemangiomas NOT found?

Answer 56

Mucous membranes

Question 57

Treatment of cherry hemangiomas

Answer 57

No treatment is usually required

Question 58

What are keloid scars?

Answer 58

Tumour like lesions that arise from connective tissue of a scar and extend beyond the dimensions of the original wound

Question 59

Predisposing factors for keloid scars

Answer 59

Ethnicity - dark skin | Young adults

Question 60

Common sites for keloid scars (in order of decreasing frequency)

Answer 60

``` Sternum Shoulder Neck Face Extensor surface of limbs Trunk ```

Question 61

When are keloid scars less likely?

Answer 61

If incisions are made along relaxed skin tension lines

Question 62

Treatment of keloid scars

Answer 62

Early - intra lesional steroids e.g. triamcinolone | Excision sometimes required

Question 63

What is a feature of a keratoacanthoma?

Answer 63

They have a rapid growth phase

Question 64

Describe a keratoacanthoma

Answer 64

Red dome shaped lesion | Central defect that contains keratinous type material