Benign Skin Lesions Flashcards
What is the appearance of seoborrhoeic keratoses?
Warty growths
Stuck on appearance
Variable appearance
Patients may or may not have several cherry angiomas
What is the treatment for seborrhoeic keratoses?
Generally left untreated but if troublesome - cryotherapy / curettage
What is cryotherapy?
Liquid nitrogen
What are the pros and cons of cryotherapy?
•Pros
–Cheap
–Easy to perform “on the day”
•Cons
–Can scar
–Failure/Recurrence
–No pathology result
What condition does a rapid onset of seborrhoeic keratoses indicate? (particularly in a younger individual)
Leser - Trelat
SK’s remain benign but may indicate underlying solid organ malignancy
GI adenocarcinoma
What are these?
They have a rough hyperkeratotic surface
They are viral warts (due to the human papilloma virus)
What is the treatmet of viral warts?
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
What is this?
(encapsulated lesion containing fluid or semi-fluid material)
Firm and fluctulant
Cysts
What are different types of cyst?
Epidermoid
Pilar
Steatocystoma - genetic predisposition - may be treated with isotretinoin
What risks are associated with cysts?
Can rupture and cause inflammation of surrounding skin
May become secondary infected
What are the treatments of cysts?
Treated with excision
If inflamed / infected:
- Antibiotics
- Intralesional steroid
- Incision and drainage
What is this?
(described as a benign fibrous nodule - often on limbs)
Dermatofibroma
The proliferation of what type of cell causes dermatofibroma?
Fibroblasts
The cause is unknown, they are sometimes attributed to an area of trauma
What are the features of dermatofibroma?
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
What is a lipoma?
It is a benign tumour consisting of fat cells
What are the features of lipomas?
Common
Smooth and rubbery subcutaneous mass
Usually asymptomatic
If the lipoma is tender what might that indicate?
Angiolipoma
Liposarcoma - rare malignancy
What is an angioma?
Overgrowth of blood vessels in the skin due to proliferating endothelial cells
What are the features of angiomas?
Generally asymptomatic but they may bleed and can be described as unsightly
They occur in liver disease or pregancy
What is the treatment for angiomas?
Excsion or laser
What is this?
Pyogenic granuloma
What are the features of pyogenic granuloma?
Rapidly enlarging
Bleed easily
Occur in 5% of pregnancies
Common on the head and the hands
What is the treatment for pyogenic granuloma?
Curettage and cautery
So what were the vascular lesions?
Pyogenic granuloma
Angioma
What are some pre-malignant skin conditions?
Actinitic keratoses
Bowen’s disease
Melanoma in situ
What does actinitc keratoses progress to?
SCC
Common in the elderly population
Described as a crusty scaly patch - sign of partial thickness epidermal dysplasia
If actinitic keratoses is partial thickness epidermal dysplasia - what is full thickness epidermal dysplasia known as?
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
What is the treatment if bowens?
Cryotherapy
Curettage - Lesion scraped off and heat applied to seal vessels and destroy residual cancer cells
Photodynamic therapy
Imiquimod
How does photodynamic therapy work?
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
Pros and cons of photodynamic therapy
•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
How does imiquimod work?
Stimulates cytokine release - inflammation and destruction of lesion
Pros and cons for imiquimod
•Pros
–Useful where surgery is undesirable
–Usually good cosmetic result
–Large surface area
•Cons
–Treatment time is 6 weeks
–Significant inflammation
–Failure/recurrence
What is treatment of actinitic keratoses?
–Cryotherapy
–Curettage
–Diclofenac Gel
–Imiquimod
What is meant by melanoma in situ?
Melanoma cells are entirely confined to the epidermis
No metastatic potential
Treated with excision
Give an example of a melanoma in situ
Lentigo maligna
Usually facial
What are ways to avoid the sun?
Actinitic keratoses is described as rough scaly patches on sun damaged skin
- 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
