Benign Skin Lesions Flashcards
What is used to describe a skin lesion?
Site
Size
Shape
Colour
When palpating a skin lesion, what are we checking?
Mobility
Surface changes
Temperature
Consistency
What are some examples of different kinds of benign skin lesions?
- Seborrhoeic keratosis
- Causing Sign of Leser-Trelat
- Viral warts
- Cysts
- Dermatofibroma
- Lipoma
- Vascular lesions
What does SK stand for?
Seborrhoeic keratoses (SK)
What is seborrhoeic keratoses?
Warty growths, stuck out appearance
Patients often have multiple
What is the treatment of seborrhoeic keratoses?
Causes sign of Leser-Trelat, which is a paraneoplastic phenomenon with abrupt onset of widespread seborrheic keratosis:
- Particularly in younger person
- Usually benign but may indicate underlying solid organ malignancy
- Such as GI adenocarcinoma
What does cyrotherapy utilise?
Liquid nitrogen
What are the pros of cyrotherapy?
- Cheap
- Easy to perform on the day
What are the cons of cyrotherapy?
- Can scar
- Failure/recurrence
- No histology
What is cyrotherapy?
Use of low temperatures in medical therapy
What causes viral warts?
Human papilloma virus
Describe the lesion due to viral warts?
Rough hyperkeratotic surface
What is the treatment of viral warts?
- Will clear when immunity developed to virus
- Cryotherapy or wart paints can stimulate immune system slightly
- Can curette in severe cases
What are cysts?
Encapsulated lesion containing fluid or semi-fluid material
What are some different types of cysts?
- Epidermoid cyst (often wrongly called sebaceous)
- Pilar cyst
- Steatocystoma
- Dermoid cyst
- Hidrocystoma
- Ganglion cyst
What can happen if a cyst ruptures?
Inflammation of surrounding skin, may become secondary infected
What is the treatment of cysts?
- Excision
- If inflamed/infected
- Antibiotics
- Intralesional steroid
- Incision and damage
What is dermatofibroma?
Benign fibrous nodule, often on limbs:
Proliferation of fibroblasts
What is the aetiology of dermatofibroma?Cause is unknown, sometimes due to area of trauma
Cause is unknown, sometimes due to area of trauma
Describe the lesion due to dermatofibroma?
Firm nodule, tethered to skin but mobile over fat, pale pink/brown often paler in centre
What is the clinical presentation of dermatofibroma?
Firm nodule, tethered to skin but mobile over fat, pale pink/brown often paler in centre
Dimple sign positive
Usually asymptomatic, can be itchy or tender
What is the treatment for dermatofibroma?
Excision if concern of symptomatic
What is lipoma?
Benign tumour consisting of fat cells
Is lipoma common or uncommon?
Common
Describe the lesion due to lipoma?
Smooth and rubbery subcutaneous mass
What is the clinical presentation of lipoma?
Usually asymptomatic
What are 2 types of vascular lesions?
- Angioma
- Overgrowth of blood vessels in skin due to proliferating endothelial cells
- Usually asymptomatic, can be unsightly or bleed
- Occurs in pregnancy and liver disease
- Excision or laser
- Pyogenic granuloma
- Rapidly enlarging red/raw growth, often at site of trauma
- Bleeds easily
- Cause is unknown
- Common on head and hands
- Removed by curettage and cautery
What is angioma?
- Overgrowth of blood vessels in skin due to proliferating endothelial cells
What is the clinical presentation of angioma?
Usually asymptomatic, can be unsightly or bleed
In who does angioma usually occur?
Pregnancy and liver disease
What is the treatment of angioma?
Excision or laser
What is pyogenic granuloma?
- Rapidly enlarging red/raw growth, often at site of trauma
What is the aetiology of pyogenic granuloma?
Unknown
What is the treatment of pyogenic granuloma?
Removed by curettage and cautery
Where on the body is pyogenic granuloma most common?
Head and hands
What is the main risk factor for pre-malignant lesions?
- UV radiation
- Causes DNA damage and immunosuppression
- Ultraviolet radiation is split into vacuum UV, UVC, UVB and UVA (in order of decreasing frequency)
What are the different kinds of ultraviolet radiation in order of decreasing frequency?
Vacuum UV
UVC
UVB
UVA
What are some examples of pre-malignant tumours?
- Actinic keratoses
- Bowen’s disease
- Melanoma in situ
Describe the spectrum of damaged cells?
1) Normal/benign
2) Hyperplasia
3) Dysplasia
4) In-situ disease
5) Invasive malignancy
What is actinic keratoses?
Rough scaly patches on sun damaged skin
How high is the risk of actinic keratoses transforming to SCC?
Low risk
What is the treatment for actinic keratoses?
- Cryotherapy
- Curettage
- Diclofenac gel
- Imiquimod
What is Bowen’s disease?
Squamous cell carcinoma in situ:
- Full thickness dysplasia, entirely contained within the epidermis
- No metastatic potential
- Potential to become malignant (around 5%)
Describe the lesion due to Bowen’s disease?
Irregular, scaly erythematous plaque
What is the treatment of Bowen’s disease?
- Cryotherapy
- Curette
- Lesion scrapped off and heat applied to seal vessels and destroy residual cancer cells
- Photodynamic therapy
- Photochemical reaction to selectively destroy cancer cells
- Topical photosensitising agent applied
- Concentrates in cancerous cells
- Red light applied and photodynamic reaction occurs
- Imiquimod
- Called Aldara and is topical cream
- Immune response modifier
- Stimulates cytokine response, causing inflammation and destruction of lesion
- Pros
- Useful where surgery undesirable
- Good cosmetic result
- Cons
- Treatment time is 6 weeks
- Signifianct inflammation
- Failure/recurrence
Describe a curette procedure?
- Lesion scrapped off and heat applied to seal vessels and destroy residual cancer cells
What is photodynamic therapy?
- Photochemical reaction to selectively destroy cancer cells
- Topical photosensitising agent applied
- Concentrates in cancerous cells
- Red light applied and photodynamic reaction occurs
How is imiquimob administered?
Topical cream
What is the mechanism of action of imiquimod?
- Immune response modifier
- Stimulates cytokine response, causing inflammation and destruction of lesion
What are the pros of imiquimob?
- Useful where surgery undesirable
- Good cosmetic result
What are the cons of imiquimob?
- Treatment time is 6 weeks
- Significant inflammation
- Failure/recurrence
What is melanoma in situ?
Melanoma cells entirely confined to epidermis
No metastatic potential
Does melanoma in situ have any metastatic potential?
No
What is the treatment for melanoma in situ?
Excision
What are some ways to protect yourself from the sun?
Cover up
Avoid sun at peak hours
Don’t burn and try not to tan
Avoid sunbeds
Suncreen:
- UVA and UVB protected
- At least SPF 30/4 star
- Need to apply 2 tablespoons every 2 hours
How much sunscreen should be applied to be effective?
- UVA and UVB protected
- At least SPF 30/4 star
- Need to apply 2 tablespoons every 2 hours
