Derm - benign and malignant conditions Flashcards
Benign Mole
aka Benign malanocytic naevi
- acquired or congenital
- acquired starts as junctional naevi = flat brown mole (pigment is within epidermis); with time it evolves to have pigment in dermis as well –> becomes raised and still brown (compound naevus); finally intradermal naevus - no pigment in epidermis (raised flesh coloured nodule)
- halo naevus - ring of pigmentation on the outside - normal in young adults but in older adults could be a sign of melanoma elsewhere
Premalignant condition: Actinic Keratosis
Actinic Keratosis (Solar keratosis)
- Indicate chronic sun damage
- 20% regress spontaneously
- A small number can progress to SCCs
Look for:
- Flaky / keratotic patches, feels hard and crusty
- Bald scalps, foreheads, ears, dorsum of hands and forearms
Treatment
- Efudix (5 FU) cream – causes inflammatory reaction
- Liquid Nitrogen (cryotherapy)
- if very thick –> scrape them off with curettage
Premalignant condition: Bowens Disease
Bowens Disease
- Typically presents on lower legs of elderly women
- 3-5% will progress to an SCC
Look for:
- Well defined scaly plaques
- No raised edge (unlike SCC)
Treatment
- Surgical excision, curettage or Efudix
Basal Cell Carcinoma - features
Commonly affects head and neck
- Slow growing (months to year),
- 50% are nodule with pearly edge and centrally ulcerated, with arborizing telangectasia on the surface
- Skin coloured, pink or pigmented
- Can bleed easily or ulcerate
- Very rarely metastasise
BCC - treatment
Surgery
- Diagnostic biopsy initially
- Excision
- Moh’s micrographic surgery (when you want to preserve the tissue)
- Curettage and cautery
Radiotherapy (if not fit for surgery)
Superficial variant:
- Cryotherapy (liquid nitrogen)
- Topical treatment e.g. 5-FU, Imiquimod,
- Photodynamic therapy (PDT)
What is Gorlin Syndrome?
Gorlin syndrome (basal cell naevus syndrome)
Features: Multiple BCC’s Young age Calcified falx cerebri Broad forehead Odontogenic cysts jaw Abnormal ribs (bifid, fused, missing) Palmar/plantar pitting Other tumours – melanoma, breast carcinoma, NHL, ovarian fibroma
PATCH gene Chr 9; SUFU gene Chr 10
Management: Excision; Vismodegib
Squamous Cell Carcinoma - features
- Cancer arising from keratinocytes in the epidermis
- Typically elderly patients on sun-exposed sites
- other important RF is immunosuppression
- history – weeks to months
- Rapidly enlarging papule/nodule
- Tender erythematous nodules (keratin producing), can have rolled edges, can have lots of crust on top and can ulcerate
- can spread to LNs (though not common)
- more likely to spread if on non-sun exposed sites or if it arises from bowen’s disease
SCC - treatment
Surgery
- Excision
+/- Radiotherapy
50% develop another SCC within 5 yeas (high risk group)
Melanoma - features
Asymmetry Borders - irregular Colour variation Diameter > 6mm Evolotion (Funny looking)
Where else can you get melanoma other than skin?
Nail melanoma
- Hutchinson’s sign – pigment extending onto the proximal nail fold beyond the nail
- Splitting / cracking of the nail + pigment = melanoma until proved otherwise
Melanoma - treatment
- surgical excision
(initially narrow margin to biopsy it and if found to be malignant –> wide local excision) - treatment then depends on stage (Breslow thickness)
- LN biopsy and clearance
- if it spreads, consider chemo and targeted treatments
Seborrheic Keratosis
benign
- Very common, related to skin aging
- Can occur anywhere other than palms and soles and mucous membranes
- Have a ‘stuck on’ and ‘warty’ appearance
- Don’t require treatment
(Name is misleading – they do not form in a seborrhoeic distribution and are not from the sebaceous unit.)
Campbell de Morgan Spots
(cherry angioma)
(benign)
- May develop on any part of the body but they appear most often around the midtrunk.
- Can be red, blue, purple, or almost black.
- Increase in number from about the age of 40.
- Cause is unknown
- No treatment required
Advising on Sun Protection
- How to recognise sunburn (if skin goes red, not necessarily peeling or blistering)
- Ask about previous sunburn (damage is cumulative)
- Avoid the strong sun – (11am – 3pm)
- Cover up – hats, t-shirts, sun glasses
- Use Factor 50
- Know your skin type
- UV index (how ‘strong’ the sun is)
- Avoid sunbeds
- Vitamin D (many misconceptions)
What is Lentigo Maligna
- Melanoma in situ
Lentigo maligna is an early form of melanoma in which the malignant cells are confined to the tissue of origin, the epidermis, hence it is often reported as ‘in situ’ melanoma. It occurs in sun damaged skin so is generally found on the face or neck, particularly the nose and cheek. It grows slowly in diameter over 5 to 20 years or longer.
