Lecture 8: Benign and Pre-Malignant Skin Lesions

Question 1

seborrhoeic keratoses are commonly referred to as?

Answer 1

warts

Question 2

pros and cons to cryotherapy in treating warts

liquid nitrogen

Answer 2

Pros:
- cheap
- easy to perform on the day

Cons:
- can scar
- failure/recurrence
- no pathology result

Question 3

describe Leser-Trelat and what its presence could indicate

Answer 3

• a paraneoplastic phenomenon
• abrupt onset of widespread seborrhoeic keratosis, particularly in younger individual
• benign but may indicate underlying solid organ malignancy: GI adenocarcinoma

Question 4

what is a cyst?

Answer 4

• an encapsulated lesion containing fluid or semi-fluid material
• usually firm and fluctuant

Question 5

what is the treatment for cysts?

Answer 5

• treated with excision
• if inflammed/infected: Abx, intralesional steroid and incision and drainage.

Question 6

what is a dermatofibroma?

Answer 6

• a benign fibrous nodule often on limbs > proliferation of fibroblasts.
• appears as a firm nodule, tethered to skin but mobile over fat. Pale pink/brown. Often paler in centre.

Question 7

what is a lipoma?

Answer 7

benign tumour consisting of fat cells

Question 8

what is an angioma?

Answer 8

• an overgrowth of blood vessels in the skin due to proliferating endothelial cells.
• can occur in pregnancy and liver disease sometimes.

Question 9

what is a pyogenic granuloma and how is it treated?

Answer 9

• rapidly enlarging red/raw growth, often at a site of trauma.
• bleeds easily.
• removed by curettage and cautery.

Question 10

Answer 10

Question 11

describe Bowens disease and its appearance

Answer 11

aka intraepidermal squamous cell carcinoma:
- full thickness dysplasia, entirely contained within the epidermis, no metastatic potential.
- potential to become malignant (5%)
- irregular, scaly erythematous plaque

Question 12

what is the treatment for Bowens disease?

Answer 12

• cryotherapy
• curettage: lesion scraoed off and heat applied to seal vesse;s and destroy residual cancer cells.
• photodynamic therapy causes photochemical reaction to selectively destory cancer cells.
• Imiquimod

Question 13

what are the pros and cons of photodynamic therapy?

Answer 13

Pros:
- done for the patient by hospital staff
- can treat multiple areas, including those which would be hard to reach by the patients
- 1 or 2 treatments

cons:
- requires hopsital appointments
- can be painful and scar

Question 14

how does Imiquimod work?

Answer 14

• sold under brand name Aldara
• acts as an immune response modifier to stimulate cutokine release causing inflammation and destruction of a lesion.

Question 15

Imiquimod pros and cons

Answer 15

pros:
- useful where surgery is undesirable
- usually good cosmetic result
- large surface area

cons:
- treatment time is 6 weeks
- significant iflammation
- failure/recurrence

Question 16

describe actinic keratoses

Answer 16

• rough scaly pathces on sun damaged skin
• have a low risk of progressing to squamous cell carcinoma
• may spontaneously resolve

Question 17

actinic keratoses treatment

Answer 17

• cyrotherapy
• curettage
• diclofenac gel
• imiquimod

Question 18

what does a melanoma in situ mean?

Answer 18

melanoma cells entirely confined to epidermis
- no metastatic potential
- treated with excision