Non-Pigmented Lesions

Question 1

What are the features of a basal cell carcinoma (BCC)?

Answer 1

Slow growing
Sun exposed sites
Raised rolled pearly edge
Repeatedly crust and scab
Central ulceration
Telangiectasia

Question 2

What is the metastatic potential of BCC?

Answer 2

Almost never metastasises

Question 3

What are the different types of BCC?

Answer 3

Nodular (most common)
Superficial
Infiltrative (most challenging)

Question 4

What is the management of a nodular BCC?

Answer 4

Surgical excision with a 4mm margin

Question 5

What is the management of a superficial BCC?

Answer 5

Non surgical management:

• biopsy to confirm then
• -> imiquimod cream, photodynamic therapy (PDT) or cryotherapy

Question 6

What is the management of an infiltrative BCC?

Answer 6

Mohs surgery

• good for conserving skin in cosmetic areas e.g. face
• test histology as you remove each part during surgery
• ensures excision but minimal loss of unaffected skin

Question 7

What are the histological differences between actinic keratosis, bowen’s disease and SCC?

Answer 7

Actinic keratosis –> dysplastic keratinocytes
Bowen’s disease –> full thickness dysplasia/carcinoma in situ
SCC –> invasive carcinoma

Question 8

What does actinic keratosis look like?

Answer 8

Scaly erythematous papule on sun exposed site

Question 9

What is the treatment for actinic keratosis?

Answer 9

Solitary lesion --> cryotherapy, advice on sun protection
Field change (multiple lesions) --> topical imiquimod or 5-fluorouracil

Question 10

What does Bowens disease look like?

Answer 10

Scaly patch/plaque, irregular border, no dermal invasion

Common on the legs of older women

Question 11

What is the management of Bowen’s disease?

Answer 11

Biopsy to exclude invasive SCC

Topical imiquimod. 5-fluorouracil, cryotherapy or PDT

Question 12

Which other factors are thought to predispose to development of SCC?

Answer 12

HPV virus

Immunosuppression e.g. transplant patients

Question 13

What are some other non-melanoma skin cancers?

Answer 13

Merkel cell tumour (red nodule, rare but aggressive)
Cutaneous B cell lymphoma
Kaposi’s sarcoma (multiple purple nodules, HIV/post transplant)

Question 14

What are seborrhoeic warts/keratosis?

Answer 14

Common, benign proliferation of epidermal keratinocytes

Stuck on appearance, warty surface

Question 15

What is a lipoma?

Answer 15

Subcutaneous, benign, mobile swelling

Question 16

What is a dermatofibroma?

Answer 16

Firm lump with some pigmentation

–> result of an insult e.g. insect bite

Question 17

What is an epidermoid/sebaceous cyst?

Answer 17

Firm, well defined, benign swelling

May become inflammed + discharge cheesy material

Question 18

What is the management of an epidermoid/sebaceous cyst?

Answer 18

Asymptomatic –> leave

Troublesome/repeated inflammation –> excise

Question 19

What is an acrocordon?

Answer 19

Skin tag

Question 20

What is a haemangioma and how is it managed?

Answer 20

Redish purple lesion
Benign overgrowth of blood vessels
Can be mistaken for melanoma
Dermoscope reassuring --> multiple red globules
No treatment required

Question 21

What is a pyogenic granuloma?

Answer 21

Overgrowth of vascular and granulation tissue
Develops a few weeks after trauma
Bleeds very easily on contact

Question 22

When excising a lesion, which direction is best to cut the elipse lines?

Answer 22

Along the resting skin tension lines

–> Langer’s lines