Skin Lesions Flashcards
Mx of lesion with regular borders and appendages but increased in size
Excisions biopsy
Factor with greatest bearing on prognosis of BCC
Completeness of excision
BCC types
Nodular- most common, raised transclucent
Superficial- younger
Cystic- Clear or blue
Morpheoform- flat, lateral spread
Basosquamous -Atypical BCC
Basaloid histological BCC features with eosinophillic squamoid features of SCC
Biologically more aggressive and are more locally destructive
Features of BCC
Pearly
Raised edges
Ulcerated lesion
Sun exposed
Small itchy papule with coeliac
Dermatitis herpetiformis
Multiple irregular itchy lesions on abdo
Shave biopsy and cautery
Likely seborrhoea warts
Ulcerated area over medial malleolus- investigations for skin
Punch biopsy- as Marjolin ulcer can form from venous ulcers
PIlar cyst features
Pilar cysts may contain foul smelling cheesy material and are surrounded by the outer part of a hair follicle
Mx of infected sebaceous cyst
Incision and drainage with excision of cyst wall and packing
Lesion that has ulcerated and bleeds easily on contact- formed after trauma
Pyogenic granuloma
Overgrowth of blood vessels.
Seborrhoeic keratosis features
scaly, thick, greasy surface with scattered keratin plug
Dermatofibroma features
Solitary dermal nodules
Usually affect extremities of young adults
Lesions feel larger than they appear visually
Histologically they consist of proliferating fibroblasts merging with sparsely cellular dermal tissues
Can occur at site of trauma, pigmented
Dermoid cyst features
Embryological remnants and may be lined by hair and squamous epithelium
They are often located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion. Complete excision is required as they have a propensity to local recurrence if not excised.
Keratoacanthoma features
Rapid growth
Keratin core
Dome shame
Red
Become v large then come off and scar
SCC features
Scaly, crusty
May ulcerate
Telangiectases
Bowens disease and actinic keratosis features
Bowen SCC in situ- erythematous, plaque from sun exposed area
Actinic keratosis- rough erythematous with white to yellow scale- pre SCC
Ix of lichen sclerosis
Punch biopsy
Margin of excision related to Breslow
0-1mm 1cm
1-2mm 1-2cm
2-4mm 2-3cm
>4mm 3cm
Skin lesion biopsy for diagnosis
Punch biopsies are useful in gaining histological diagnosis of unclear skin lesions where excision biopsy is undesirable
Types of nevi
Congenital- at birth
Usually greater than 1cm diameter
Increased risk of malignant transformation (increased risk greatest for large lesions)
Junctinal- circular macules, same colour
Compound- raised
Rise from junctional
Spitz- red, rapidly rises
Epidermal cyst contains
Lined by stratified squamous
Filled with keratin
Also known as sebaceous cyst
Kaposi sarcoma most common location
Limbs
Most common skin malignancy
Basal
Spread of SCC
Lymphatic
Tx of Bowens or actinic keratoses
Cryo, excision, 5 flurouracial cream
Acral lentiginous melanoma
On palms and soles
Melanoma mx
Excisions biopsy
Then wide local later
Lentigo maligna melanoma
Large facial lesion
White spots, smooth non tender 1mm
Fordyce granules
Sebaceous glands
Ix for spread of melanoma
Sentinel node biopsy
Most common melanomas
1st superficial spreading
2nd nodular
Least- acral
Mx of contracted scar
Z pasty or graft
Pre cursors for SCC
Keratoacanthoma- surgical
Bowen- in situ- cryo, fluro, cutterage
Actinic keratoses- cryo, excision, floro, imiquimod
