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SKIN LESIONS ,BENIGN AND MALIGNANT
DR. OLGA WATKINSApril 2014
Outline of presentation
Common Skin Lesions, Benign and Malignant
Assessment of Pigmented Lesion
Points to Take Home
Which is malignant?SSMM BCP
Which is benign?Amelanotic melanoma Blue naevus
Which would worry you?Irritated BCP Pyogenic granuloma
Benign
Viral warts/molluscumSeborrhoeic keratosesNaeviAngiomasEpidermoid cysts( sebaceous cysts)Other common lesions
Viral warts
Viral warts on fingers
Molluscum contagiosum
Treatment of viral warts
There are several choices1. Leave them alone2. 12 – 26% salicylic acid nocte for 3 months or
more3. Cryotherapy every 2-3 weeks4. Combine 2 and 35. Duct tape - very popular ? evidence
Seborrhoeic keratoses
Seborrhoeic keratoses
Benign naevi
Atypical naevus
Blue naevusMelanocytes deep
within the skinBenign but usually
excised to exclude melanoma
Halo naevusBenign lesionAuto-immune
reaction, with depigmentation of skin surrounding naevus. Skin eventually re-pigments.
Remember
Melanoma is rare in children under 12 years age
Adults can develop benign naevi up to 50 years of age
Regression surrounding melanoma
Cherry angioma
Angiokeratoma
Angiokeratoma of Fordyce
Epidermoid (sebaceous) cyst
Dermatofibroma
Feels hard, dimples when edges pressed together
Scarring due to insect bite
Pinch sign
Senile comedone
Keratoacanthoma
Pre-malignant
Actinic keratoses
Bowens disease
Lentigo maligna
Actinic keratosis
Found on sun-exposed sites
Patient with ≥ 10 lesions has 10% risk of developing SCC in one
Treated with cryotherapy, 5-FU , Picato, Photodynamic Therapy (PDT)
AKs on scalp
Bowens disease on leg
Bowens disease
Pre-cancerous
5% risk of developing SCC if not treated
Melanoma in situ
Lentigo maligna melanoma
LM/melanoma-in-situ
LM arises on sun-damaged skin, face and neck
Melanoma-in-situ in other areas
5% develop melanoma so need to be treated
Can monitor in secondary care in older people if treatment difficult
Malignant
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Metastatic disease
Superficial basal cell carcinoma
Treatment options include cryotherapy, 5- FU and PDT
Nodular BCC
Pigmented BCC
Squamous cell carcinoma
Squamous cell carcinoma
Which is which?Keratoacanthoma SCC
Superficial spreading malignant melanoma
Nodular melanoma
Amelanotic melanoma
Similar to pyogenic granuloma but the history is different
MAJORS SURGERYLONGANDWINDING ROAD
GLASGOWG46 6HT
Dermatology ClinicStirling Community HospitalFK8 2QR
Dear Doctor,DERMOT TITUS 12/04/1945
This patient has a pigmented lesion on his back that he has had for some time. It is increasing in size. It has an irregular border, and is crusty and itchy. Please can you see him urgently to exclude a melanoma?
Sincerely,
Dr. DoolittleDr. Doolittle MB ChB
Assessment of naeviSEVEN POINT CHECKLIST
Change in shapeChange in size Change in colour
Over 6 mm. in diameterInflammationCrusting or bleedingMinor itch or irritation
Assessment of naeviABCD(E) METHOD
A - asymmetryB - borders irregularC - colour variationD - diameter larger than pinkie nail(E – rapid elevation)
A – asymmetry
B - borders irregular
C - colour variation
D - diameter larger than pinkie nail
(E – rapid elevation)
POINTS TO TAKE HOME
Always take a full history
Learn to recognise the difference between seborrhoeic keratoses and naevi
The most important history in melanoma is one of rapid change in a pre-existing naevus or of a new naevus
Internet support
www. pcds.org.uk
www.dermnetnz.org
www.gpnotebook.co.uk
www.bad.org.uk
www. pathways.scot.nhs.uk
ANY QUESTIONS?