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?