Skin lesions benign and malignant
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SKIN LESIONS , BENIGN AND MALIGNANT. DR. OLGA WATKINS November 2013. Outline Of Presentation. Common Skin Lesions, Benign And Malignant Assessment Of Pigmented Lesion Points to take home. Skin lesions, tumours and cancers. Actinic keratosis Angiokeratoma Angiolymphoid hyperplasia

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SKIN LESIONS , BENIGN AND MALIGNANT

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SKIN LESIONS ,BENIGN AND MALIGNANT

DR. OLGA WATKINS

November 2013


Outline Of Presentation

  • Common Skin Lesions, Benign And Malignant

  • Assessment Of Pigmented Lesion

  • Points to take home


Skin lesions, tumours and cancers

  • Actinic keratosis

  • Angiokeratoma

  • Angiolymphoid hyperplasia

  • Angiosarcoma

  • Aplasia cutis

  • Atypical fibroxanthoma

  • Atypical naevi

  • Basal cell carcinoma

  • Bazex syndrome


Which is Malignant?

SSMM

BCP


Which is Benign?

Amelanotic melanoma

Blue naevus


Which Would Worry You?

Irritated BCP

Pyogenic granuloma


Benign

  • Viral warts

  • Seborrhoeic keratoses

  • Naevi

  • Angiomas

  • Epidermoid cysts

  • Other common lesions


Viral warts


Viral warts on fingers


Seborrhoeic Keratoses


Seborrhoeic Keratoses


Benign naevi


Atypical naevus


Blue Naevus

  • Melanocytes deep within the skin

  • Benign but usually excised to exclude melanoma


Halo Naevus

  • Benign lesion

  • Auto-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 bites


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 SURGERY

LONGANDWINDING ROAD

GLASGOW

G46 6HT

Dermatology Clinic

Stirling Community Hospital

FK8 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 very itchy. Please can you see him urgently to exclude a melanoma?

Sincerely,

Dr. Doolittle

Dr. Doolittle MB ChB


Assessment of Naevi

SEVEN POINT CHECKLIST

  • Change in shape

  • Change in size

  • Change in colour

  • Over 6 mm. in diameter

  • Inflammation

  • Crusting or bleeding

  • Minor itch or irritation


Assessment of Naevi

ABCD(E) METHOD

  • A - asymmetry

  • B - borders irregular

  • C - colour variation

  • D - 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?


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