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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

SKIN LESIONS ,BENIGN AND MALIGNANT

DR. OLGA WATKINS

November 2013


Outline of presentation
Outline Of Presentation

  • Common Skin Lesions, Benign And Malignant

  • Assessment Of Pigmented Lesion

  • Points to take home


Skin lesions tumours and cancers
Skin lesions, tumours and cancers

  • Actinic keratosis

  • Angiokeratoma

  • Angiolymphoid hyperplasia

  • Angiosarcoma

  • Aplasia cutis

  • Atypical fibroxanthoma

  • Atypical naevi

  • Basal cell carcinoma

  • Bazex syndrome



Which is benign
Which is Benign?

Amelanotic melanoma

Blue naevus


Which would worry you
Which Would Worry You?

Irritated BCP

Pyogenic granuloma


Benign
Benign

  • Viral warts

  • Seborrhoeic keratoses

  • Naevi

  • Angiomas

  • Epidermoid cysts

  • Other common lesions








Blue naevus
Blue Naevus

  • Melanocytes deep within the skin

  • Benign but usually excised to exclude melanoma


Halo naevus
Halo Naevus

  • Benign lesion

  • Auto-immune reaction, with depigmentation of skin surrounding naevus. Skin eventually re-pigments.


Remember
Remember

  • Melanoma is rare in children under 12 years age

  • Adults can develop benign naevi up to 50 years of age







Dermatofibroma
Dermatofibroma

  • Feels hard, dimples when edges pressed together

  • Scarring due to insect bites





Pre malignant
Pre-malignant

  • Actinic keratoses

  • Bowens disease

  • Lentigo maligna


Actinic keratosis
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)




Bowens disease
Bowens Disease

  • Pre-cancerous

  • 5% risk of developing SCC if not treated




Lm melanoma in situ
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
Malignant

  • Basal cell carcinoma

  • Squamous cell carcinoma

  • Melanoma

  • Metastatic disease


Superficial basal cell carcinoma
Superficial Basal Cell Carcinoma

  • Treatment options include cryotherapy, 5- FU and PDT






Which is which
Which is Which?

Keratoacanthoma

SCC




Amelanotic melanoma
Amelanotic Melanoma

  • Similar to pyogenic granuloma but the history is different


Skin lesions benign and malignant

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
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 naevi1
Assessment of Naevi

ABCD(E) METHOD

  • A - asymmetry

  • B - borders irregular

  • C - colour variation

  • D - diameter larger than pinkie nail

  • (E – rapid elevation)


Skin lesions benign and malignant

A – asymmetry

B - borders irregular

C - colour variation

D - diameter larger than pinkie nail

(E – rapid elevation)


Points to take home
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
Internet Support

  • www. pcds.org.uk

  • www.dermnetnz.org

  • www.gpnotebook.co.uk

  • www.bad.org.uk

  • www. pathways.scot.nhs.uk