Name 3 premalignant skin lesions
Bowens disease
Actinic Keratoses
Melanoma in situ
Name 6 benign skin lesions
Viral warts Epidermoid and pilar cysts Seborrhoeic keratoses Dermatofibroma Lipoma Vascular lesions
When describing a skin lesion, what characteristics of it should be included
Site Size Shape Colour Mobility Texture Temperate
Clinical features of seborrhoeic keratoses
- number
- appearance
- where
- colour
MULTIPLE well-circumscribed ‘stuck-on’ GREASY plaques/papules that look like warts
usually on trunk
yellow/brown
Seborrhoeic keratoses typically affects what age group
40s-50s
What benign vascular lesion is associated with seborrhoeic keratoses
cherry angiomas - bright red spots
Seborrhoeic keratoses generally left untreated because not troublesome but if irritated, itching, and displeasing, then can be treated with (2)
cryotherapy
curettage (scraping them off)
Cryotherapy involves the use of what substance
liquid nitrogen
What is the leser-trelat sign
Abrupt onset of widespread seborrhoeic keratosis, particularly in a younger individual associated with an underlying malignancy; not direct result but paraneoplastic effect
Leser-trelat sign may indicate what underlying malignancy
GI cancer
What differentiates a cyst from an abscess
Cyst contains non-infected fluid while abscess contains infected fluid
Most common type of cyst
Epidermoid - i.e. epidermis like cells lining the wall of the cyst
affects young/middle aged
Pilar cysts are seen where
Scalp
Epidermoid cysts are often confused with what cyst
sebaceous cyst
Clinical features of an epidermoid cyst - face, neck, chest (2)
firm, elastic, dome-shaped lesion
central keratin-filled punctum may be present
Cysts may get infected and consequently enlarge, becoming red and tender and discharge pus
Treatment of acutely infected cysts (3)
Antibiotics
Intralesional steroid - calms inflammation
Incision & Drainage - removing whole sac as sac can refill again if you only drain the fluid
Clinical features of a dermatofibroma
- firm or soft
- mobility
- colour
- what do you see when you squeeze it
Firm nodule,
tethered to skin but mobile over fat (moves with skin)
Pale pink/brown
Dimple sign
Dermatofibromas commonly seen where
Lower legs
Upper arms
Treatment if dermatofibroma becomes symptomatic/concerning
Excision
What is a lipoma
Benign tumour of adipose tissue
Clinical features of a lipoma
- texture
- mobility
- superficial/deep
- size
soft,
mobile
superficial
quite big and lumpy <5cm
Lipomas could be confused with
liposarcomas which have potential to be malignant unlike lipomas
Benign vascular lesions include (2)
angioma
pyogenic granuloma
What is an angioma
Overgrowth of blood vessels in the skin due to endothelial hyperplasia (i.e. dilated vessel)
Clinical features of angiomas
- soft or hard
- colour
- distribution
Soft papules/nodules
Red/ blue/ purple
usually on trunk
Angiomas aren’t usually treated but if they start catching on things or bleeding then can be removed by (2)
Curettage
Laser
What form of angioma is associated with liver disease
Spider naevi
What is a pyogenic granuloma + initiating factor
Sudden onset rapidly growing vascular lesion (rapid overgrowth of tiny blood vessels), often resulting from trauma
Clinical feature of a pyogenic granuloma
- colour
- texture
usually asymptomatic but vulnerable to what
Starts as a small deep red lesion but quickly enlarges into a nodule
Initially smooth and shiny, but often becomes eroded and crusty after they’ve bled
bleeds significantly on mild contact
Treatment of pyogenic granuloma
Curettage + cautery of area left behind
Risk factors of premalignant skin lesions
UV radiation
How does UV radiation predispose to premalignancy
Causes DNA damage + immunosuppression
Describe the spectrum normal/benign cells proceed through to become a malignancy (5)
Benign –> hyperplasia – dysplasia –> in situ disease –> invasive malignancy
What happens to cells in dysplasia (3)
Nuclei change, DNA damage, shape change
What is wrong with cells in situ disease
cells look cancerous under microscope, but not cancer because haven’t invaded anywhere, cell is still where it should be, e.g. epidermal cell is still in epidermis
Clinical features of actinic keratoses
- type of lesion
- shape
- texture
- scaling?
- colour
Irregularly shaped rough hyperkeratotic scaly macules/plaques
yellow/brown
Biggest risk factor of actinic keratoses
Chronic sun exposure/ sun damage
Actinic keratoses (premalignant lesion) may progress to what skin cancer type
Squamous cell carcinoma
Treatment of actinic keratoses
- destructive methods (2)
- topical methods (3)
Destructive
- Cryotherapy
- Curettage
Topical
- fluorouracil - interferes with DNA/RNA synthesis
- imiquimod,
- diclofenac gel
What is Bowen’s disease
Squamous cell carcinoma in situ
entirely contained within epidermis
Clinical feature of Bowen’s disease (premalignant disease)
Irregular scaly erythematous plaque
Risk of Bowen’s disease (premalignant lesion) becoming malignant
Low
Bowen’s disease is often confused with what skin conditions
Eczema or psoriasis because it’s an red scaly plaque
Treatment of Bowen’s disease (4)
Cryotherapy
Curettage + electrocautery (to seal vessel and destroy residual cells)
Photodynamic therapy
Topical imiquimod
How does photodynamic therapy work in treating Bowen’s disease
Photochemical reaction to selectively destroy cancer cells
- topical photosensitising agent applied to cancerous cells
- then red light applied to trigger photodynamic reaction of the photosensitive agent absorbed into the cancerous cells and destroys the cells
Topical imiquimod can be used for the premalignant lesions (actinic keratinosis and Bowen’s disease), viral warts and superficial basal cell carcinomas - what does it do/mechanism of action
Is an immunotherapy cream, i.e. modifies immune response
-activates the immune system to recognise abnormal cells by flagging the abnormal cells which stimulates cytokine release –> causes inflammation and destruction of lesion
Melanoma in situ (a premalignant lesion) aka stage 0 melanoma is confined to which layer of skin + since it is in situ, it has no … potential
epidermis
metastatic
Melanoma in situ treatment
Excision with 5mm margin