Benign Skin Lesions

Question 1

Describe the appearance of seborrhoeic keratoses?

Answer 1

Warty growths - ‘stuck on’ appearance

Patients often have multiple cherry angiomas

Question 2

Management for seborrhoeic keratoses?

Answer 2

Generally left untreated

If troublesome - cryotherapy, curettage

Question 3

What is cryotherapy?

Answer 3

Liquid nitrogen applied to lesion

Question 4

Pros and cons of cryotherapy?

Answer 4

Pros: cheap, easy to perform on day
Cons: can scar, failure/recurrence, no histology

Question 5

What is the ‘Sign of Leser-Trelat’? What does it indicate?

Answer 5

Abrupt onset of widespread seborrhoeic keratosis, particularly in youth
SKs remain benign but may indicate underlying solid organ malignancy (GI adenocarcinoma)

Question 6

What virus causes viral warts? What do they look like?

Answer 6

Human Papilloma Virus

Rough, hyperkeratotic

Question 7

How are viral warts treated?

Answer 7

Difficult to treat
Will clear when immunity to virus develops
Cryotherapy/wart paints
Curette if severe

Question 8

What is a cyst?

Answer 8

Encapsulated lesion containing fluid or semi-fluid material; firm + fluctuant

Question 9

Try to name some types of cyst

Answer 9

Epiermoid cyst 
Pilar cyst 
Steatocystoma (genetic; isotretinoin)
Dermoid cyst 
Hidrocystoma
Ganglion cyst

Question 10

What is the risk associated with cysts?

Answer 10

Can rupture and cause inflammation of surrounding skin; may become infected

Question 11

How are cysts treated?

Answer 11

Treated with excision

If inflamed/infection - abx, intralesional steroid, incision + drainage

Question 12

What is a dermatofibroma?

Answer 12

Benign fibrous nodule, often on limbs

Question 13

Cause of dermatofibroma?

Answer 13

Cause unknown; sometimes trauma

Proliferation of fibroblasts

Question 14

How does a dermatofibroma present?

Answer 14

Firm nodule, tethered to skin but mobile over fat
Pale pink/brown; paler in centre
Usually asymptomatic (can be itchy/tender)
Dimple sign +ve

Question 15

How is dermatofibroma managed?

Answer 15

Excised if concern or asymptomatic

Question 16

What is a lipoma?

Answer 16

Benign tumour of fat cells

Question 17

Cause of lipoma?

Answer 17

Cause unknown, but a common lesion

Question 18

How does a lipoma present?

Answer 18

Smooth + rubbery subcutaneous mass

Usually asymptomatic

Question 19

What can it mean if a lipoma is tender?

Answer 19

Possible angiolipoma or liposarcoma (rare malignancy)

Question 20

What is an angioma?

Answer 20

Overgrowth of blood vessels in the skin due to proliferating endothelial cells

Question 21

How do angiomas present?

Answer 21

Generally asymptomatic

Can be unsightly/bleed

Question 22

In what conditions are angiomas more likely to occur?

Answer 22

Pregnancy

Liver disease

Question 23

How are angiomas dealt with?

Answer 23

Excision or laser

Question 24

What is a pyogenic granuloma?

Answer 24

Rapidly enlarging red/raw growth, often at site of trauma

Question 25

What are features of pyogenic granulomas?

Answer 25

``` Bleed easily Common on head and hands Red/raw Occur ~5% pregnancies Unknown cause ```

Question 26

How are pyogenic granulomas dealt with?

Answer 26

Removed by curettage and cautery

Question 27

Name 3 pre-malignant lesions

Answer 27

Actinic keratoses Bowen's disease Melanoma in situ

Question 28

What are actinic keratoses?

Answer 28

Rough scaly patches on sun damaged skin

Question 29

What is there a risk of developing form actinic keratoses?

Answer 29

SCC

Question 30

How are actinic keratoses treated?

Answer 30

Cryotherapy Curettage Diclofenac gel Imiquimod

Question 31

What is Bowen's disease?

Answer 31

SCC in situ

Question 32

What is the appearance of Bowen's disease?

Answer 32

Full thickness dysplasia, entirely contained in epidermis | Irregular, scaly erythematous plaque

Question 33

What is the potential of Bowen's disease?

Answer 33

Potential to become malignant (~5%) | No metastatic potential

Question 34

How is Bowens treated?

Answer 34

Cryotherapy Curettage (lesion scraped off and heat applied to seal vessels and destroy residual cancer cells) Photodynamic therapy Imiquimod

Question 35

What is photodynamic therapy?

Answer 35

Photochemical reaction to selectively destroy cancer cells

Question 36

Process of photodynamic therapy?

Answer 36

Topical photosensitising agent applied - concentrates in cancerous cells Red light applied Photodynamic reaction occurs

Question 37

What is imiquimod - how does it work? (aka Aldara)

Answer 37

Cream | Immune response modifier which stimulates cytokine release leading to inflammation and destruction of lesion

Question 38

Pros and cons of imiquimod?

Answer 38

Pros: useful where surgery is undesirable; usually good cosmetic result Cons: treatment time ~6 weeks; significant inflammation; failure/recurrence

Question 39

What is melanoma in situ?

Answer 39

Melanoma cells entirely confined to epidermis | No metastatic potential

Question 40

How is melanoma in situ dealt with?

Answer 40

Excision

Question 41

What is essential to try and avoid development of these pre-malignant skin lesions?

Answer 41

Sun protection - SPF, cover up, avoid sunbeds etc