Benign skin lesions

Question 1

Describe Sebborrhoeic keratosis

Answer 1

• Benign, but commonly referred
• Warty growths, “stuck on appearance”
• Can have variable appearance
• Patients often have multiple +/- cherry angiomas
• Generally left untreated, but if troublesome
– Cryotherapy
– Curettage

Question 2

How is Sebborrhoeic keratosis treated?

Answer 2

– Cryotherapy
– Curettage

generally left untreated, only removed if troublesome

Question 3

What are the pros and cons of cryotherapy?

Answer 3

Pros	
–	Cheap
–	Easy to perform “on the day”
Cons
–	Can scar
–	Failure/Recurrence

Question 4

What is cryotherapy?

Answer 4

Liquid nitrogen (extremely cold) is used to destroy abnormal skin lesions

Question 5

Describe Leser-Trelat sign

Answer 5

Paraneoplastic phenomenon of abrupt onset of widespread seborrhoeic keratosis, particularly in a younger individual

SKs remain benign but may indicate underlying solid organ malignancy
– GI adenocarcinoma, must always investigate

Question 6

What is Leser-Trelat sign often a sign of?

Answer 6

SKs remain benign but may indicate underlying solid organ malignancy
– GI adenocarcinoma, must always investigate

Question 7

What virus causes viral warts?

Answer 7

Human Papilloma Virus

Question 8

Describe viral warts

Answer 8

• Due to Human Papilloma Virus
• Rough hyperkeratotic surface
• Difficult to treat
• Will clear when immunity developed to virus

Question 9

How are viral warts treated?

Answer 9

• Will clear when immunity developed to virus
• Cryotherapy or wart paints can stimulate immune system slightly
• Can curette in severe cases

Question 10

What is a cyst?

Answer 10

• Encapsulated lesion containing fluid/semi-fluid matter
• Usually firm and fluctuant
• Common. Affect ~20% adults
• Multiple different types of cyst exist

Question 11

Describe an epidermoid cyst

Answer 11

– Epidermoid cyst (wrongly called sebaceous) – hard lumps under skin, grow slowly

Question 12

Describe a pilar cyst

Answer 12

– Pilar cyst – cyst that develops from hair follicle

Question 13

Describe a steatocystoma

Answer 13

Steatocystoma – cyst growth from sebaceous glands

Question 14

Describe a dermoid cyst

Answer 14

– Dermoid cyst – teratoma containing hair follicles, epidermis and glands from residual embryonic cells

Question 15

Describe a hidrocystoma

Answer 15

– Hidrocystoma – adenoma of sweat glands, usually on eyelid

Question 16

Describe a ganglion cyst

Answer 16

– Ganglion cyst – spongy swelling on top of joint or tendon

Question 17

What are the complications often seen with cysts?

Answer 17

Can rupture and cause inflammation of surrounding skin
May become secondary infected

Treated with excision

If inflammed/infected
– Antibiotics
– Intralesional steroid
– Incision & Drainage

Question 18

How are inflamed/infected cysts treated?

Answer 18

– Antibiotics
– Intralesional steroid
– Incision & Drainage

Question 19

Describe dermatofibromas

Answer 19

• Benign fibrous nodule, often on limbs
– Proliferation of fibroblasts
• Cause is unknown. They are sometimes attributed to an area of trauma.
• Firm nodule, tethered to skin but mobile over fat. Pale pink/brown. Often paler in centre.
• Dimple sign positive

Question 20

What benign skin lesions have positive dimple signs?

Answer 20

Dermatofibromas

Question 21

How are dermatofibromas treated?

Answer 21

• Usually asymptomatic. Can be itchy or tender

* Excision if concern or symptomatic.

Question 22

What is classified as a positive dimple sign?

Answer 22

Dimple sign positive – when lateral pressure on the skin causes a depression

Question 23

If someone presents with a firm nodule found on a limb that is tethered to skin/mobile over fat, and is a pale pink/brown which is paler in the centre, what would you suspect?

Answer 23

Dermatofibroma

Question 24

What condition is associated with an acute onset of widespread seborrhoeic keratosis, particularly in a younger individual?

Answer 24

Leser-Trelat paraneoplastic syndrome - GI cancer??

Question 25

Describe a lipoma

Answer 25

* Benign tumour consisting of fat cells * Common * Cause unknown * Smooth and rubbery subcutaneous mass * Usually asymptomatic

Question 26

If a lipoma is found to be tender, what should be suspected?

Answer 26

angiolipoma | ?Liposarcoma – rare malignancy

Question 27

What would you suspect if someone presented with a smooth and rubbery asymptomatic non-tender subcutaneous mass?

Answer 27

Lipoma

Question 28

What is an angioma?

Answer 28

Overgrowth of blood vessels in the skin due to proliferating endothelial cells – Generally asymptomatic. Can be unsightly or bleed – Occur in all age groups, both sexes

Question 29

What conditions can cause angioma development?

Answer 29

– Pregnancy & liver disease

Question 30

How are angiomas treated?

Answer 30

– Excision or laser therapy

Question 31

List 3 types of angioma

Answer 31

* Cherry angiomas * Spider naevi * Venous lakes

Question 32

What should be suspected if someone presents with a blue papule on a sun exposed region of skin e.g. ear, lips?

Answer 32

Venous lake angioma

Question 33

What should be suspected if someone presents with a mole like growth that appears red as it is full of blood vessels?

Answer 33

Cherry angiomas

Question 34

What should be suspected if someone presents with a central red spot with extensions?

Answer 34

Spider naevia angioma Increased in women on OCP or pregnant women due to increased oestrogen levels

Question 35

Describe a pyogenic granuloma

Answer 35

``` – Rapidly enlarging red/raw growth, often at a site of trauma. – Bleed easily – Cause is unknown – Occur in up to 5% of pregnancies – Common on head and hands ```

Question 36

What conditions is pyogenic granuloma usually associated with?

Answer 36

Pregnancy | trauma to head or hand

Question 37

What risk is associated with pre-malignant lesions?

Answer 37

UV radiation – DNA damage and immunosuppression

Question 38

Describe Bowens disease

Answer 38

Aka Intraepidermal squamous cell carcinoma – Full thickness dysplasia, entirely contained within the epidermis, no metastatic potential – Potential to become malignant (around 5%) Irregular, scaly erythematous plaque

Question 39

What number of spider naevi is suspicious and should elicit investigations?

Answer 39

> 5 on total body (may be higher in pregnancy/if on OCP)

Question 40

What is Bowen's disease also called?

Answer 40

Intraepidermal squamous cell carcinoma

Question 41

How is Intraepidermal squamous cell carcinoma/Bowens disease treated?

Answer 41

– Cryotherapy – Curettage followed by cauterisation – Photodynamic therapy – Imiquimod

Question 42

What is photodynamic therapy?

Answer 42

``` • Photochemical reaction to selectively destroy cancer cells • Topical photosensitising agent applied – Concentrates in cancerous cells • Red light applied • Photodymanic reaction occurs ```

Question 43

What is Imiquimod?

Answer 43

• Aldara • Immune response modifier – Stimulates cytokine release to cause inflammation and destruction of lesion

Question 44

What are the pros and cons of Imiquimod?

Answer 44

Pros – Useful where surgery is undesirable – Usually good cosmetic result Cons – Treatment time is 6 weeks – Significant inflammation – Failure/recurrence

Question 45

What skin lesions presents as a rough scaly patch on sun damaged skin that is associated with a risk of transforming into squamous cell carcinoma?

Answer 45

Actinic keratoses

Question 46

How is Actinic keratoses treated?

Answer 46

– Cryotherapy – Curettage – Diclofenac Gel – Imiquimod

Question 47

What is Actinic keratoses?

Answer 47

* Rough scaly patches on sun damaged skin | * Low risk of transformation to SCC

Question 48

What is melanoma in situ?

Answer 48

* Melanoma cells entirely confined to epidermis * No metastatic potential * Treated with excision

Question 49

Describe 3 pre-malignant conditions

Answer 49

Bowen's disease/Intraepidermal squamous cell carcinoma Actinic keratoses Melanoma in situ

Question 50

What are the recommendations for sunscreen use?

Answer 50

– UVA & UVB protection – At least SPF 30 / 4 Star – Need to apply 2 tablespoons every 2 hours

Question 51

What are peak hours of sunlight?

Answer 51

10am-4pm