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SKIN LESIONS , BENIGN AND MALIGNANT

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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  1. SKIN LESIONS ,BENIGN AND MALIGNANT DR. OLGA WATKINS November 2013

  2. Outline Of Presentation • Common Skin Lesions, Benign And Malignant • Assessment Of Pigmented Lesion • Points to take home

  3. Skin lesions, tumours and cancers • Actinic keratosis • Angiokeratoma • Angiolymphoid hyperplasia • Angiosarcoma • Aplasia cutis • Atypical fibroxanthoma • Atypical naevi • Basal cell carcinoma • Bazex syndrome

  4. Which is Malignant? SSMM BCP

  5. Which is Benign? Amelanotic melanoma Blue naevus

  6. Which Would Worry You? Irritated BCP Pyogenic granuloma

  7. Benign • Viral warts • Seborrhoeic keratoses • Naevi • Angiomas • Epidermoid cysts • Other common lesions

  8. Viral warts

  9. Viral warts on fingers

  10. Seborrhoeic Keratoses

  11. Seborrhoeic Keratoses

  12. Benign naevi

  13. Atypical naevus

  14. Blue Naevus • Melanocytes deep within the skin • Benign but usually excised to exclude melanoma

  15. Halo Naevus • Benign lesion • Auto-immune reaction, with depigmentation of skin surrounding naevus. Skin eventually re-pigments.

  16. Remember • Melanoma is rare in children under 12 years age • Adults can develop benign naevi up to 50 years of age

  17. Regression surrounding melanoma

  18. Cherry Angioma

  19. Angiokeratoma

  20. Angiokeratoma of Fordyce

  21. Epidermoid (Sebaceous) Cyst

  22. Dermatofibroma • Feels hard, dimples when edges pressed together • Scarring due to insect bites

  23. Pinch sign

  24. Senile Comedone

  25. Keratoacanthoma

  26. Pre-malignant • Actinic keratoses • Bowens disease • Lentigo maligna

  27. 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)

  28. AKs on scalp

  29. Bowens disease on leg

  30. Bowens Disease • Pre-cancerous • 5% risk of developing SCC if not treated

  31. Melanoma in situ

  32. Lentigo Maligna Melanoma

  33. 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

  34. Malignant • Basal cell carcinoma • Squamous cell carcinoma • Melanoma • Metastatic disease

  35. Superficial Basal Cell Carcinoma • Treatment options include cryotherapy, 5- FU and PDT

  36. Nodular BCC

  37. Pigmented BCC

  38. Squamous Cell Carcinoma

  39. Squamous Cell Carcinoma

  40. Which is Which? Keratoacanthoma SCC

  41. Superficial Spreading Malignant Melanoma

  42. Nodular Melanoma

  43. Amelanotic Melanoma • Similar to pyogenic granuloma but the history is different

  44. 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

  45. 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

  46. Assessment of Naevi ABCD(E) METHOD • A - asymmetry • B - borders irregular • C - colour variation • D - diameter larger than pinkie nail • (E – rapid elevation)

  47. A – asymmetry B - borders irregular C - colour variation D - diameter larger than pinkie nail (E – rapid elevation)

  48. 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

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