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SKIN LESIONS , BENIGN AND MALIGNANT

SKIN LESIONS , BENIGN AND MALIGNANT. DR. OLGA WATKINS April 2014. Outline of presentation. Common Skin Lesions, Benign and Malignant Assessment of Pigmented Lesion Points to Take Home. Which is malignant?. SSMM. BCP. Which is benign?. Amelanotic melanoma. Blue naevus.

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SKIN LESIONS , BENIGN AND MALIGNANT

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  1. SKIN LESIONS ,BENIGN AND MALIGNANT DR. OLGA WATKINS April 2014

  2. Outline of presentation • Common Skin Lesions, Benign and Malignant • Assessment of Pigmented Lesion • Points to Take Home

  3. Which is malignant? SSMM BCP

  4. Which is benign? Amelanotic melanoma Blue naevus

  5. Which would worry you? Irritated BCP Pyogenic granuloma

  6. Benign • Viral warts/molluscum • Seborrhoeic keratoses • Naevi • Angiomas • Epidermoid cysts( sebaceous cysts) • Other common lesions

  7. Viral warts

  8. Viral warts on fingers

  9. Molluscum contagiosum

  10. Treatment of viral warts There are several choices • Leave them alone • 12 – 26% salicylic acid nocte for 3 months or more • Cryotherapy every 2-3 weeks • Combine 2 and 3 • Duct tape - very popular ? evidence

  11. Seborrhoeic keratoses

  12. Seborrhoeic keratoses

  13. Benign naevi

  14. Atypical naevus

  15. Blue naevus • Melanocytes deep within the skin • Benign but usually excised to exclude melanoma

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

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

  18. Regression surrounding melanoma

  19. Cherry angioma

  20. Angiokeratoma

  21. Angiokeratoma of Fordyce

  22. Epidermoid (sebaceous) cyst

  23. Dermatofibroma • Feels hard, dimples when edges pressed together • Scarring due to insect bite

  24. Pinch sign

  25. Senile comedone

  26. Keratoacanthoma

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

  28. 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)

  29. AKs on scalp

  30. Bowens disease on leg

  31. Bowens disease • Pre-cancerous • 5% risk of developing SCC if not treated

  32. Melanoma in situ

  33. Lentigo maligna melanoma

  34. 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

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

  36. Superficial basal cell carcinoma • Treatment options include cryotherapy, 5- FU and PDT

  37. Nodular BCC

  38. Pigmented BCC

  39. Squamous cell carcinoma

  40. Squamous cell carcinoma

  41. Which is which? Keratoacanthoma SCC

  42. Superficial spreading malignant melanoma

  43. Nodular melanoma

  44. Amelanotic melanoma • Similar to pyogenic granuloma but the history is different

  45. 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 crusty and itchy. Please can you see him urgently to exclude a melanoma? Sincerely, Dr. Doolittle Dr. Doolittle MB ChB

  46. 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

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

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

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