dr. olga watkins april 2014. outline of presentation common skin lesions, benign and malignant...
TRANSCRIPT
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SKIN LESIONS ,BENIGN AND MALIGNANT
DR. OLGA WATKINSApril 2014
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Outline of presentation
Common Skin Lesions, Benign and Malignant
Assessment of Pigmented Lesion
Points to Take Home
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Which is malignant?SSMM BCP
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Which is benign?Amelanotic melanoma Blue naevus
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Which would worry you?Irritated BCP Pyogenic granuloma
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Benign
Viral warts/molluscumSeborrhoeic keratosesNaeviAngiomasEpidermoid cysts( sebaceous cysts)Other common lesions
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Viral warts
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Viral warts on fingers
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Molluscum contagiosum
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Treatment of viral warts
There are several choices1. Leave them alone2. 12 – 26% salicylic acid nocte for 3 months or
more3. Cryotherapy every 2-3 weeks4. Combine 2 and 35. Duct tape - very popular ? evidence
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Seborrhoeic keratoses
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Seborrhoeic keratoses
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Benign naevi
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Atypical naevus
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Blue naevusMelanocytes deep
within the skinBenign but usually
excised to exclude melanoma
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Halo naevusBenign lesionAuto-immune
reaction, with depigmentation of skin surrounding naevus. Skin eventually re-pigments.
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Remember
Melanoma is rare in children under 12 years age
Adults can develop benign naevi up to 50 years of age
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Regression surrounding melanoma
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Cherry angioma
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Angiokeratoma
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Angiokeratoma of Fordyce
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Epidermoid (sebaceous) cyst
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Dermatofibroma
Feels hard, dimples when edges pressed together
Scarring due to insect bite
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Pinch sign
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Senile comedone
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Keratoacanthoma
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Pre-malignant
Actinic keratoses
Bowens disease
Lentigo maligna
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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)
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AKs on scalp
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Bowens disease on leg
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Bowens disease
Pre-cancerous
5% risk of developing SCC if not treated
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Melanoma in situ
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Lentigo maligna melanoma
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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
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Malignant
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Metastatic disease
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Superficial basal cell carcinoma
Treatment options include cryotherapy, 5- FU and PDT
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Nodular BCC
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Pigmented BCC
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Squamous cell carcinoma
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Squamous cell carcinoma
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Which is which?Keratoacanthoma SCC
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Superficial spreading malignant melanoma
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Nodular melanoma
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Amelanotic melanoma
Similar to pyogenic granuloma but the history is different
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MAJORS SURGERYLONGANDWINDING ROAD
GLASGOWG46 6HT
Dermatology ClinicStirling Community HospitalFK8 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. DoolittleDr. Doolittle MB ChB
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Assessment of naeviSEVEN POINT CHECKLIST
Change in shapeChange in size Change in colour
Over 6 mm. in diameterInflammationCrusting or bleedingMinor itch or irritation
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Assessment of naeviABCD(E) METHOD
A - asymmetryB - borders irregularC - colour variationD - diameter larger than pinkie nail(E – rapid elevation)
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A – asymmetry
B - borders irregular
C - colour variation
D - diameter larger than pinkie nail
(E – rapid elevation)
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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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Internet support
www. pcds.org.uk
www.dermnetnz.org
www.gpnotebook.co.uk
www.bad.org.uk
www. pathways.scot.nhs.uk
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ANY QUESTIONS?