Transcript WHEN IS A MOLE NOT A MOLE?

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
Which would worry you?
Irritated BCP
Pyogenic granuloma
Benign
 Viral warts/molluscum
 Seborrhoeic keratoses
 Naevi
 Angiomas
 Epidermoid cysts( sebaceous cysts)
 Other common lesions
Viral warts
Viral warts on fingers
Molluscum contagiosum
Treatment of viral warts
There are several choices
1. Leave them alone
2. 12 – 26% salicylic acid nocte for 3 months or more
3. Cryotherapy every 2-3 weeks
4. Combine 2 and 3
5. Duct tape - very popular ? evidence
Seborrhoeic keratoses
Seborrhoeic keratoses
Benign naevi
Atypical naevus
Blue naevus
 Melanocytes deep
within the skin
 Benign but usually
excised to exclude
melanoma
Halo naevus
 Benign lesion
 Auto-immune
reaction, with
depigmentation of skin
surrounding naevus.
Skin eventually repigments.
Remember
 Melanoma is rare in children under 12 years age
 Adults can develop benign naevi up to 50 years of age
Regression surrounding melanoma
Cherry angioma
Angiokeratoma
Angiokeratoma of Fordyce
Epidermoid (sebaceous) cyst
Dermatofibroma
 Feels hard, dimples
when edges pressed
together
 Scarring due to insect
bite
Pinch sign
Senile comedone
Keratoacanthoma
Pre-malignant
 Actinic keratoses
 Bowens disease
 Lentigo maligna
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)
AKs on scalp
Bowens disease on leg
Bowens disease
 Pre-cancerous
 5% risk of developing
SCC if not treated
Melanoma in situ
Lentigo maligna melanoma
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
Malignant
 Basal cell carcinoma
 Squamous cell carcinoma
 Melanoma
 Metastatic disease
Superficial basal cell carcinoma
 Treatment options
include cryotherapy,
5- FU and PDT
Nodular BCC
Pigmented BCC
Squamous cell carcinoma
Squamous cell carcinoma
Which is which?
Keratoacanthoma
SCC
Superficial spreading malignant melanoma
Nodular melanoma
Amelanotic melanoma
 Similar to
pyogenic
granuloma but
the history is
different
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
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
Assessment of naevi
ABCD(E) METHOD
 A - asymmetry
 B - borders irregular
 C - colour variation
 D - diameter larger than pinkie nail
 (E – rapid elevation)
A – asymmetry
B - borders irregular
C - colour variation
D - diameter larger than
pinkie nail
(E – rapid elevation)
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
Internet support
 www. pcds.org.uk
 www.dermnetnz.org
 www.gpnotebook.co.uk
 www.bad.org.uk
 www. pathways.scot.nhs.uk