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BENIGN SKIN LESIONS Dr Ahmed Zwain Dermatology Specialty Doctor ST3 MBChB, MSc (Derm), MD, MRCPWhat could it be ?Seborrhoeic Keratosis • Unknown cause • Almost 90% of adults above 60 years will have at least one lesion • Well demarcated, stuck-on flat or raised lesions • Can range from 1mm to several centimeters • Skin coloured or pigmentedDiagnosis: • Clinically • Dermatoscope • Skin biopsy Treatment: • Reassurance and advice • Cryotherapy • Curettage and/or cautery • ExcisionEpidermoid cyst • Firm mobile popular/nodular lesions. • Male to female ratio 2:1 • Affecting young and middle aged adults. • Central punctum. • Thin wall prone to rapture. • Faull smelling cheesy material can be expressed from the punctum. • Can be associated with Gardner syndrome, Pachyonychia congenita, Basal cell nevus syndrome.Diagnosis: • Clinically • Skin biopsy Complications: • Rapture of the cyst • Bacterial infection • Squamous cell carcinoma (very rarely) Treatment: • Monitoring • Excision • Antibiotics +/- drainagePilar cyst (Trichilemmal cy )st • Keratin filled cysts. • Common sites: scalp and scrotum. • Middle aged adults, mostly female. • Firm, mobile subcutaneous nodule. • Usually multiple • No central punctum • Thick wall not prone to rapture. • Can have autosomal dominant mode of inheritance. • If inflamed can be tenderDiagnosis: • Clinically • Histologically Treatment: • If asymptomatic can be left alone • Symptomatic: surgical drainage/removalLipoma • The most common soft tissue tumor. • Noncancerous, consist of fat cells. • Slow growing. • Single/multiple. • Can reach several centimeters. • Soft, rubbery/doughy, mobile and painless. • Commonly affecting back, neck, trunk and arms.Diagnosis: • Clinically • Histology Treatment: • Conservative • Surgical excision • LiposuctionAny volunteers? Diagnosis?Dermatofibroma: • Nodule or papule commonly affects the limbs. • Unknow cause but can develop after trauma such as insect bite or injection. • Usually solitary lesion, but multiple can develop in immunocompromised patients. • Pinch sign (skin dimples when pinching the lesion). • Usually painless, but can be tender or itchy.Diagnosis: • Clinically • Dermoscopy • Histology Treatment: • Conservative • Cryotherapy • Surgical excisionWarts: • Cutaneous • Mucosal Cutaneous warts (verruca) • Caused by HPV, common types 1, 2, 3, 4, 10, 27, 29, and 57. • Spread by direct contact or autoinoculation (can cause pseudo-koebnerisation). • Hard, dotted, Keratinous surface. • Types: common wart, plane wart, planter wart and filiform wart. • Butcher’s wart caused by HPV7Common wart Filliform wart Plane wart Planter wartDiagnosis: • Clinical • Dermoscopy Treatment: • Spontaneous resolution (especially in children). • Active treatment for immunosuppressed patients, presence of complications, patient preference. Treatment options: • Topical paste, paints and patches contain salicylic acid, podophyllin. • Cryotherapy. • C&C • Others: Aldara, PDT, laser, bleomycin injectionVascular lesions: • Chery angioma • Pyogenic granuloma Pyogenic granuloma: • Benign proliferation of capillary blood vessels. • Commonly affecting face and oral cavity. • Can be associated with OCP, pregnancy, trauma and immucompramised patients. • Painless, red nodules, grow over few weeks. New lesion After 2 weeks After 4 weeks Diagnosis: Clinical Dermoscopy (vascular structure with white linear rail line) HistologyDifferential diagnosis: • Amelanotic Melanoma • Kaposi’s sarcoma • Bacillary angiomatosis Treatment: • Remove triggering medications. • Aldara (imiquimod)cream 5% • Topical B-blocker such as timolol gel 0.5% • C&C • Surgical excision. • LaserChery angioma: • Campbell de Morgan spots, senile angiomas. • Multiple popular lesions. • About 75% of people aged 75 years will have them. • Eruptive patterns has been reported with malignancy or pregnancy. • Rarely affecting hands, feet or mucus membrane.Diagnosis: • Clinical • Dermoscopy (lacunar pattern) • Histology Treatment: • Conservative • Surgical excision (for suspicious lesions). • Vascular laserQuestions?Your feedback is much appreciatedReferences: Wollina U. Seborrheic Keratoses- The Most Common Benign Skin Tumor of Humans. Clinical presentation and an update on pathogenesis and treatment options. Open Access Maced J Med Sci 2018;6(11):2270-2275. Published 2018 Nov 23. doi:10.3889/oamjms.2018.460 Luba MC, Bangs SA, Mohler AM, Stulberg DL. Common benign skin tumors. Am Fam Physician. 2003 Feb 15;67(4):729 -38. PMID: 12613727. Higgins JC, Maher MH, Douglas MS. Diagnosing Common Benign Skin Tumors. Am Fam Physician. 2015 Oct 1;92(7):601-7. PMID: 26447443. Doorbar J, Egawa N, Griffin H, Kranjec C, Murakami I. Human papillomavirus molecular biology and disease association. Rev Med Virol. 2015;25 Suppl 1(Suppl Suppl 1):2-23. doi:10.1002/rmv.1822. Guidelines for Management of Cutaneous Warts (JC Sterling, S Handfield-Jones, PM Hudson). BJD, Vol. 144, No.1, January 2001 (p4) – British Association of Dermatologists. Al Aboud DM, Yarrarapu SNS, Patel BC. Pilar Cyst. [Updated 2021 Aug 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534209/