Flat, circular, spots - vary in color, red, yellow, tan, light brown. Always darker than surrounding skin and m ore frequent in light com plected

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Beatrice Nicholson
5 years ago
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Flat, circular, spots - vary in color, red, yellow, tan, light brown Always darker than

1 Ephilis Ephilides (Gr. freckle) Norm al num ber of m elanocytes but hypertrophy and increased m elanin production Flat, circular, spots - vary in color, red, yellow, tan, light brown Always darker than surrounding skin and m ore frequent in light com plected H ereditary in som e fam ilies Regular use of sunscreen m ay suppress Inconsequential provided diagnosis is correct

few years and m ore common in black infants. Normal to have a few such spots - m ore than six spots greater than 1.

2 Cafe au lait coffee with m ilk, light to m edium brown, hence nam e Flat, well dem arcated, evenly pigmented More or less oval, long axis situated along cutaneous nerve tract Normal number of m elanocytes but hypertrophy and increased m elanin production Usually present at birth but m ay arise later in first few years and m ore common in black infants. Normal to have a few such spots - m ore than six spots greater than 1.5 m illimeters in diam eter in the pre-pubertal child greater than 5 m m in diam eter in post-pubertal child - suggests diagnosis of neurofibromatosis - additional features required to m ake diagnosis

exposure Distribution classically forehead, cheeks,

3 Lentigo liver spots that appear beyond 30 or 40 years Most com m on in Caucasians Due to chronic sun exposure Distribution classically forehead, cheeks, nose, back of the hand or forearm, and upper back and chest

occasionally itch H alf will resolve if protected from sun Can be precancerous, official nam

4 Actinic keratosis Scaly crusty bum ps Known as AK's and popular in television advertising Light or dark, tan, pink or red, or com bination, or even skin color Crust dry, rough, occasionally itch H alf will resolve if protected from sun Can be precancerous, official nam e is intraderm al squam ous carcinom a Not threatening provided detected and treated in early stages

5 Actinic keratosis Treatm ent 5-FU (Efudex) topically bid for 3-4 weeks Im iquim od 5% cream for 12 weeks Cryotherapy, phototherapy, derm abrasion, or diclofenac gel 60% of squam ous cell carcinom as arise from AK. Progression of solitary AK to squam ous cell - 1/1000*yr

Cause unknown May appear in large num bers Painless but m ay becom e irritated and

6 Seborrheic keratosis Benign wart-like growths on skin surface and described as resem bling hot wax allowed to drip and set on skin Com m only appear after age 40 Cause unknown May appear in large num bers Painless but m ay becom e irritated and itch Cosm etic problem and rem oval m ay be indicated Treatm ent freezing or shaving

7 Achrochordon Skin tags Arm pits, neck, groin More frequent with age Treatm ent Cosm etic excision at base, followed by AgNO3 prn, but som etim es sim ple ligature will suffice

20% - m alignancy in 15 20% If m alignancy, squam ous cell carcinom a m ost com m on, increasing to 33% if present on penis Treatm ent -

8 Cutaneous horn Conical projection above skin surface com posed of com pacted keratin Base m ay be flat, nodular, or crater-like Results from hyperkeratoses that develops over surface of another lesion Other lesion m ost often: - actinic keratosis, about 30% - common wart, 20% - m alignancy in 15 20% If m alignancy, squam ous cell carcinom a m ost com m on, increasing to 33% if present on penis Treatm ent - pare down w/ scalpel, cryotherapy, topical salicylic acid, duct tape Treating base properly with those m easures will take care of any skin cancer

Epiderm al nevus H am artom a arising from em bryonic ectoderm Pluripotential cells differentiate into keratinocytes and also into cell-form ing epiderm al appendages Lesions m ay

but also occurs in 20's or 30's Estim ated one third of individuals have involvem ent of other organ system s and condition considered to be an epiderm al nevus syndrom e which m

9 Epiderm al nevus H am artom a arising from em bryonic ectoderm Pluripotential cells differentiate into keratinocytes and also into cell-form ing epiderm al appendages Lesions m ay be: - deeply or slightly pigmented - unilateral or bilateral - often favor the extremities derm atomal pattern - be found on oral m ucosa and conjunctivae Onset usually at birth but also occurs in 20's or 30's Estim ated one third of individuals have involvem ent of other organ system s and condition considered to be an epiderm al nevus syndrom e which m ay represent m ultiple entities Treatm ent (if required) Excision for cosm etic reasons and for historical concern of transform ation to basal cell carcinom a, although this is rare

Acanthosis nigricans May begin at any age Causes velvety light brown to black m arkings, usually on neck, under arm s, or in groin Most often associated with obesity and m ost patients have high

10 Acanthosis nigricans May begin at any age Causes velvety light brown to black m arkings, usually on neck, under arm s, or in groin Most often associated with obesity and m ost patients have high insulin levels thought to activate insulin receptors in skin causing it to grow abnorm ally Rarely associated with tum or, such as stom ach, lung, breast, and uterus usually seen in unusual places such as lips or hands, and unusually severe Treatm ent - Retin-A (cream, gel) m ay soften lesions - Accutane in severe cases

skin Minor injury seem s required to trigger reaction but often either not apparent or unrem em bered Cells start m ultiplying in hair follicle

11 Keratoacanthom a Often starts at site of m inor injury to sun dam aged skin Appears as sm all pim ple or boil with solid core Grows rapidly and when seen by physician, m ay be 2 cm in diam eter Past sun exposure plays role, appears to arise from hair follicle, only seen on hair-bearing skin Minor injury seem s required to trigger reaction but often either not apparent or unrem em bered Cells start m ultiplying in hair follicle and cell m ass grows into keratoacanthom a Can be confused with squam ous cancer but growth ceases after few weeks and then involutes leaving a scar

not be easily visible Occurs on any skin surface but m ost com m on in face, back, or lobe of ears, or chest Treatm ent

12 Epiderm al cyst Som etim es known as a sebaceous cyst (m isnom er) Collection of keratin-like m aterial derived from follicular cells usually cheesy or firm contained within the cyst wall not sebaceous Sm all com m unicating pore m ay not be easily visible Occurs on any skin surface but m ost com m on in face, back, or lobe of ears, or chest Treatm ent Antibiotics if infected, or follow up for excision to include capsule, or incision and then curettage or extraction of capsule

rounded, bum p 1-3m m in diam eter Start to appear in adolescence and m ore com m on in wom en Som

13 Syringom a H arm less sweat duct tum ors Most often found in clusters on eyelids but m ay also arise elsewhere on face, arm pits, umbilicus, upper chest and vulva Skin-colored or yellowish, firm, rounded, bum p 1-3m m in diam eter Start to appear in adolescence and m ore com m on in wom en Som etim es another affected m em ber of fam ily Treatm ent - excision - shaving - electrodessication - curettage

14 And now for som ething com pletely different year old m ale and avid life-long runner Num erous uncatalogued injuries rappelling from rescue chopper in Vietnam Long history of left shoulder pain from pum ping arm s while running Awakened from sleep with m oderately severe pain above left scapula for last 8 nights

15 Im ages

16 Returns for m ri results

ilunare Virus has not been recovered from hum an nerve cells by cell culture and location and structure of the viral DNA not known Vast m ajority > 50 years Repeated

17 H erpes zoster Double-stranded DNA virus related to H erpes sim plex. Most are infected as children, developing chickenpox Im m une system elim inates virus from m ost locations, but rem ains latent in dorsal root ganglia or ganglion sem ilunare Virus has not been recovered from hum an nerve cells by cell culture and location and structure of the viral DNA not known Vast m ajority > 50 years Repeated attacks can occur but m ore than 3 recurrences extremely rare Why im m une suppression fails is poorly understood Not infectious before blisters but then extremely contagious until crusts Postherpetic neuralgia (pain m ore than 3 m onths) related to age, 40% > 60 yrs

Treatm ent Antiviral drugs inhibit VZ V replication and reduce severity and duration with m inim al side effects Do not reliably prevent postherpetic neuralgia Recom m ended for im m unocom petent

18 Treatm ent Antiviral drugs inhibit VZ V replication and reduce severity and duration with m inim al side effects Do not reliably prevent postherpetic neuralgia Recom m ended for im m unocom petent individuals over 50 within 72 hours of rash Corticosteroids frequently used despite unconvincing clinical trials In postherpetic neuralgia, no difference between acyclovir plus prednisone, or acyclovir alone

Prevention Live vaccine (Z ostavax) prevents 50% of zoster, reduces postherpetic neuralgia by 66% Im m une boost from contact with children infected with varicella, preventing about a quarter of

19 Prevention Live vaccine (Z ostavax) prevents 50% of zoster, reduces postherpetic neuralgia by 66% Im m une boost from contact with children infected with varicella, preventing about a quarter of cases am ong unvaccinated adults Population-based varicella im m unization not practiced in UK Antibodies m easured in wom en without chickenpox history, prenatally, and im m unized if naieve By 2005, immunity of NH S personnel determ ined and immunized if non-immune and had direct patient contact

Skin lesions The Good and the Bad. Dr Virginia Hubbard Ipswich Hospital NHS Trust Barts and the London School of Medicine and Dentistry

Skin lesions The Good and the Bad Dr Virginia Hubbard Ipswich Hospital NHS Trust Barts and the London School of Medicine and Dentistry Case 1 32 year old woman Australian Lesion on back New hair growing