Common Benign Lesions and Skin Cancers. 22nd May 2015 Dr Mark Foley
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1 Common Benign Lesions and Skin Cancers 22nd May 2015 Dr Mark Foley
2 Thank you for downloading this file. This intended to supplement the presentation given at the NZ Wound Care Conference, it is not intended to be a standalone resource. The Skin Clinic Marlborough
3 Overview Reminder of skin structure Role of dermoscopy Common benign lesions Common skin cancers The Skin Clinic Marlborough
4 Reminder of skin structure The Skin Clinic Marlborough
5 Reminder of skin structure The Skin Clinic Marlborough
6 Epidermis Dermis Fat The Skin Clinic Marlborough
7 The Skin Clinic Marlborough
8 Reproduction The Skin Clinic Marlborough
9 Reproduction Keratin production The Skin Clinic Marlborough
10 Lipid and enzyme production Reproduction Keratin production The Skin Clinic Marlborough
11 Physical Barrie Lipid and enzyme production Reproduction Keratin production The Skin Clinic Marlborough
12 BCC The Skin Clinic Marlborough
13 AK/SCCi/SCC BCC The Skin Clinic Marlborough
14 AK/SCCi/SCC BCC Melanoma The Skin Clinic Marlborough
15 AK/SCCi/SCC Aldara BCC Melanoma The Skin Clinic Marlborough
16 Epidermis: Melanoma insitu Squamous cell carcinoma insitu Wart virus infection Seborrhoeic keratosis Junctional Naevus Psoriasis Eczema Merkel Cell Tumour Dermis: Compound Naevus Fungal infections (superficial) Intradermal Naevus Blue Naevus Dermatofibroma Basal cell carcinoma Squamous Cell Carcinoma
17 Skin Cancers and Benign Lesions can mimic each other The Skin Clinic Marlborough
18 How do we differentiate benign from malignant? The Skin Clinic Marlborough
19 Dermoscopy / Dermatoscopy The Skin Clinic Marlborough
20 Dermoscopy Allows visualisation of skin architecture not able to be seen with the naked eye. Dramatically improves ability to diagnose early skin cancer and benign lesions The Skin Clinic Marlborough
21 The Skin Clinic Marlborough
22 The Skin Clinic Marlborough
23 The Skin Clinic Marlborough
24 The Skin Clinic Marlborough
25 Coiled vessels The Skin Clinic Marlborough
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27 Branching or arborising vessels
28 Two important dermoscopic signs for non-pigmented lesions These will improve your pick up rate dramatically The Skin Clinic Marlborough
29 Branching /Arborising vessels The Skin Clinic Marlborough
30 Coiled Vessels Coiled vessels The Skin Clinic Marlborough
31 BCC SCC insitu The Skin Clinic Marlborough
32 Common Benign Lesions The Skin Clinic Marlborough
33 Common Benign Lesions Epidermis: Wart virus infection Seborrhoeic keratosis Junctional Naevus Psoriasis Eczema Fungal infections (superficial) Dermis: Compound Naevus Intradermal Naevus Sebaceous Hyperplasia Blue Naevus Dermatofibroma The Skin Clinic Marlborough
34 Solar Lentigo Sun induced freckle Associated with sun damage Harmless Can mimic melanoma The Skin Clinic Marlborough
35 Epidermis: Lentigo The Skin Clinic Marlborough
36 The Skin Clinic Marlborough
37 The Skin Clinic Marlborough
38 The Skin Clinic Marlborough
39 The Skin Clinic Marlborough
40 Seborrhoeic Keratoses Often referred to as senile warts But they occur in younger people They are not a viral infection Are not sun related Harmless They can mimic SCC s and Melanoma The Skin Clinic Marlborough
41 Epidermis: Seborrhoeic keratosis Senile wart, barnacle The Skin Clinic Marlborough
42 The Skin Clinic Marlborough
43 The Skin Clinic Marlborough
44 The Skin Clinic Marlborough
45 The Skin Clinic Marlborough
46 The Skin Clinic Marlborough
47 Haemangioma Benign growth of vasculature- forming locules. Harmless The Skin Clinic Marlborough
48 Dermis: Haemangioma The Skin Clinic Marlborough
49 The Skin Clinic Marlborough
50 The Skin Clinic Marlborough
51 The Skin Clinic Marlborough
52 The Skin Clinic Marlborough
53 The Skin Clinic Marlborough
54 The Skin Clinic Marlborough
55 Sebaceous Hyperplasia Overgrowth of sebaceous gland Can mimic BCC The Skin Clinic Marlborough
56 Sebaceous Hyperplasia Dermis: Mid to deep dermis as involves piloseb unit The Skin Clinic Marlborough
57 The Skin Clinic Marlborough
58 The Skin Clinic Marlborough
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68 The Skin Clinic Marlborough
69 Moles or Naevi Multiple classification systems for moles Most commonly used is based on histopathology. Accurate classification can be problematic clinically. The Skin Clinic Marlborough
70 Junctional - confined to epidermis Compound - epidermal and dermal Intradermal - confined to dermis Blue - blue grey colour, dermis Dysplastic - can mimic melanoma but harmless Spitz.and others The Skin Clinic Marlborough
71 Epidermis: Junctional Naevus The Skin Clinic Marlborough
72 Epidermis and Dermis: Compound Naevus The Skin Clinic Marlborough
73 Dermis: Intradermal Naevus Blue Naevus The Skin Clinic Marlborough
74 Junctional Naevus Compound Naevus Intradermal Naevus Blue Naevus The Skin Clinic Marlborough
75 Spitz Naevus Dysplastic Naevus The Skin Clinic Marlborough
76 Dermatofibroma Fibrous lump deep in the dermis May have +ve pinch sign May be related to micro-trauma (eg insect bite or vaccination) The Skin Clinic Marlborough
77 Dermis: Dermatofibroma The Skin Clinic Marlborough
78 +ve Pinch Sign The Skin Clinic Marlborough
79 +ve Pinch Sign The Skin Clinic Marlborough
80 +ve Pinch Sign The Skin Clinic Marlborough
81 Psoriasis Epidermal Multiple red scaly plaques Extensor surfaces, scalp, trunk and limbs Face is usually spared The Skin Clinic Marlborough
82 The Skin Clinic Marlborough
83 The Skin Clinic Marlborough
84 The Skin Clinic Marlborough
85 The Skin Clinic Marlborough
86 The Skin Clinic Marlborough
87 The Skin Clinic Marlborough
88 BCC s Common Skin Cancers SCC s Melanoma The Skin Clinic Marlborough
89 Common Skin Cancers Basal Cell Carcinoma - Superficial - Nodular - Aggressive - Micronodular - Sclerosing - Infiltrating The Skin Clinic Marlborough
90 Common Skin Cancers Squamous Cell Carcinoma Insitu Invasive The Skin Clinic Marlborough
91 Common Skin Cancers Melanoma - Insitu - Invasive - Metastatic The Skin Clinic Marlborough
92 Common Skin Cancers The Skin Clinic Marlborough
93 Solar Keratosis / Actinic Keratosis Considered Pre-malignant AK vs SCCi
94 Epidermis AK lower 1/3 SCCi full thickness Dermis Invasive SCC SCC AK SCCi
95 Actinic Keratosis and SCC insitu AK and SCCi therefore have similar naked eye features Dermoscopically key differences Dot vessels, if any with AK Coiled vessels +/- dot vessels with SCCi
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99 SCC insitu
100 Epidermis AK lower 1/3 SCCi full thickness SCCi AK
101 The Skin Clinic Marlborough
102 The Skin Clinic Marlborough
103 The Skin Clinic Marlborough
104 The Skin Clinic Marlborough
105 The Skin Clinic Marlborough
106 SCC insitu The Skin Clinic Marlborough
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109 SCCi
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113 SCCi
114 Epidermis AK lower 1/3 SCCi full thickness Dermis Invasive SCC SCC AK SCCi
115 Well differentiated SCC SCC s are usually a naked eye diagnosis as there are very few useful dermoscopic signs. The Skin Clinic Marlborough
116 The Skin Clinic Marlborough
117 The Skin Clinic Marlborough
118 SCC can grow rapidly in the elderly immunocompromised patients Differential includes Keratoacanthoma Excision is indicated rather than observation The Skin Clinic Marlborough
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120 wdscc
121 The Skin Clinic Marlborough
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133 The Skin Clinic Marlborough
134 Common Skin Cancers The Skin Clinic Marlborough
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138 Dermis: Superficial BCC The Skin Clinic Marlborough
139 The Skin Clinic Marlborough
140 The Skin Clinic Marlborough
141 The Skin Clinic Marlborough
142 The Skin Clinic Marlborough
143 sbcc The Skin Clinic Marlborough
144 Nodular BCC The Skin Clinic Marlborough
145 Dermis: Nodular BCC The Skin Clinic Marlborough
146 48 yr old woman, new lesion The Skin Clinic Marlborough
147 The Skin Clinic Marlborough
148 60 yr old woman, slow growing lesion, past 3 yrs. The Skin Clinic Marlborough
149 The Skin Clinic Marlborough
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152 nbcc
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155 mnbcc
156 The Skin Clinic Marlborough
157 The Skin Clinic Marlborough
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159 The Skin Clinic Marlborough
160 Dermis: Infiltrating BCC The Skin Clinic Marlborough
161 The Skin Clinic Marlborough
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168 Pigmented BCC
169 Common Skin Cancers The Skin Clinic Marlborough
170 Epidermis: Melanoma insitu The Skin Clinic Marlborough
171 Melanoma Insitu The Skin Clinic Marlborough
172 The Skin Clinic Marlborough
173 2 Melanoma Insitu The Skin Clinic Marlborough
174 The Skin Clinic Marlborough
175 Melanoma Insitu The Skin Clinic Marlborough
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178 MIS
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181 MIS
182 The Skin Clinic Marlborough
183 The Skin Clinic Marlborough
184 MELANOMA Breslow 0.5 mm The Skin Clinic Marlborough
185 The Skin Clinic Marlborough
186 The Skin Clinic Marlborough
187 Melanoma, Breslow 2.5 mm The Skin Clinic Marlborough
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189 Nodular Melanoma 3.5 mm
190 Chronic ulceration Dermoscopy may not be helpful Biopsy to exclude malignancy Some chronic ulceration -> SCC (Marjolin ulcer) The Skin Clinic Marlborough
191 SCC The Skin Clinic Marlborough
192 Summary Common Skin Cancers have epidermal origin They can be difficult to differentiate from benign lesions Dermoscopy can help Biopsy chronic ulcers The Skin Clinic Marlborough
193 Thank you Dr. Mark Foley 28 Alfred St Blenheim Tel theskinclinic.co.nz
Skin lesions The Good and the Bad. Dr Virginia Hubbard Ipswich Hospital NHS Trust Barts and the London School of Medicine and Dentistry
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