Common Benign Lesions and Skin Cancers 22nd May 2015 Dr Mark Foley
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
Overview Reminder of skin structure Role of dermoscopy Common benign lesions Common skin cancers The Skin Clinic Marlborough
Reminder of skin structure The Skin Clinic Marlborough
Reminder of skin structure The Skin Clinic Marlborough
Epidermis Dermis Fat The Skin Clinic Marlborough
The Skin Clinic Marlborough
Reproduction The Skin Clinic Marlborough
Reproduction Keratin production The Skin Clinic Marlborough
Lipid and enzyme production Reproduction Keratin production The Skin Clinic Marlborough
Physical Barrie Lipid and enzyme production Reproduction Keratin production The Skin Clinic Marlborough
BCC The Skin Clinic Marlborough
AK/SCCi/SCC BCC The Skin Clinic Marlborough
AK/SCCi/SCC BCC Melanoma The Skin Clinic Marlborough
AK/SCCi/SCC Aldara BCC Melanoma The Skin Clinic Marlborough
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
Skin Cancers and Benign Lesions can mimic each other The Skin Clinic Marlborough
How do we differentiate benign from malignant? The Skin Clinic Marlborough
Dermoscopy / Dermatoscopy The Skin Clinic Marlborough
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
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Coiled vessels The Skin Clinic Marlborough
Branching or arborising vessels
Two important dermoscopic signs for non-pigmented lesions These will improve your pick up rate dramatically The Skin Clinic Marlborough
Branching /Arborising vessels The Skin Clinic Marlborough
Coiled Vessels Coiled vessels The Skin Clinic Marlborough
BCC SCC insitu The Skin Clinic Marlborough
Common Benign Lesions The Skin Clinic Marlborough
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
Solar Lentigo Sun induced freckle Associated with sun damage Harmless Can mimic melanoma The Skin Clinic Marlborough
Epidermis: Lentigo The Skin Clinic Marlborough
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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
Epidermis: Seborrhoeic keratosis Senile wart, barnacle The Skin Clinic Marlborough
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Haemangioma Benign growth of vasculature- forming locules. Harmless The Skin Clinic Marlborough
Dermis: Haemangioma The Skin Clinic Marlborough
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Sebaceous Hyperplasia Overgrowth of sebaceous gland Can mimic BCC The Skin Clinic Marlborough
Sebaceous Hyperplasia Dermis: Mid to deep dermis as involves piloseb unit The Skin Clinic Marlborough
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The Skin Clinic Marlborough
The Skin Clinic Marlborough
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
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
Epidermis: Junctional Naevus The Skin Clinic Marlborough
Epidermis and Dermis: Compound Naevus The Skin Clinic Marlborough
Dermis: Intradermal Naevus Blue Naevus The Skin Clinic Marlborough
Junctional Naevus Compound Naevus Intradermal Naevus Blue Naevus The Skin Clinic Marlborough
Spitz Naevus Dysplastic Naevus The Skin Clinic Marlborough
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
Dermis: Dermatofibroma The Skin Clinic Marlborough
+ve Pinch Sign The Skin Clinic Marlborough
+ve Pinch Sign The Skin Clinic Marlborough
+ve Pinch Sign The Skin Clinic Marlborough
Psoriasis Epidermal Multiple red scaly plaques Extensor surfaces, scalp, trunk and limbs Face is usually spared The Skin Clinic Marlborough
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BCC s Common Skin Cancers SCC s Melanoma The Skin Clinic Marlborough
Common Skin Cancers Basal Cell Carcinoma - Superficial - Nodular - Aggressive - Micronodular - Sclerosing - Infiltrating The Skin Clinic Marlborough
Common Skin Cancers Squamous Cell Carcinoma Insitu Invasive The Skin Clinic Marlborough
Common Skin Cancers Melanoma - Insitu - Invasive - Metastatic The Skin Clinic Marlborough
Common Skin Cancers The Skin Clinic Marlborough
Solar Keratosis / Actinic Keratosis Considered Pre-malignant AK vs SCCi
Epidermis AK lower 1/3 SCCi full thickness Dermis Invasive SCC SCC AK SCCi
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
SCC insitu
Epidermis AK lower 1/3 SCCi full thickness SCCi AK
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SCC insitu The Skin Clinic Marlborough
SCCi
SCCi
Epidermis AK lower 1/3 SCCi full thickness Dermis Invasive SCC SCC AK SCCi
Well differentiated SCC SCC s are usually a naked eye diagnosis as there are very few useful dermoscopic signs. The Skin Clinic Marlborough
The Skin Clinic Marlborough
The Skin Clinic Marlborough
SCC can grow rapidly in the elderly immunocompromised patients Differential includes Keratoacanthoma Excision is indicated rather than observation The Skin Clinic Marlborough
wdscc
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Common Skin Cancers The Skin Clinic Marlborough
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Dermis: Superficial BCC The Skin Clinic Marlborough
The Skin Clinic Marlborough
The Skin Clinic Marlborough
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sbcc The Skin Clinic Marlborough
Nodular BCC The Skin Clinic Marlborough
Dermis: Nodular BCC The Skin Clinic Marlborough
48 yr old woman, new lesion The Skin Clinic Marlborough
The Skin Clinic Marlborough
60 yr old woman, slow growing lesion, past 3 yrs. The Skin Clinic Marlborough
The Skin Clinic Marlborough
nbcc
mnbcc
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The Skin Clinic Marlborough
The Skin Clinic Marlborough
The Skin Clinic Marlborough
Dermis: Infiltrating BCC The Skin Clinic Marlborough
The Skin Clinic Marlborough
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The Skin Clinic Marlborough
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Pigmented BCC
Common Skin Cancers The Skin Clinic Marlborough
Epidermis: Melanoma insitu The Skin Clinic Marlborough
Melanoma Insitu The Skin Clinic Marlborough
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2 Melanoma Insitu The Skin Clinic Marlborough
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Melanoma Insitu The Skin Clinic Marlborough
MIS
MIS
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The Skin Clinic Marlborough
MELANOMA Breslow 0.5 mm The Skin Clinic Marlborough
The Skin Clinic Marlborough
The Skin Clinic Marlborough
Melanoma, Breslow 2.5 mm The Skin Clinic Marlborough
Nodular Melanoma 3.5 mm
Chronic ulceration Dermoscopy may not be helpful Biopsy to exclude malignancy Some chronic ulceration -> SCC (Marjolin ulcer) The Skin Clinic Marlborough
SCC The Skin Clinic Marlborough
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
Thank you Dr. Mark Foley 28 Alfred St Blenheim Tel 03 578 1665 theskinclinic.co.nz