1. DR. OLGA WATKINS November 2013

2. Outline Of Presentation Common Skin Lesions, Benign And Malignant Assessment Of Pigmented Lesion Points to take home

3. Skin lesions, tumours and cancers Actinic keratosis Angiokeratoma Angiolymphoid hyperplasia Angiosarcoma Aplasia cutis Atypical fibroxanthoma Atypical naevi Basal cell carcinoma Bazex syndrome

4. Which is Malignant? SSMM BCP

5. Which is Benign? Amelanotic melanoma Blue naevus

6. Which Would Worry You? Irritated BCP Pyogenic granuloma

7. Benign Viral warts Seborrhoeic keratoses Naevi Angiomas Epidermoid cysts Other common lesions

8. Viral warts

9. Viral warts on fingers

10. Seborrhoeic Keratoses

12. Benign naevi

13. Atypical naevus

14. Blue Naevus Melanocytes deep within the skin Benign but usually excised to exclude melanoma

15. Halo Naevus Benign lesion Auto-immune reaction, with depigmentation of skin surrounding naevus. Skin eventually re- pigments.

16. Remember Melanoma is rare in children under 12 years age Adults can develop benign naevi up to 50 years of age

17. Regression surrounding melanoma

18. Cherry Angioma

19. Angiokeratoma

20. Angiokeratoma of Fordyce

21. Epidermoid (Sebaceous) Cyst

22. Dermatofibroma Feels hard, dimples when edges pressed together Scarring due to insect bites

23. Pinch sign

24. Senile Comedone

25. Keratoacanthoma

26. Pre-malignant Actinic keratoses Bowens disease Lentigo maligna

27. 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)

28. AKs on scalp

29. Bowens disease on leg

30. Bowens Disease Pre-cancerous 5% risk of developing SCC if not treated

31. Melanoma in situ

32. Lentigo Maligna Melanoma

33. 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

34. Malignant Basal cell carcinoma Squamous cell carcinoma Melanoma Metastatic disease

35. Superficial Basal Cell Carcinoma Treatment options include cryotherapy, 5- FU and PDT

36. Nodular BCC

37. Pigmented BCC

38. Squamous Cell Carcinoma

40. Which is Which? Keratoacanthoma SCC

41. Superficial Spreading Malignant Melanoma

42. Nodular Melanoma

43. Amelanotic Melanoma Similar to pyogenic granuloma but the history is different

44. 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 very itchy. Please can you see him urgently to exclude a melanoma? Sincerely, Dr. Doolittle Dr. Doolittle MB ChB

45. 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

46. Assessment of Naevi ABCD(E) METHOD A - asymmetry B - borders irregular C - colour variation D - diameter larger than pinkie nail (E – rapid elevation)

49. A – asymmetry B - borders irregular C - colour variation D - diameter larger than pinkie nail (E – rapid elevation)

50. 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

51. Internet Support www. pcds.org.uk www.dermnetnz.org www.gpnotebook.co.uk www.bad.org.uk www. pathways.scot.nhs.uk