A/Prof Amanda Oakley CNZM Dermatologist, Hamilton Skin lesions
Transcript of A/Prof Amanda Oakley CNZM Dermatologist, Hamilton Skin lesions
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Skin lesions
A/Prof Amanda Oakley CNZM
Dermatologist, Hamilton
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Conflict of interestI am a consultant and on the Medical Advisory Board for MoleMap New Zealand
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Outline
Melanocytic + keratinocytic + other
Benign + malignant
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Melanocytic naevi
Congenital naevi
Childhood naevi
Acquired naevi
• Junctional naevi
• Compound naevi
• Dermal naevi
• Blue naevi
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Congenital
melanocytic
naevus
Large distinctive pigmented lesion present at birth
Various types –often hair-bearing
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Congenital MN
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Childhood
Nearly everyone has several to many naevi
Dermal naevi > compound naevi
Any site – not really related to sun exposure
< 10 years (most) < 20 years (some) < 20 years (a few)
Pink (white skin) to brown (most) to black (dark skin)
Most are oval, some odd shapes
Symmetrical colours, structures
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Naevi in children
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Adult
More naevi upper back > upper arms > elsewhere
Dermal naevi become more elevated
Each person has own pattern(s) of naevi
Dermoscopy fading border, symmetrical colours and structures
• Reticular pattern, clod pattern, structureless pattern
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Dermal naevus
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Papillomatous dermal naevus
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Blue naevus
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Junctional naevus
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Compound naevus
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Dermal naevus
Dermoscopy 15
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Blue naevus
Dermoscopy 16
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Globular pattern
Dermoscopy 17
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Reticular pattern
Dermoscopy 18
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Structureless pattern
Dermoscopy 19
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Compound naevus
Dermoscopy 20
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Facial pseudonetwork
Dermoscopy 21
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Palms/soles parallel furrow
Dermoscopy 22
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Melanoma
Superficial spreading melanoma
Lentigo maligna melanoma
Nodular melanoma
Other
Melanoma in situ
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Flat
melanoma
ABCD: Asymmetrical, Border, Colours, Different
In situ phase for years prior to invasion
Slowly growing, irregular pigmented lesion
Asymmetrical in shape, structure, colour
Variable, multiple colours
Dermoscopy – lack of pattern (chaos) + clues
• Focal grey, thick lines, eccentric structureless zones, peripheral black dots or radial streaming, polygons, white lines, parallel ridge (palms/soles)
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Superficial spreading MM
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SSM
Dermoscopy 26
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Lentigo maligna melanoma
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Lentigo maligna
Dermoscopy 28
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Thick
melanoma
EFG: Elevated Firm Growing
Fast growing – weeks to months
Red, black, blue
May be round or oval nodules
Dermoscopy – lack of pattern (chaos) + clues
•Focal grey, eccentric structureless zones, peripheral superficial features, white lines, polymorphous blood vessels
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Nodular melanoma
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Nodular melanoma
Dermoscopy 31
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Benign
keratinocyte
lesions
Keratinocyte → scale
Epidermal → sit on skin surface
Viral warts – HPV
Seborrhoeic keratoses
Solar lentigines
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Viral wart
> HPV subtypes
Children or anyone
Fingers, feet, knees or anywhere
Irregular distribution, often linear or grouped
Rough surface
Dermoscopy shows capillary surrounded by keratin
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Viral wart
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Viral wart
Dermoscopy 35
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Seborrhoeic
keratosis
Adult or anyone
Almost everyone: few to many
Location – any hair-bearing site (not palms, soles, mucosal sites)
White to black, often multicoloured
‘Stuck on’ – sharp border
Dermoscopy orange clods, white clods, thick curved lines (polarised best)
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Seborrhoeic keratosis
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Seborrhoeic keratosis
Dermoscopy 38
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Solar lentigo
Adults, any skin colour
Sun-exposed sites → few to many
Mainly light or dark brown, greyish/yellowish
Inflammatory reaction: purple → grey → disappear
•Lichen planus like keratosis
Seborrhoeic keratosis can develop within them
Sharp border, scalloped edge
Dermoscopy structureless or fingerprinting, face pseudonetwork
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Solar lentigo
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Solar lentigo
Dermoscopy 41
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Keratinocyte
cancers
Actinic keratosis
Squamous cell carcinoma in situ
Squamous cell carcinoma
Basal cell carcinoma
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Actinic keratosis
Adults especially older outdoor workers
Fair skin > tanned skin >> dark skin
Hands, bald scalp, ears, nose, face, forearms, lower legs
Ill-defined, tender, adherent scale, erythematous
Dermoscopy on face: red pseudonetwork, prominent follicles
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Actinic keratosis
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Actinic keratosis
Dermoscopy45
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SCC in situ
Adults, especially older adults
Lesions often multiple
Sun-exposed sites or anywhere
Irregular shape, irregular adherent scale, orange red to pigmented
Dermoscopy crops of rounded, irregular vessels
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SCC in situ
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SCC in situ
Dermoscopy 48
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Cutaneous
SCC
Older people, immune suppressed
Sun-exposed sites: scalp, ears, lips, face, hands, legs
• Often within actinic keratosis or SCC in situ
• In darker skin, in chronic wound or scar
Painful, fast-growing nodules
Dermoscopy central keratin/ulcer, peripheral white
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cSCC
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cSCC
Dermoscopy 51
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Nodular BCC
The most common cancer
Head and neck > other sites
Increasing prevalence with age
Bleed, ulcerate early
Pigmented or not pigmented
Dermoscopy irregular pigmented structures on white/pink/greige stroma, linear branched blood vessels, short white lines (polarised only)
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nBCC
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nBCC
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nBCC
Dermoscopy 55
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Superficial
BCC
Very common, often unnoticed
Trunk, limbs > face, acral sites
Slow-growing, usually pink, irregular plaque – not much scale
May bleed
Dermoscopy microerosions, short red lines, white lines (polarised only)
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sBCC
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sBCC
Dermoscopy 58
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Dermatofibroma
Vascular lesions
Other
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Dermatofibroma
Single or multiple fibrous lesions
Legs > arms > trunk
Firm papules that dimple on lateral pressure
Pink to brown
Dermoscopy central white area, peripheral fine network or light pigment or radial vessels
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Dermatofibroma
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Dermatofibroma
Dermoscopy 62
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Vascular lesions
Pink, red, purple, blue
Proliferation (angioma) – round papule
Dermoscopy clods separated by fibrous bands
Dilatation (ectasia) – squashable linear lesion
Dermoscopy structureless
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Angioma
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Angioma
Dermoscopy 65
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Ectasia
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Ectasia
Dermoscopy 67
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