BENIGN- well differentiated, slow progressive cohesive growth, normal appearing tissue, can be capsule, good prognosis

MALIGNANT - lack of differentiation, slow-rapid infiltrative growth, atypical tissue, metastasis, poor prognosis

- 1mm-6cm brown stuck on warty look papule or flat plaque, multiple sometimes (rapid increase in numbers may mean internal malignancy), pigmented

- mainly sun exposed areas esp after 30

- treatment is cosmetic, usually once it becomes itchy

- lower extremities and forearms

- multiple small white, dry scaly lesions, can be oval or round papules

Dermatofibroma: appearance and location?

- 5-10mm firm nodule with well defined border, is round/oval. Can be yellow, brown or pink. Sometimes squeezing causing dimpling.

-Lower legs or arms of younger women. Last yrs. 

-fast growing bright red nodule with collarette, sometimes pedunculated and bleeds easily

- young adults/children/pregnant

- resolves after pregnancy or drug stoppage

-curette/laser/cryotherapy/topical/chemical

- compression

-intralesional streoid and cytotxic meds

-surgery (but can result in larger keloid)

-radiotherapy

-laser

-cryotherapy

- 1-3mm small bright red papules, look like red ink spots

-elderly people

- injury/trauma/overuse that forms internal blister

- tears in tendon membrane or joint capsule allowing contents to squeeze out

- med hx, physical examination, US, xray, needle aspiration for lab examination

- monitor, it may disappear, needle aspiration, surgery

soft domed shaped smooth translucent white to pink cyst around nails or DIP. 

Can be a type of ganglion caused by OA or RA, or depostion of mucins

- none

-drainage

-cryo/cautery

-intralesional steroids

surgery

- tumour of nail matrix, esp in fingers of middle aged white people

- 4 signs

- thickened nail plate, proximal splinter haemorrhages, longitudinal overcurvature of nail plate, v shaped tumour with filamentous projections

- doppler, US, MRI, histology

- surgery

- solitary/multiple pink/red plaques +/- scale, can be several cm

may progress to SCC

occurs on lower leg in older persons

-efudix cream (poor compliance)

- cyrotherapy

-curettage

-excision

-surgery (esp at hair site)

- well defined, raised red paupules with a rough HK scaly surface

- can be single or multiple, <2cm, varying

- on sun exposed areas

- can be lumpy underneath, sore, rapid growing, have cutaneous horn (itchy, need sun protection)

- solitary or multiple rapidly growing dome shaped lesions with central keratin plug

- affect mainly sun exposed skin

- rarely metastasising malignancy, sun exposed areas esp face of middle aged/elderly, M>F

- UV, arsenic, xray, chronic scars

- nodular (commonest, pearly, raised nodule, may have telangectasia)

-cystic (like nodular)

-superficial (erythematous patch, may be crusty or have multiple centres with a rim)

- morphoeic (white yellow plaque, may have central depression)

all may or may not be pigmented. Can be mixed forms also

- sun exposed areas or non healing ulcers that may evolve

- M>F 55 yrs and older

- excision and/or radiotherapy

typically begins as a nodule that ulcerates and has hard edges

can be verrucous

mostly sun exposed areas following episodes of severe sunburn

first sign is change in freckle or mole (7 pt check list). May even bleed or have sensory changes

A = Asymmetry in shape

B = Border is irregular, scalloped, poorly defined

C = Colour is many/or changes

D = Diameter is large

E = Elevation/enlargement/evolution

o   Superficial spreading melanoma

o   Lentigo maligna melanoma

o   Nodular  melanoma

o   Acral lentiginous melanoma

o   And Amelanotic Melanoma – rare but very difficult!

- macule with variable pigmentation

- esp lower leg or trunk

- pigmented or non pigmented nodule in any area of the body, may ulcerate, poor prognosis

- M>F, 50-60 yrs

- palms, soles, nail bed

-racially pigmented people

-lesion not always black, can be red or brown

-propmpt excision

-          Violaceous macules and papules on lower legs, Gradually form plaques with purple-red nodules

-          May ulcerate

- HIV

- caused by herpes virus

- mediterranean background

o   No treatment

o   Cryotherapy

o   Radiotherapy

o   Topicals – Anti-virals, Retinoids, immunomodulators

o   Systemic -Anti-virals, Retinoids, immunomodulators

o   Reduce underlying immunosuppression