benign malignant

• stuck-on, warty, crust
• very variable appearance
• benign

• because it changes...it starts out skin color, then gets darker then crustier.
• it is benign

• lower legs, feet
• it is benign

• skin tags, skin folds, high friction, snip cryo dessication
• it is benign

• dimple sign
• circular
• legs
• from shaving
• excision
• benign

• corn.
• specially shaped callus of dead skin
• benign

• chondrodermatitis nodularis helicis
• (cartilage skin nodule helix)
• benign

• relieve pressure, inject kenalog, excision, C&D
• benign

• subQ keratin filled cyst hair follicle
• central punctum like open comedone
• benign

• trunk, posterior neck, postauricular
• benign

they are STINKY inside

• wen
• benign

• scalp. develops from hair follicle
• no punctum!
• i think these are dad's
• family inheritance, multiple, after puberty
• benign

• enlargement of sebaceous gland on FACE
• forehead nose cheeks
• umbilicated
• benign

• shave or C&D
• benign

• red-blue-purple in year one
• girls more than boys
• head neck more than others
• usually one
• one in year one
• benign

• laser, roids, excise, aldara (offlabel) propanolol (off label)
• benign

• angiokeratoma of Fordyce
• scrotum, vulva
• [they look like purple angiomas]
• benign

lobular capillary hemangioma

• grow rapidly and bleed easily
• looks like the indian dot
• benign

• pregnant women
• benign

• soft movable
• painless
• 40-60 yrs
• benign

• very squishy
• benign

• senile lentigo
• benign

• tan brown
• associated with agina
• 40+ yrs
• increased number of melanocytes and melanin
• benign

flat mole, benign

• what people usually think of as moles
• squishy brown or flesh
• benign

• firmer, slightly elevated, can't wiggle it
• benign

• birthmark, grows with you
• benign

• "tricky"
• these can be flat or papule
• bluish black symmetrical
• benign

• could be precursor, do clear margins
• benign

• white ring around it that doesn't tan
• you can leave the halo
• if the mole looks normal, you can just watch it
• benign

• if you've had one removed and it starts coming back
• if benign? leave it
• if you think precancerous, you need to go back and take more out

• pre-malignant
• sun exposed areas
• treat all as SCC
• 40yrs+ (or younger if sun)

• cryo
• efudex
• imiquimod
• levulan/blue light (less irritating than efudex)

• squamous cell carcinoma (SCC) in situ
• superficial variant of SCC
• pre-malignant

• sun
• radiation/chemicals
• hpv

faint inflammation, raised, red plaque, dry appearance

wart. crustier and wartier looking eczema

Bowen's disease of the penis, under foreskin

Erythroplasia of Queyrat (SCC in situ)

• premalignant
• usually on head/scalp
• linear-oval yellow-flesh colored plaque
• 3 stages
• tx: excision

• 1. childhood, barely noted, velvety, no sx
• 2. puberty, more verrucous-like, sxs possible
• 3. adulthood, 20% neoplastic changes--7% can turn into BCC

• TREATMENT EXCISION
• pre-malignant

• orangey yellowish irregular plaque
• scalp

• multiple clinically atypical moles, increased risk melanoma
• moles continue to form into adulthood

more than 50

• larger
• border irregular
• color variation
• surface irregular

• A asymmetry, fold in half
• B borders notching or irregular
• C more than one color
• D diameter bigger than pencil eraser

basal cell carcinoma

• over 40 yrs
• only sun exposed areas
• mets rare
• fair skin and sun exposure before 14 yrs

(mom)

• pink/red shiny pearly papule with superficial telangiectasias
• rolled translucent borders
• ulcerated center
• firm to palpation
• non healing

• complete excision with primary closure
• MOHS
• C&D

squamous cell carcinoma

rare

outdoor occupations, industrial, HPV, arsenic ingestion

• variant of SCC
• volcano/crater-like

• complete excision with primary closure
• MOHS
• C&D

malignant melanoma

• 4% of all skin CA
• #1 25-29yrs, #2 30-35yrs

• MMRISK
• M atypical nevi more than 5-10
• M moles more than 50 on the body
• R red hair and freckling
• I inability to tan
• S severe sunburns before 14 yrs
• K kindred (any 1st degree relative with melanoma)

• Asymmetry
• Borders
• Color
• Diameter
• *Evolution

take punches in different places, one from lighter, one from darker, for example

• laterally before vertical growth
• trunk/extremities
• whites, females

• grows vertically
• extremities
• raised

laterally in epidermis but if left untreated can grow into dermis and becomes LMM lentigo maligna melanoma

• dark skinned people
• palms, soles, subungual

• non pigmented melanoma
• bx and tx often delayed because it appears innocent

• wide excition with 1cm margin
• 2cm margin for bigger

Stage 1B and II: sentinel node bx

upper stages--high dose interferon-2a (chemo)

helper T cell lymphoma

• pre-MF
• patch
• plaque
• tumor