Clinical images - Nodular skin lesions

Differentiate the diagnosis of haemangioma, nodular prurigo, squamous cell carcinoma and keratoacanthoma. By Dr Nigel Stollery



  • Can occur at any age and be of varied size
  • Benign vascular lesion that may easily bleed
  • No potential for malignant transformation
  • Typical appearance on dermoscopy
  • Multiple small haemangiomas, known as Campbell De Morgan spots, are common with increasing age


  • Treatment not always necessary
  • If symptomatic, can be excised under local anaesthesia
  • Smaller haemangiomas can be treated with cautery or hyfrecation

Nodular prurigo


  • Firm nodules, may result from repeated localised trauma, usually scratching, or from previous trauma, such as a bite
  • 80% of those affected are atopic
  • If diagnosis is in doubt, a biopsy can be helpful
  • Hyperpigmentation may occur in and around the nodules


  • Treatment can be difficult
  • Potent topical steroid cream can be helpful
  • Covering the skin to prevent scratching can help, for example, by paste bandaging
  • In severe, very symptomatic cases, ciclosporin or azathioprine can be helpful

Squamous cell carcinoma


  • Appearance very variable and incidence increases with age
  • May develop in damaged skin, such as ulcers or burns
  • Often develops as a rapidly growing nodule that may bleed
  • More common on sun-exposed areas and in patients taking immunosuppressive medication
  • Second most common type of skin malignancy in the UK
  • If suspected, histology should be checked


  • Excision is treatment of choice
  • Radiotherapy may be more appropriate for elderly or for very large, inoperable lesions



  • Relatively common, benign lesions in sun-exposed skin
  • Usually form a nodule with a central keratin plug
  • Cause unknown, but incidence increases with age
  • Often clinically difficult to differentiate from squamous cell carcinoma
  • May grow very rapidly
  • If untreated, usually resolve over four to six months


  • Treatment not required, but most are excised because of diagnostic uncertainty
  • Curettage and cautery may be an alternative to formal excision

Dr Stollery is a GP in Kibworth, Leicestershire, and a clinical assistant in dermatology at Leicester Royal Infirmary

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus