Haemangioma
Presentation
- 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
Management
- Treatment not always necessary
- If symptomatic, can be excised under local anaesthesia
- Smaller haemangiomas can be treated with cautery or hyfrecation
Nodular prurigo
Presentation
- 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
Management
- 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
Presentation
- 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
Management
- Excision is treatment of choice
- Radiotherapy may be more appropriate for elderly or for very large, inoperable lesions
Keratoacanthoma
Presentation
- 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
Management
- 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
