Primary cutaneous B-cell lymphoma
Presentation
- Rare condition, which develops slowly over months or years
- Most common on the head, neck and trunk
- Nodular, with a red or pink appearance
- Single or multiple tumours may be present
- May transform into more aggressive forms
Management
- Diagnosis can be difficult and biopsy is usually required
- Condition is always managed in secondary care
- Treatment will depend on the patient's symptoms and general health, and the stage of their disease
- Options include radiotherapy or excision
Nodular prurigo
Presentation
- Can occur anywhere that is easily scratched
- History of recurrent trauma sometimes disclosed by patient on questioning
- Single or multiple firm lesions
- Condition may be associated with mental illness
Management
- Treatment can be difficult
- Topical steroids may help to decrease the pruritus
- Occlusion can be helpful
Actinic keratosis
Presentation
- Common condition
- Rarely seen in patients with Fitzpatrick skin types IV and V
- Incidence increases with age
- Occurs on sun-exposed areas
- More common in people who work outdoors and those living in hot countries
- Lesions have a low risk of malignant transformation
Management
- Various treatment options are available, including topical preparations, cryotherapy, and curettage and cautery
- Future sun protection is an important part of management in these patients
- Usually managed in primary care
- If diagnosis is in doubt, a biopsy can be helpful
Keratoacanthoma
Presentation
- More common in areas of sun-damaged skin
- May be triggered by trauma
- Starts as a pimple or boil, but is solid when squeezed
- Lesion arises from hair follicle skin cells
- Central keratin plug present
- Rapid growth up to 2cm diameter
Management
- As it is difficult to differentiate from squamous cell carcinoma, suspected keratoacanthoma should be referred under the two-week wait system
- May resolve without treatment
- Treatment options include cryotherapy, radiotherapy or electrocautery
Dr Stollery is a GPSI in dermatology in Kibworth, Leicestershire
