Compound naevus
Presentation
- Common benign pigmented naevus arising in melanocytes
- Colour varies from white to dark brown
- May occur congenitally
- Usually raised above the surface of the skin
- Size varies from 2-7mm in diameter
Management
- Treatment not always needed
- Indications for removal include diagnostic uncertainty, cosmetic reasons, or if there is repeated trauma
- Treatment of choice is surgical excision
- Whole lesions should be removed and sent for histology
Malignant melanoma
Presentation
- Malignant skin lesion with potential to be life-threatening
- Metastatic spread will occur if untreated
- Incidence increasing
- Occurs at younger age than other skin malignancies
- More common in skin types 1 and 2 and with UV exposure
- 30% develop in existing naevi
Management
- Early excision is treatment of choice
- Whole lesions should be removed and sent for histology with 2mm margin
- Once diagnosis is confirmed, wide excision required
- When spread has occurred, prognosis is poor, with few treatment options
Pigmented basal cell carcinoma
Presentation
- Most common type of skin malignancy
- Incidence increases with age
- Occur mainly on sun-exposed areas of skin
- When pigmented, differential includes malignant melanoma
- Lesions have little potential for metastatic spread
Management
- Excision is the treatment of choice
- Histology to check for complete excision and confirm diagnosis
- Further lesions commonly occur
- Advise patients on sun protection
Seborrhoeic keratosis
Presentation
- Very common benign lesions
- Pale to dark brown in colour
- Stuck-on appearance, with crusted warty surface
- Incidence increases with age
- No potential for malignant transformation
- Typical keratin plugs and horny cysts when viewed with a lens
Management
- Treatment not usually necessary
- If required, cryotherapy can be undertaken
- Other treatments include curettage and cautery
Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary
