Suspicious skin lesions

Dr Philip Marazzi, a GP in East Horsley, Surrey

Solar keratosis



This 55-year-old man had red hair and fair skin, which has been exposed to too much sun. This solar keratosis lesion is one of many that he has already developed as a result of his previous exposure to excessive sunlight. Liquid nitrogen cryotherapy has been effective so far, but he is kept under regular review. He has been advised to avoid the sun where possible and use a high protection factor suncream where necessary.

Bruise


This teenager presented with a black mole on her heel that had been spotted by her mother, who had never noticed it before, and was correctly very concerned. In fact it was a small collection of blood which faded and disappeared spontaneously within two weeks. The sole of the foot is a site where melanoma may develop and go unnoticed for some time.

Spindle cell tumour


This 17-year-old girl presented with a very black suspicious-looking lesion on her hip. She was rightly concerned about the possibility of it being a malignant melanoma. It was excised, and histology proved it to be a pigmented spindle cell tumour, also known as a Spitz naevus. This is a completely benign lesion, most commonly occurring in young women, often on the lower limb. No further action was required.

Halo naevus


This patient was another teenager concerned about a changing mole. A mole like this, also known as Sutton's naevus, is probably in the process of involuting as a result of being attacked by the immune system. This process may be triggered by an episode of sunburn, perhaps altering the mole and making it trigger an immune reaction. He was reassured and no action was taken other than a review three months later to ensure that this was not a melanoma.

Intradermal naevus


This image shows another changing mole with some growth, both in diameter and depth, as well as slight irregularity of pigmentation. This mole did not look like a malignant melanoma, but it was excised. This subsequently provided reassurance of the benign nature of the lesion. These types of mole are completely benign and extremely common. They will not become malignant.

Basal cell carcinoma


This woman spent a lot of time in the sun and developed this lesion on her neck. It shows a characteristic raised nodular pattern. The diagnosis was basal cell carcinoma, which was excised. She will also need to remain vigilant for further lesions in the future as she clearly has sensitive skin, and may have been exposed to too much sun in the past.

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