Page 408 - Medicine and Surgery

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404 Chapter 9: Dermatology and soft tissues

Skin and soft tissue lumps Aetiology/pathophysiology
Solar keratoses are seen in fair-skinned patients asso-
ciated with sun exposure. They are most common in
Seborrhoeic keratoses patients who burn easily and tan poorly. There is debate

Definition as to whether solar keratoses leads to squamous cell car-
Seborrhoeic keratoses are a benign localised prolifera- cinoma, or whether squamous cell carcinomas arise in
tion of the basal layer of the epidermis. They are some- the same areas due to the sun damage.
times termed basal cell papillomas; however, they are not
neoplastic and are not premalignant. Clinical features
Lesions initially appear as a small, well-demarcated, red
Incidence brown plaque that progress to become more erythema-
Common; by age 40 approximately 10% of individuals tousandhyperkeratotic.Solarkeratosesbleedeasilywith
have one seborrhoeic keratosis. minor trauma.

Age Management
Increase in incidence with increasing age. Treatment includes cryotherapy, curettage or topical
5-fluorouracil.
Sex
M = F
Dermatofibromas
Aetiology/pathophysiology Definition
The cause of seborrhoeic keratoses is unclear, although Adermatofibroma is a cutaneous nodule containing
they occur more commonly on sun-exposed skin. macrophages or histiocytes.

Clinical features Incidence
Lesions occur most commonly on the trunk. They are Common.
flat, raised or pedunculated with a yellow brown ap-
pearance of the overlying skin. With time the surface Age
becomes irregular and wart-like. Lesions may cause con- Can occur at any age, more common in adults.
cern due to bleeding, itching or surrounding inflamma-
tion.
Sex
4F:1M
Management
If treatment is required, cryotherapy or currettage are
Aetiology/pathophysiology
usually effective.
Historically dermatofibromas have been associated with
trauma or insect bites, although the cause is unknown.
Solar keratoses

Definition Clinical features
Solar keratoses or actinic keratoses are single, small scaly Lesions occur most commonly on the lower limbs. They
plaques occuring as a result of sun damage to the skin. are solitary firm elevated nodules with pigmentation of
the overlying skin. Although classically asymptomatic
Incidence they may cause itching or pain.
Common.
Management
Age Dermatofibromas are removed only if troublesome or if
Occurs in the middle-aged and elderly. there is diagnostic uncertainty.