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Overview

There are a wide variety of benign conditions affecting the skin (such as keratoses, nevi and cysts) but of most concern is early diagnosis and adequate treatment of skin carcinoma (squamous cell, basal cell, melanoma). It can be difficult to distinguish between benign and malignant lesions on clinical examination.

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In many countries, there is increasing incidence of these tumors. An increasing community emphasis is being placed on prevention and early diagnosis. Analyses of diagnostic accuracy show a significant error rate. More accurate and early diagnosis is required to minimize treatment delay and maximize its suitability.

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Examination of a skin lesion requires adequate exposure and lighting. Definitive diagnosis can only be made on histology. If there is any doubt, the lesion should be excised.

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Regular review is required where lesions may turn from benign to malignant. Immunosuppressed patients are more susceptible to malignancy.

Other skin lesions of importance to the surgeon are burns and pre-tibial lacerations. Skin grafting is often required.

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Video 02-01: Skin Lesion Overview

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Video 02-02: Skin Lesion Examination

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Squamous Cell Carcinoma and Keratoses

A solar keratosis may undergo malignant change to a squamous cell carcinoma (SCC) but the risk in any individual is low. This type of SCC has a low incidence of metastases, except where occurring on the lip or in a burns scar.

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Keratoacanthoma is also grouped here for convenience, along with Bowen's disease.

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The history of the lesion will often give a clue to the diagnosis (exemplified by the rate of onset and subsequent growth).

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The physical characteristics of the lesion are often critical in diagnosis and treatment.

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The specific treatment of benign or malignant conditions will vary with both the individual patient and the treating doctor.

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Video 02-03: Squamous Cell Carcinoma

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Melanoma and Nevi

Malignant melanoma, a potentially lethal condition, may develop from a benign nevus with junctional activity, or de novo from dysplastic melanocytes.

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The only significant advance made in achieving a higher cure rate of malignant melanoma has been in recognizing the importance of prevention and early diagnosis. With the emphasis placed on these factors, the lesions at risk of developing malignancy have ...

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