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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.

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.

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*.

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.

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.

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

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

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

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


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