Potentially pre-malignant cutaneous tumours

Solar keratoses (actinic keratoses):

• These frequently develop later in life in white-skinned people who have had significant sun exposure
• They appear on exposed skin as erythematous silver-scaly papules or patches with a conical surface and a red base
• The background skin is often inelastic and wrinkled and may show flat brown macules (‘liver spots’), reflecting diffuse solar damage
• A small proportion of these keratoses can transform into squamous cell carcinoma, but only after many years

Treatment:

• Cryotherapy
• Topical 5-fluorouracil cream

Bowen’s disease:

• This is a form of intra-epidermal carcinoma-in-situ which rarely can become invasive
• It presents on exposed skin as an isolated scaly red patch or plaque looking rather like psoriasis, although it has a rather irregular edge
• The lesions do not clear, but slowly increase in size over the years

Treatment:

• Cryotherapy
• Topical 5-fluorouracil cream
• Curettage

Atypical mole syndrome (dysplastic naevus syndrome):

• This is often familial
• A large number of melanocytic naevi begin to appear in childhood, even on unexposed sites
• Individual lesions may be large with irregular pigmentation and border
• Individuals with this condition have an increased risk of developing malignant melanoma
• They should have their moles photographed and be regularly reviewed
• Suspicious lesions should be excised

Giant congenital melanocytic naevi:

• These are very large moles present at birth
• They show an increased risk of developing malignant melanoma
• Excision should be considered if it is possible