NPLEX - Dermatology & Minor Surgery
Condylomata acuminata - (genital warts)
pale, pink, numerous discrete projections with a broad base; width varies; smooth surface, velvety, moist
(lack hyperkeratosis of common wart)
REFERRAL: Topical/ antiviral therapies; cryosurgery, excision, Ed&C
Dysplastic Nevi - Controversial definition; no standardized criteria for diagnosis
Possess features between a benign nevus and malignant melanoma
*Possibly melanoma precursor*; *probably a marker* for individuals at increased risk for
melanoma (MMs may arise at sites away from the dysplastic nevi)
Have features of the ABCDs
*Dysplastic Nevus Syndrome*: also "gray area", but in general refers to someone with an
increased number of nevi, many of large size with atypical clinical features, and
predisposition to melanoma in particular watch for new nevi in patients over 30 years old, changing,
symptomatic (bleeding, itching, tender), 2 or 3 colors, greater than 6-8mm, large number and large size
of nevi
Rx: *REFER* to specialist for surveillance, possible removal (elliptical excision; margins
determined on a case by case basis)
Milia - Tiny, pearly-white cysts on the face, resulting from entrapped keratin
Primary- spontaneously; eyelids, cheeks
Secondary- retention cysts post injury to skin
No tx recommended
, Verruca (warts) - Benign epidermal neoplasms caused by HPV - Smooth, flesh-colored papule -
evolve into dome-shaped gray-brown hyperkeratotic growth with black dots on surface
Common; usually on hands, plantar surfaces, genitals (condyloma acuminata)
Avoid surgical removal, especially on face (will often resolve spontaneously)
Rx: try medical measures first (duct tape, *salicylic acid*, podophyllin, thuja, tea tree oil); then
*cryo* (hyfrecation, curette/cautery, excision)
Skin Tag(Acrochordons)/Papillomata - Small, fleshy, pedunculated lesions; often in neck/axillae -
attached by stalk
Rx: cryo, forceps/cautery,*"lift and snip"* by pressure/cautery/cayenne, tie procedure
Actinic Keratoses (solar keratoses, senile keratoses) - Red, scaly, "sandpapery" patches of
dysplastic epithelium, found on light-exposed skin; can
become pigmented (yellow sharp scales/ pigmented)
Most common precancerous lesion of the skin (10-15% transform into SCC)
REFERRAL for re-examination
Rx: can leave alone, *Cryosurgery*, *hyfrecation*, ED&C, *shave excision*, topical chemotherapy (5%
flurouracil cream)
Keratoacanthoma - Characterized by rapid growth, on light-exposed skin (smooth dome-shaped
red papule to 1-2 cm tumor)
Round with rolled edges and central keratin plug; often inflamed
Usually spontaneously resolves ~ 6 months
