Identifying Skin Conditions

Educational Objectives

The goal of this program is to improve diagnosis of skin lesions. After hearing and assimilating this program, the clinician will be better able to:

1. Identify common skin lesions.

Summary

Skin lesions: can vary greatly, and their history, duration, and changes over time are crucial for diagnosis; sun exposure, particularly severe childhood sunburns, significantly increases skin cancer risk; tanning beds are classified as carcinogenic by the World Health Organization; some genetic syndromes can lead to skin lesions, and certain drugs can trigger eruptions; immunocompromised individuals (ie, those with HIV or organ transplants) are at higher risk for skin cancer

Terminology: flat lesions are termed macules and patches, while raised ones are papules and plaques; nodules are subcutaneous, and vesicles and bullae are fluid-filled

Diagnosis: biopsy is essential for accurate diagnosis; it is a simple procedure requiring lidocaine, a scalpel or biopsy blade, and a specimen jar; a shave or punch biopsy is effective, though a punch biopsy is preferred for full-thickness specimens, especially for suspected melanoma

Benign skin lesions: common benign lesions include seborrheic keratosis, formerly called senile warts, which appear as verrucous, stuck-on growths; by age 50 yr, nearly everyone has ≥1; solar lentigines (senile freckles) are flat, well-circumscribed macules caused by UV exposure; sebaceous hyperplasia, seen in ≈1% of people, presents as yellowish papules with central umbilication, sometimes mistaken for basal cell carcinoma; immunosuppression can increase its occurrence; milia are small keratin-filled cysts appearing in newborns around the eyes and cheeks or in adults after skin resurfacing; chondrodermatitis nodularis helicis, or Winkler disease, causes recurrent ulceration on the ear because of pressure ischemia, often from sleeping on one side; using a donut pillow can help, but surgical excision is needed if it persists; rhinophyma is thickened, nodular skin on the nose due to sebaceous gland hypertrophy and is an advanced stage of acne rosacea; severe cases require surgical excision and skin resurfacing

Malignant skin lesions: basal cell carcinoma (BCC) is the most common, with a nodular form characterized by pearly, waxy lesions with rolled borders and telangiectasias; other aggressive subtypes include pigmented and morpheaform BCCs; squamous cell carcinoma (SCC) appears as scaly, pink-red plaques with crusting or ulceration, sometimes forming a distinctive cutaneous horn; these lesions can grow large and cause discomfort; melanoma follows the ABCDE rule (ie, asymmetry, border irregularity, color variation, diameter >6 mm, evolution); biopsy is urgent for suspicious pigmented lesions; Merkel cell carcinoma is a highly aggressive skin cancer; a lesion that grows rapidly within weeks, resembling both BCC and SCC, should raise suspicion and be biopsied immediately

Readings

El-Khatib H, Popescu D, Ichim L. Deep learning-based methods for automatic diagnosis of skin lesions. Sensors (Basel). 2020;20(6):1753. Published 2020 Mar 21. doi:10.3390/s20061753; Kittler H. Evolution of the clinical, dermoscopic and pathologic diagnosis of melanoma. Dermatol Pract Concept. 2021;11(Suppl 1):e2021163S. doi:10.5826/dpc.11S1a163S; Lin EY, Rao L, Wang WJ, et al. Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy. Front Med (Lausanne). 2023;10:1194748. doi:10.3389/fmed.2023.1194748.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Chen was recorded at 2023 ENT for the Non-ENT, held virtually on February 11, 2023, and presented by Cedars-Sinai Medical Center. For information about upcoming CME activities from this presenter, please visit https://cedars.cloud-cme.com. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.25 CE contact hours.

Lecture ID:

IM721903

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.