44 | Nursing in Practice | Autumn 2022
PICTURE QUIZ
Skin growths
The following presentations are of four different types of skin lesions . Can you identify the different types and explain how they should be managed ?
Dr Toni Hazell is a GP in north London
1 2
A 35-year-old female patient presents with this `funny mole ’ on her arm . She explains the mole has grown quite rapidly over the past two months and it has started weeping .
This 55-year-old female patient explains she originally noticed this `dimple ’ near her eye over two years ago . It has gradually grown bigger and she has started to become concerned , particularly as it is close to her eye .
3 4
A 65-year-old male shows you this `lump ’ on his neck . He explains it is a bit tender , keeps bleeding and scabbing over without healing and has grown rapidly over the past month .
A male patient , aged 62 , explains he ’ s had this `wart ’ on his nose for two months . It wasn ’ t noticeable to begin with but it has gradually grown much bigger . He says it ’ s painless but unsightly and the central scab won ’ t heal .
Answers 1 Melanoma . Key features include variation in colour and the irregular edge . Patients may also report the mole has grown , is oozing or has a change in sensation . NICE advises urgent referral under the two-week-wait pathway if the patient scores three or more on a seven-point checklist , where major features ( change in shape , irregular shape and irregular colour ) score two points each , and minor features ( largest diameter 7mm or more , inflammation , oozing and change in sensation ) score one point each . 1 2 Basal cell carcinoma . Key features include an ulcer with a raised rolled edge and prominent blood vessels around the lesion , particularly in sun-exposed skin . These are slow growing and do not metastasise to different parts of the body , but can spread locally with potentially severe consequences if they are on the face . They should be referred routinely , unless there is concern due to lesion site or size about any delay in treatment . 1 3 Squamous cell carcinoma ( SCC ). This type of skin cancer presents as an ulcerated nodule that grows quickly , particularly on sun-exposed skin . It may be tender or painful . These should be referred on the urgent , two-week-wait pathway as they can metastasise . 4 Keratoacanthoma . A mostly benign tumour that grows quickly over weeks or a few months . These lesions can be difficult to distinguish from SCC , and while most are benign and regress spontaneously , some may progress to SCC . Therefore they should be referred via the urgent two-week-wait pathway .
Reference 1 NICE . NG12 . Suspected cancer : recognition and referral .. nice . org . uk / ng12
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