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July 7, 2012 / molehunter

2 more traumatised warts

Warts are of various kinds, not always viral. Their key feature is that they are growths in the epidermis, the uppermost layer of the skin. They don’t have deep roots. The seborrhoiec wart (or keratosis, also known as a basal cell papilloma) in particular is ‘stuck on’ to the skin, and is quite prone to become semi-detached as a result of lateral shearing force. Clothing straps (belt or bra) will often do it, scratching with fingernails or combs also. The result can be that a previously unnoticed ‘mole’ starts to itch, bleed, swell and turn darker (due to blood). This quite reasonably sets alarm bells ringing. The concerned patient rightly consults their doctor, who sees an odd looking skin lesions he or she can’t feel relaxed about, so an urgent skin cancer referral is made. The patient receives their letter, which by UK government diktat is marked ‘URGENT CANCER PATHWAY’. The only word she sees is ‘CANCER’. She then goes on line, Google ‘melanoma’, finds some shockingly grueseome pictures (try it and see!) and some melanoma blogs (like poor Alethea Ayres’ deeply moving and courageous account of her battle with melanoma) and experiences considerable anxiety.

A week later, she walks into a dermatologist’s office, clutching a loved one for support. The specialist applies their dermoscope to the lesion. It takes 4 or 5 seconds to ascertain that its only a traumatised seborrhoiec wart. This is not to blame the GP, these lesions can look very worrying.

Granted these lesions can frighten, but the dermoscope provides clues that will often enable the trained and experienced user to offer safe reassurance.

This lesion shows irregular white areas in the upper half representing keratin. The ovals highlight looped/hairpin vessels. Note the pale ‘halos’ around each of these. There is also some blood. A fairly typical example of a traumatised seborrhoiec wart. Ignore the clothing debris.

The looped vessels in pale halos here are very distinct, forming a global feature of the lesion. This appearance has been described as ‘frogspawn’ and is very characteristic of a papillomatous seborhhoiec wart. Some blood clot can be seen at around 5 o’clock and elsewhere.

The learner should study as many examples as possible of specific types of lesion to gain confidence. I offer these images as a contribution to the growing on line dermoscopy education resource that is developing, and wish good success to the growing number of people from Eastern Europe to Hong Kong, and from Canada to New Zealand who are checking this blog out. Check out Dr Eric Erhsam’s www.dermoscopic.blogspot blog, its much better than mine (so far!). There are also some great dermoscopy resources on YouTube-may as well look, ‘don’t cost nothing’! Don’t forget to make a supportive/positive comment and/or post a link if you find it helpful, it encourages people to post more material if they know learners out there appreciate it.

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