Ordinary viral warts are extremely common. Most people have had,
have or will have these small viral turnoUTs. Fortunately the great
majority disappear spontaneously within weeks or months. Patience
and reassurance should be the ingredients of treatment. If these
do not suffice, a keratolytic agent containing salicylic acid or
a destructive substance such as formaldeh-yde or podophyllin extract
can be used. Referral of patients with these lesions is only recommended
if:
- There are several lesions that are persistent and have resisted
simple treatments.
- There are a vast number of lesions and it
seems possible that there is a serious underlying immunological
defect.
- There are some warts that are large, persistent and embarrassing,
and lectrocautery or cryotherapy seem to be indicated.
- There
is some doubt as to the diagnosis.
Seborrhoeic warts
Ordinary viral
warts have to be distinguished from simple seborrhoeic warts which
usually start to make their appearance in the fifth and sixth decades.
Seborrhoeic warts are usually pigmented, the shade varying from
light fawn to dark brown and black. These mostly do not need attention
unless they are very large or become inflamed. Sometimes they occur
in large numbers and are an embarrassment, and referral for advice
as to treatment may be required.
Extensive warts affecting the back of the hand.Treatment of this number of warts is always a problem.
Multiple seborrhoeic warts. some of these lesion get in the way and catch in clothing
Solar keratoses and small skin
cancers
As their name suggests, solar keratoses occur on
the light-exposed sites. They are preneoplastic in the broadest
sense of the term but only progress to squamous cell carcinoma extremely
rarely (perhaps in 0.01 per cent of cases). Their main importance
is that they signify solar damage of the kind that can result in
a malignant lesion. Solar keratoses are usually found in the elderly
although they may occur at an earlier age if there has been a great
deal of sun exposure in the past. They are much commoner in the
fair-skinned, who have little protective pigmentation. Small skin
cancers (squamous cell epithelioma and Bowen's disease) may also
be difficult to distinguish from other warty lesions. If there is
any question, refer.
Genital warts
Warty lesions on the genitalia
probably always require the opinion of a specialist. The majorities
are simple viral warts, but tragedies occur if syphilitic warts
or squamous cell carcinoma are not diagnosed at an early stage.
Pigmented Lesions
Whatever else the practitioner may forget of his
undergraduate training in dermatology, the danger of malignant melanoma
usually remains well in mind. Delay in the referral of a suspected
malignant melanoma is usually either due to the patient presenting
late because of fear or ignorance, or an office bungle. In few other
skin disorders is early referral so vital to the well-being of the
patient. If a pigmented lesion enlarges, changes in colour, ulcerates
or bleeds the patient should be seen by a dermatologist at the first
opportunity. Dermatologists would prefer to see a hundred patients
referred to their clinics who did not have the disease than one
patient with the disease in an advanced stage who has been referred
late and for whom there is a bad prognosis. The danger signals of
a melanoma are:
- History of change in colour, increase in size
and surface changes including scaling, crusting and bleeding.
-
Irregularity in colour (variegation).
- Irregularity of margin.
- A lesion more than 1 em in diameter.
