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Lucy Knox - Year 2.5 > 225 - Malignant Melanoma > Flashcards

225 - Malignant Melanoma Flashcards

1
Q

Name 3 common skin commensals

A

Staph epidermidis
Staph hominis
Micrococci

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2
Q

Which 2 bacteria commonly cause cutaneous infections?

A

Staph Aureus

Strep Pyogenes

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3
Q

What sort of cutaneous infection does Staph aureus cause?

A 
Superficial ones
Impetigo
Folliculitis
ecthyma
Abscess/carbuncles/furuncles/boils
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4
Q

What sort of cutaneous infection does Strep Pyogenes cause?

A

Deeper infections
Cellulitis
Abscess
Nectrotising fasciitis

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5
Q

What is the treatment for staph/strep cutaneous infectioms?

A

Staph - Flucloxacillin

Strep - Penicillin

Or Erythromycin

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6
Q

What sort of cutaneous infection can be caused by a mycobacterium?

A

Fisktank granulmoa - eg. mycobacterium marinus

Red scaly plaques

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7
Q

What sort of cutaneous infections are caused by spirochaetes

A

Syphilis (Primary- painles lesion on heals, then secondary rash on hands, then tertiary neuro problems)

Lyme disease - Borrelia burgotferi, transmitted by tick
Rash that spreads. Use doxy

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8
Q

What is Erythrasma cause by?

A

Diptheroid skin commensal - Corynebacterium minutissimum

Red/brown dry patches in flexures

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9
Q

Fungal infections can cause cutaneous infections - What types are there?

A

Yeasts - Candida albicans - thrush/intertrigo…

Pityriasis versicolour - malassezie furfur

Dermatophytes - tinea corpis/pedis/ungum..

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10
Q

How do you treat fungal cutaneous infections?

A

Imidazoles - clotrimazole
Terbinafine

Lots of choice

Systemic - Itraconazole

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11
Q

What sort of cutaneous manifestations does Herpes simplex cause?

A

Highly contagious, direct contact spread
Penetrates epidermis

HSV I and II - Primary on skin, oral or genital
Reoccurs as coldsore of genitals

VZV - Zoster: Primary chicken pox (crops of vesicles), can reoccur as shingles

Complications:
Can cause Eczema herpitcum, Herpes enchephalitis, Keratoconjunctivitis

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12
Q

What cutaneous manifestation does HPV have?

A

Viral warts - dif types in dif locations

Treat: paring down/excision
They spontaneously resolve in 6-12 months
Can use salicylic acid / cryotherapy

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13
Q

What cutaneous manifestation does the Pox virus have?

A

Molluscum contagiosum

(in sheep = Orf)

Contagious, umbilicated papules associated w. atopic dermatitis, contain jelly like material

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14
Q

What is Erythema nodosum? What is it a cutaneous manifestation of?

A

Erethmatous tender nodules, usually on shins, more common in women

Causes:
TB, OCP, Pennicillin, Pregnancy, IBD…

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15
Q

What is Pyoderma Gangrenosum? What is it a cutaneous manifestation of?

A

Ulcer with irregular boarders, violaceous edge _ necrotic areas. Very painful

Causes:
RA, IBD, Haematological disease, Wegnar’s, PAPA syndrome

Can manage with immunosuppression therapy

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16
Q

What is a malar eruption/butterfly rash? What is it a cutaneous manifestation of?

A

Red patches across cheeks + photosensitivity

Systemic Lupus Erythematous

Also: mouth ulcers, urticaria, hair thinning

+ve ANA, ENA, anti dsFNS, anti-sm

Manage - sun protection, camouflage, topical steroids, antimalarials

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17
Q

What is Scleroderma? What is it a cutaneous manifestation of?

A

Localised skin hardening/thickening

Cause?
Morphea = only on skin -> can follow lyme disease, pregnancy, radiotherapy.

Systemic Sclerosis = systemic autoimmune disease against connective tissue

Increase in dermal collagen + ECM = thickening

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18
Q

What is Dermatomyositis?

A

Inflammation of coluntary muscles + a rash
2x as common in women

Get red/bluish-purple patches on sun exposed sites
Heliotrope rash on eyelids
Gottron's papules on bony prominances
Calcinosis
Raynauds

Investigations - CK, ANA, Skin biopsy, Muscle biopsy, EMG…

Manage - Systemic steroids, immunosupression, Ca channel blockers, sun protection

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19
Q

What is Pseudoxanthoma Elasticum (PXE)

A

Recessive disorder - affecting elastic tissue of skin, blood vessels + eyes - abnormal collagen
Ca accumulates in elastic fibres of skin/blood vessels/eyes/heart

  • > small yellow papules / patches
  • > Soft, lax, wrinkled skin - at neck first

No skin management, but can address vessel complications (eg. mitral valve prolapse..)

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20
Q

What is neurofibromatosis?

A

Genetic disorder: skin bone soft tissue + nervous system.

Type 1: Cafe au lait spots, neurofibromas, axillary freckling, iris tumour (Lisch nodule)

Type 2: Brain + spinal cord tumour
Auditory nerve tumour

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21
Q

Name 4 cutaneous markers for malignancy

A

Peutz-Jegher’s syndrome - dark spots on lips, mouth, anus, and polps in GI tract.

Paraneoplastic Pempigus - autoimmune disorder due to tumour, painful blisters + denuded areas in mouth, skin, oesophagus

Acanthosis Nigricans - Darkened thickened skin in neck, armpit, groin

Sweet syndrome - Tender lesions - papules + vesicles. Acute neurophilic dermatoses

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22
Q

What are 2 pre-malignancy changes seen in skin cancer?

A

Actinic/Solar Keratoses - discreet rough scaly patches in sun exposed areas

Bowen’s disease - single patch of red, scaly skin, often on lower leg, expands over time

Both can be removed - cryotherapy, chemo cream, photodynamic therapy..

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23
Q

What are the 2 types of non-melanocytic skin cancer?

A

Squamous cell carcinoma
- Less common, where pre-malig changes were, fast growing, can be on lip from smoking/sun, risk of metastasis increases with size/immunocompromised state.

Basal Cell Carcinoma - most common tumour in white pop. Locally invasive, rarly metastasize. 80% head/neck.

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24
Q

What are the risk factors for BCC?

A 
Cummulative sun exposure
Fair skin
Age
Radiotherapy damage
Aresnic
Tars
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25
What do BCCs look like?
``` Nodular-cystic Purly, telangetic vessels Central dip/ulcer Soft Bleed easily ``` Can be pigmented with a rolled, smooth, shiny boarder
26
How do you treat a BCC?
Surgical excision gold standard Radiotherpahy Cryotherapy or PDT or curitage if superficial.
27
What is Moh's micrographic surgery?
Histology os checked to ensure you've cut out edge during surgery.
28
Describe malignant melanoma
Serious, malignant potential. More in females. Incidence doubled last decade. - New black/brown mole, or old one that has changed in size/shape/colour.
29
What are 4 types of malignant melanoma?
Superficial spreading - horizontal growth Nodular - vertical growth - lumpy Acral - lentigenous - under nail Lentigo maligna - face/scalp, sun linked, elderly
30
What treatment is available for malignant melanomas?
``` Surgery - with 1-3cm margin Sentinal lymph node biopsy Adjuvant interferon Chemo New therapies: for mets - BRAF inhibitors - vemurafenib - immune therapy - ipilimumab ```
31
What is uricaria/angioedema?
Looks like nettle sting - raised areas, red around, lasts a day. Angioedema - severe joined up, diffuse swelling. 50% ideopathic, 50% trigger - allergens, viral,NSAIDS... Treat: antihistamines, steroids, fluids if needed.
32
What is toxic epidermal necrolysis?
Type IV cell mediated immune response Reaction to drug Ketitonocyle apoptosis STOP DRUG eg. allopurinol, carbamazopine
33
What is necrotising fasciitis?
Severe infection spreading along fascial planes V painful, tense swelling, feverish, hard woody purplish skin Lots of different bacteria can cause tissue necrosis Urgent surgical debridement needed
34
What is staphylococcal scalded skin syndrome?
V red, flaking skin Staph exfoliative toxin Flucloxacillin essential + emolliants
35
What is anaphylaxis?
Systemic release of histamine -> oropharyngeal oedema + extreme urticaria. Rapidly fatal ``` Treatment: Adrenaline 1:1000 IM ? intubation + ventilation Fluid bolus Steroids + antihistamines ```
36
What are 3 autoimmune blistering disorders?
``` Bullois pemphigoing (intact bulla) Pemphogus Vulgaris (fragile bulla) Dermatitis herpetiformis (on extensor surfaces) ```
37
What is an infective blistering disorder?
Bullous impetigo Exfoliative toxin
38
What is the treatment for blistering disorders?
Pop blisters Prevent infection - iodine dressings Barrier restoration - emollient
39
What is eczema?
Itchy, red, inflammation of skin Types? - Endogenous: atopic, seborrhoeic, discoid, venous - Exogenous - allergic, irritant, photo-reactive Treatment: Emollient + Steroid - avoid irritation, use soap substitute..
40
What will investigations show in eczema?
If allergic - IgE RAST testing for type I | - Patch testing for Type IV allergy
41
What is a weak topical steroid?
Hydrocortisone | Help Every Busy Dermatologist
42
What is a moderate topical steroid?
Eumovate | Help Every Busy Dermatologist
43
What is a potent topical steroid?
Betnovate | Help Every Busy Dermatologist
44
What is a very potent topical steroid?
Dermovate | Help Every Busy Dermatologist
45
What is the normal pH of skin?
5.5
46
What is acne vulgaris?
Disorder of pilosebaceous units - increased sebum excretion, hyperkeratosis + blockages of follicle opening, colonisation of ducts with propionibacterium acnes, release of inflam mediators
47
What are the 3 severities of acne vulgaris?
Mild: comedonal - black + white heads Mod: papules + pustules Severe - Nodulocystic
48
What is the treatment for acne vulgaris?
Topical: Benzolyl Peroxide Retinoids Antibiotics Systemic: Antibiotics (tertracycline/erythromycin) OCP Isoterinoin (Roaccutaine)
49
What is Rosacea?
Chronic inflam. facial dermatosis - Erythema + pustules, comes and goes. In older group than acne. Treat: top metronidazole cream, systemic tetracycline
50
What are papulosquamous eruptions? What can cause them?
Red, scaly, marginated, dry eruptions. Inflam : lichen planus, pityriasis alba, pityriasis lichenoides Infective: Pityriasis versicolour, pityriasis rosea, tinea corporis
51
What is Hidradenitis suppurative?
Acne inversa Female, overweight, smoker Treat with antibiotics
52
What is Psoriasis?
A papulo-squamous skin disorder Well demarkated, scaly, red plaques
53
What are the features of chronic plaque psoriasis?
On extensor surfaces, red scaly plaques that are itchy and sore, have a silver sheen.
54
What are the features of flexural psoriasis?
Later in life onset Well demarcated, red-glazed plaques Not scaly Occurs within flexures
55
What is Gluttate Psoriasis?
Raindrop like, small circular or oval plaques on trunk. Often after strep URTI
56
How do you treat psoriasis?
``` Topical - Emollients, mild/mod steroids, vit D analogues (cacipotiol) Coal tar Dithranol (accumulated in mitochondria - less proliferation) Tazarotene (reduce keratinocyte prolif) ```
57
What associated factors are seen in someone with Psoriasis?
50% get nail changes - pitting, onycholysis, thickening, subungual hyperkeratosis 5-10% get Psoriatic arthritis
58
When does atopic eczema usually present?
Under 2 years, around 4-6 months - around weaning.
59
What is the key dysfunction in eczema?
A barrier dysfunction
60
In addition to emollients and topical steroids, what can you give in moderate eczema?
Topical calcineurin inhibitors + bandaging
61
In addition to emollients and topical steroids, what can you give in severe eczema?
Phototherapy | Systemic therapy - cyclosporin, Asothyoprine
62
What can be used in a child older than 2 years in addition to topical steroids or if steroids are unsuitable?
Topical immunomodulators - eg. Elidel cream or Protopic. Affect the immune response + have local antiinflam response. Don't cause thickening or atrophy
63
What is the prognosis of atopic eczema?
60-70% of children clear by teens Dry sensitive skin persists
64
Describe the course of measles
Prodrome period of 10-12 days Fever, conjunctivitis, coryza(cold) and cough 2-3 days get Koplik's spots in mouth 4-5 days get rash - ill defined, macula rash, head first
65
Describe rubella
Less severe than measles, slight fever, sore throat Rash from head down Tender lymph nodes - congenital rubella - can cause blindness if in pregnancy
66
What causes hand-foot and mouth disease?
Coxsachie enterovirus Small flat blisters on hands and feet + mouth ulcers
67
What is the offical name for headlice?
Pediculosis Capitis
68
What is Scabies?
A mite - sarcoptes Scabei Spread by direct physical contact, burrows in skin Must treat whole family and close contacts with Permethrin 5% cream, applied from neck down twice a week apart.

Lucy Knox - Year 2.5 (15 decks)

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