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core clinical problems > 39b. Benign and malignant skin lesions > Flashcards

39b. Benign and malignant skin lesions Flashcards

1
Q

Assessment of pigmented lesions for red flags for melanoma

A

ABCDE for pigmented lesions - red flags for melanoma:
For superficial melanomas — ABCDE signs
A: Asymmetry of shape and colour
B: Border irregularity, including smudgy or ill-defined margin
C: Colour variation and change
D: Different (formerly diameter)
E: Evolving (enlarging, changing)

Melanomas may not conform to the ‘ABCD’ rule alone. For nodular melanomas, also consider the EFG signs
E: Elevated
F: Firm to touch
G: Growing

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2
Q

what scoring system for pigmented skin lesions is used by GPs to know when to warrant referrals

A

Glasgow 7 point weighted checklist (3 or more indicates referral)

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3
Q

what is Glasgow 7 point weighted checklist?

A

Major features (2 points)
Change in size of lesion (G)
Irregular pigmentation ©
Irregular border (B)

Minor features (1 point)
Inflammation
Itch or altered sensation
Larger than other lesions (diameter >7mm) (D)
Oozing/crusting of lesion

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4
Q

4 Ss for non-pigmented lesions

A

Site
Size
Shape
Surrounding skin

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5
Q

what % of melanoma aarise from moles

A

20-30% of melanomas are found in existing moles

70-80% arise on normal looking skin

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6
Q

Most common type of melanoma

A

Superficial spreading

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7
Q

most aggressive form of melanoma? presentation

A

Nodular melanoma

Red or black lump or lump which bleeds or oozes

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8
Q

plan ?melanoma

A
  1. excision biopsy
  2. re-excision of margins if required / Sentinel node biopsy

Immunotherapy and BRAF stuff used in some cases

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9
Q

what is the single most important factor in determining prognosis of patients with malignant melanoma

A

The invasion depth of a tumour (Breslow depth)

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10
Q

features of basal cell carcinoma

A

Slowly growing plaque or nodule
Skin coloured, pink or pigmented, often shiny or pearly
Rolled edges
Telangiectasia
Ulceration and spontaneous bleeding

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11
Q

rf for BCC

A

routine rf: lesion that raises the suspicion of a BCC

2ww: lesion that raises the suspicion of a BCC with a particular concern that a delay may have a significant impact due to site or size

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12
Q

high risk factors BCC

A

High risk site : near eyes etc
Large size >2cm
Morpheic
Poorly defined

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13
Q

management bcc

A

Surgery
Radiotherapy sensitive if surgery not an option

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14
Q

most important RF SCC

A

Chronic UVR exposure

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15
Q

presentation SCC

A

indurated nodular keratinising or crusted tumour that may ulcerate, or it may present as an ulcer without evidence of keratinisation

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16
Q

red flags for SCC

A

Rapid growth
Raised base
May ulcerate and/or bleed
May be painful

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17
Q

plan ?SCC

A

2ww rf

Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm.

Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

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18
Q

presentation actinic keratosis

A

Erythema, scaling, on sun exposed areas

DO NOT HAVE ANY
Red flags:
Rapid growth
Raised base
May ulcerate and/or bleed
May be painful

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19
Q

presentation bowens disease

A

slowly enlarging erythematous scaly plaques,

DO NOT HAVE ANY
Red flags:
Rapid growth
Raised base
May ulcerate and/or bleed
May be painful

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20
Q

management of pre-squamous disorders (actinic keratosis and bowens)

A

5-fluorouracil cream (Efudix)

cryotherapy

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21
Q

what are warts caused by?

A

HPV

Types 1, 2, 3, 4, 10, 27 and 57 are most often implicated in the aetiology of cutaneous warts

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22
Q

Management of cutaneous warts

A
  1. no treatment (they will resolve without)
  2. Topical salicylic acid
    Daily treatment for at least 12 weeks is required.
  3. Cryotherapy with liquid nitrogen every two weeks until the wart has gone (up to four months)
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23
Q

presentation seborrhoeic keratosis

A

Flat or raised papule or plaque
1 mm to several cm in diameter
Skin coloured, yellow, grey, light brown, dark brown, black or mixed colours
Smooth, waxy or warty surface
Solitary or grouped in certain areas, such as within the scalp, under the breasts, over the spine or in the groin
They appear to stick on to the skin surface like barnacles.

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24
Q

what is solar lentigo

A

harmless patch of darkened skin. It results from exposure to ultraviolet (UV) radiation, which causes local proliferation of melanocytes and accumulation of melanin within the skin cells (keratinocytes).

25
Q

presentation solar lentigo

A

flat, well-circumscribed patch. It can be round, oval or irregular in shape. Colour varies from skin-coloured, tan to dark brown or black, and size varies from a few millimetres to several centimetres in diameter. They can be slightly scaly.

on sun-exposed sites

26
Q

presentation lichen keratosis

A

Small, inflamed macule or thin pigmented plaque, usually solitary, with a lichenoid tissue reaction on histology.

27
Q

what is lichenoid keratosis

A

Lichenoid keratosis is an inflammatory reaction arising in a regressing existing solar lentigo or seborrhoeic keratosis. It is not known what causes the reaction, but triggers can include minor trauma such as friction, drugs, dermatitis, and sun exposure.

Lichenoid keratoses gradually disappear.

28
Q

what is a Melanocytic naevi

A

a mole

29
Q

presentation epidermoid cyst

A

They have a central punctum, they may contain small quantities of sebum

30
Q

presentation dermatofibroma

A

solitary firm papule or nodule, typically on a limb
typically around 5-10mm in size
overlying skin dimples on pinching the lesion

31
Q

Pathophysiology acne

A

Obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.

Activity of sebaceous glands may be controlled by androgen

colonisation by the anaerobic bacterium Propionibacterium acnes

inflammation

32
Q

whata re inflammatory lesions in acne

A

Inflammatory lesions form when the follicle bursts releasing irritants
papules
pustules

33
Q

comedones acne

A

Comedones are due to a dilated sebaceous follicle
if the top is closed a whitehead is seen
if the top opens a blackhead forms

34
Q

monomorphic acne

A

drug-induced acne is often monomorphic (e.g. pustules are characteristically seen in steroid use)

35
Q

what is acne fulminans

A

very severe acne associated with systemic upset (e.g. fever). Hospital admission is often required and the condition usually responds to oral steroids

36
Q

Management of mild to moderate acne

A

12 week course of topical combination therapy

topical adapalene with topical benzoyl peroxide
topical tretinoin with topical clindamycin
topical benzoyl peroxide with topical clindamycin

topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic

37
Q

Management of moderate to severe acne

A

12 week course of

topical adapalene with topical benzoyl peroxide
topical tretinoin with topical clindamycin
topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
a topical azelaic acid + either oral lymecycline or oral doxycycline

38
Q

how long should antibiotics be used for acne

A

only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances

39
Q

why is it important that a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics in acne

A

to reduce the risk of antibiotic resistance developing

40
Q

cautions tetracyclines acne treatment

A

tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age. Erythromycin may be used in pregnancy.

41
Q

what is an alternative to oral antibiotics for women with acne

A

combined oral contraceptives (COCP)

42
Q

who should be referred to a dermatologist for acne

A

severe acne:
- conglobate acne
- nodulo-cystic acne

acne that hasn’t responded:
- mild to moderate acne has not responded to two completed courses of treatment
- moderate to severe acne has not responded to previous treatment that includes an oral antibiotic

complications:
- acne with scarring
- acne with persistent pigmentary changes
- acne is causing or contributing to persistent psychological distress or a mental health disorder

43
Q

presentation salmon patches

A

Pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck.

44
Q

what are salmon patches? how do they change over time?

A

vascular birthmark

They usually fade over a few months, though marks on the neck may persist.

45
Q

what are port wine stains? how do they change over time?

A

Port wine stains are vascular birthmarks that tend to be unilateral.

They do not spontaneously resolve, and in fact often darken and become raised over time.

46
Q

Presentation port wine stains

A

Unilateral

Deep red or purple in colour

47
Q

management port wine stains

A

cosmetic camouflage or laser therapy (multiple sessions are required).

48
Q

bacteria impetigo

A

Staphylcoccus aureus or Streptococcus pyogenes

49
Q

features impetigo

A

‘golden’, crusted skin lesions typically found around the mouth

50
Q

Management impetigo limted local disease ‘people who are not systemically unwell or at a high risk of complications’

A
  1. hydrogen peroxide 1% cream
  2. topical antibiotic creams:
    topical fusidic acid
    topical mupirocin should be used if fusidic acid resistance is suspected
    MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation
51
Q

management impetigo extensive disease

A

oral flucloxacillin
oral erythromycin if penicillin-allergic

52
Q

school exclusion impetigo

A

children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

53
Q

what type of melanoma can cause brown lesion on palms, soles, and nails?

A

acral lentingious melanoma

54
Q

what is different about acral lentingious melanoma vs other types of skin cancer?

A

not as related to sun exposure, most common type in darker skin

55
Q

what sign to look for in acral lengingious melanoma

A

Hutchinson’s sign

periungual extension of brown-black pigmentation from longitudinal melanonychia onto the proximal and lateral nailfolds

56
Q

plan ?acral lentingious melanoma

A

incision biopsy

Amputation, margins depending on biopsy results.

57
Q

red dots on skin - like small freckles

A

cherry angiomas

58
Q

small, raised, and red bumps on the skin. The bumps have a smooth surface and may be moist. They bleed easily because of the high number of blood vessels at the site

A

pyogenic granuloma

core clinical problems (94 decks)

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