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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
presentation solar lentigo
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
presentation lichen keratosis
Small, inflamed macule or thin pigmented plaque, usually solitary, with a lichenoid tissue reaction on histology.
27
what is lichenoid keratosis
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
what is a Melanocytic naevi
a mole
29
presentation epidermoid cyst
They have a central punctum, they may contain small quantities of sebum
30
presentation dermatofibroma
solitary firm papule or nodule, typically on a limb typically around 5-10mm in size overlying skin dimples on pinching the lesion
31
Pathophysiology acne
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
whata re inflammatory lesions in acne
Inflammatory lesions form when the follicle bursts releasing irritants papules pustules
33
comedones acne
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
monomorphic acne
drug-induced acne is often monomorphic (e.g. pustules are characteristically seen in steroid use)
35
what is acne fulminans
very severe acne associated with systemic upset (e.g. fever). Hospital admission is often required and the condition usually responds to oral steroids
36
Management of mild to moderate acne
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
Management of moderate to severe acne
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
how long should antibiotics be used for acne
only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances
39
why is it important that a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics in acne
to reduce the risk of antibiotic resistance developing
40
cautions tetracyclines acne treatment
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
what is an alternative to oral antibiotics for women with acne
combined oral contraceptives (COCP)
42
who should be referred to a dermatologist for acne
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
presentation salmon patches
Pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck.
44
what are salmon patches? how do they change over time?
vascular birthmark They usually fade over a few months, though marks on the neck may persist.
45
what are port wine stains? how do they change over time?
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
Presentation port wine stains
Unilateral Deep red or purple in colour
47
management port wine stains
cosmetic camouflage or laser therapy (multiple sessions are required).
48
bacteria impetigo
Staphylcoccus aureus or Streptococcus pyogenes
49
features impetigo
'golden', crusted skin lesions typically found around the mouth
50
Management impetigo limted local disease 'people who are not systemically unwell or at a high risk of complications'
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
management impetigo extensive disease
oral flucloxacillin oral erythromycin if penicillin-allergic
52
school exclusion impetigo
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
53
what type of melanoma can cause brown lesion on palms, soles, and nails?
acral lentingious melanoma
54
what is different about acral lentingious melanoma vs other types of skin cancer?
not as related to sun exposure, most common type in darker skin
55
what sign to look for in acral lengingious melanoma
Hutchinson’s sign periungual extension of brown-black pigmentation from longitudinal melanonychia onto the proximal and lateral nailfolds
56
plan ?acral lentingious melanoma
incision biopsy Amputation, margins depending on biopsy results.
57
red dots on skin - like small freckles
cherry angiomas
58
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
pyogenic granuloma

Core clinical problems (94 decks)

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