Derm images --> OSCE

Question 1

Answer 1

• Description –> 2cm diameter, raised lesion with rolled edges, ‘ground glass’ appearance, pearly translucent with ulcerated centre, telangiectasia
• Dx –> Nodular BCC, SCC, AKs
• Investigations/Management –> Skin excision biopsy (left untreated can invade local tissue)

Question 2

Answer 2

• Description –> Erythematous lesion, ulceration in centre with white/yellow crust, borders are fairly irregular
• Dx –> SCC, AKs, keratoacanthoma, BCC
• Investigations/Management –> Skin excision biopsy

Question 3

Answer 3

• Description –> site and size hard to comment on, asymmetrtical shape, some elevation, well-defined borders, brown/blue in colour (there are multiple shades)
• Dx –> Melanoma, lentigo maligna, seborrhoeic keratoses
• Investigations/Management –> Wide skin excision biopsy

Question 4

Answer 4

• Description –> Areas of depigmentation and hyperpigmentation, multiple scalp lesions, 1-2.5cm in diameter, irregular shapes, poorly demarcated borders, raised, erythematous with white/yellow crust
• Dx –> Actinic keratoses, Bowen’s or SCC, solar lentigo
• Investigations/Management –> Efudix cream or topical fluorouracil (twice dialy for 4 weeks) OR cryotherapy, consider surgical excision

(can evolve into SCC)

Question 5

Answer 5

• Description –> left cheek, 4-5cm, irregular shape, borders are well-defined, macule (not raised), brown/lighter shades of brown
• Dx –> Lentigo maligna, melanoma, dysplastic naevus
• Investigations/Management –> imiquimod (immunosuppressive drug) or surgical excision

Question 6

Answer 6

• Description –> erythematous lesion, irregular shape, borders are somewhat well-defined, slight elevation, crust/scab over the top with some darker red parts
• Dx –> Bowen’s disease, SCC, trauma
• Investigations/Management –> efudix cream or topical fluorouracil + cryotherapy + C+C, can consider surgical excision

Question 7

Answer 7

• Description –> multiple elevated brown lesions on back, size varies from 1cm diamter to 3cm, fairly round in shape, well-defined borders, ‘stuck on’ appearance, some scales/dry appearance
• Dx –> seborrhoeic keratoses, melanoma, dysplastic naevus
• Investigations/Management –> benign lesion, cryotherapy is an option

Question 8

Answer 8

• Description –> dark brown nodule, top of forehead, 3cm diamater, well-defined border, round in shape
• Dx –> Nodular melanoma, blood-filled cyst
• Investigations/Management –> wide excision skin biopsy

Question 9

Answer 9

• Description –> face/forehead/back, multiple erythematous lesions, 3-5mm in size, papules and pustules, evidence of ice pick scarring and some hyperpigmentation
• Dx –> Acne vulgaris, rosacea, atopic dermatitis
• Management –> Benzoyl peroxide, topical retinoids (tretinoin, adapalene), topical antibiotics (erythromycin) +/- oral contraceptive pill/oral antibx, oral isotretinoin if severe (specilaist use)

Question 10

Answer 10

• Description –> erythematous lesion on back of the head (scalp/neck), white scales and crusty, fairly well-defined borders
• Dx –> Scalp/neck psoriasis, seborrhoeic dermatitis
• Investigations/Management –> Vit D3 analogues (calcipotriol), corticosteroids (topical or oral), coal tar (soothes), keratolytics (eg. salicylic acid), biologics can be used if others don’t work (anti-TNFs)

Question 11

Answer 11

• Description –> extensor surfaces of elbows, covers half the forearm in length, erythematous lesion with white scales, looks dry, well-defined borders
• Dx –> Chronic plaque psoriasis, sebhorrhoeic dermatitis
• Investigations/Management –> Vit D3 analogues (calcipotriol), corticosteroids (topical or oral), coal tar (soothes), keratolytics (eg. salicylic acid), biologics can be used if others don’t work (anti-TNFs)

Question 12

Answer 12

• Description –> flexor surfaces of elbows, irregular eythermatous patches and papules, poorly demarcated edges, flat or slightly raised, evidence of skin picking (excoriation)
• Dx –> Atopic eczema (dermatitis), seborrhoeic dermatitis, flexural psoriasis, contact dermatitis
• Investigations/Management –> emollients and topical corticosteroids (hydrocortisone 1%)

Question 13

Answer 13

• Description –> round erythematous nodule with central keratin plug, well-defined edges, 1-3cm in diamter
• Dx –> keratoacanthoma, SCC, BCC
• Investigations/Management –> surgical excision biopsy

Question 14

Answer 14

• Description –> multiple small erythemaous lesions, 1-2cm in diameter, some are pustular, fairly well-demarcated, no scale/crust
• Dx –> dermatitis herpetiformis, atopic eczema, seborrheoic dermatitis, eczema herpeticum
• Investigations/Management –> gluten-free diet (associated with coeliac)

Question 15

Any herpes infection –> eczema herpeticum

Answer 15

• Description –>
• Dx –> any herpes infection
• Investigations/Management –> oral aciclovir

Question 16

Answer 16

• Description –> Widespread erythematous ulcerated patches from ruptured blisters
• Dx –> Pemphigus vulgaris,
• Investigations/Management –> skin bioposy to confirm –> potent topical steroids, high dose oral prednisolone, azathioprine

Question 17

Answer 17

• Description –> Fluid-filled blisters, erythematous patches
• Dx –>
• Investigations/Management –> skin biopsy to confirm –> high dose oral prednisolone is mainstay, then can add potent topical steroids + azathioprine

Question 18

Answer 18

• Description –> Erythematous target lesion
• Dx –> Erythema migrans (tick bite/lyme disease)
• Investigations/Management –> serology testing (ELISA) for lyme disease –> oral antibiotics (doxy, amox)

Question 19

Answer 19

• Description –> erythematous lesions, broken skin, crust around mouth …
• Dx –> Staphylococcal scalded skin syndrome, pemphigus vulgaris, impetigo
• Investigations/Management –> antibitoics (fluclox) + IV fluids

Question 20

Answer 20

• Description –> umbilicated centres…
• Dx –> Molluscum contagiosum
• Investigations/Management –> usually spontaneously resolves, antibitoics (if infected), topical corticosteroids

Question 21

Answer 21

• Description –> Raised erythematous patches (macules or wheals), well-defined borders, no crust/scale
• Dx –> Urticaria, tinea?
• Investigations/Management –> avoid trigger, oral antihistamines (loratidine or chlorphenamine at night)

Question 22

Answer 22

• Description –> facial erythema, rhinophyma, inflammatory papules, rhinophyma, multiple telangiectasia
• Dx –> Rosacea, acne vulgaris, SLE
• Investigations/Management –> avoid triggers/sun exposure, non-oily moisturiser, topical brimonidine (for erythema), topical ivermectin, oral antibx

Question 23

Answer 23

• Description –> erythematous, looks fungal …
• Dx –> Tinea pedis (athlete’s foot), fungal nail infection, tinea capitus, tinea corporis –> head (ringworm) –> trunk, legs, or arms
• Investigations/Management –> antifungals (ketoconazole, terbinafine, fluconazole), fungal nail infection –> no treatment or ORAL terbinafine

Question 24

Answer 24

• Description –> widespread erythematous lesions, ruptured blistering of skin
• Dx –> TENS/SJS
• Investigations/Management –> stop the trigger/drug! supportive care (fluids, oxygen, transfusions), IV immunogolubilin

Question 25

Answer 25

• Description –>
• Dx –> Impetigo
• Investigations/Management –> hydrogen peroxide (antiseptic) + fusidic acid (antibiotic used for bacterial sin and eye infections), antibiotics

Question 26

Answer 26

• Description –> erythematous rash/lesions, crust/pustules/papules
• Dx –> Seborrhoeic dermatitis, folliculitis?
• Investigations/Management –> topical corticosteroids + antifungals (topical, shampoo ( selenium sulphide) –> ketoconazole)