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derm2 Flashcards

1
Q

haematological findings of SLE?

A

haemolytic anemia
thrombocytopenia
leukopenia

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2
Q

antibodies in SLE?

A

ANA
anti-dsDNA
anti-Sm
anti-phospjolipid

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3
Q

derm fidnings in SLE?

A

photodistributed rash
chillblains
livedo reticularis
alopecia

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4
Q

how does SCLE present?

A

widespread photosensitive rash

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5
Q

baby has annular plaques. diagnosis? next tests?

A

neonatal lupus - Ro positive

do ecg as risk of heart block

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6
Q

pt presents with gottrons papule, heliotrope rash, ragged cuticles, and shawl sign. dx? antibody?

A

dermatomyositis

anti-Jo1

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7
Q

pt has dermatomyositis and interstitial lung disease - antibody? other symptoms?

A

anti-MDA5

digital ulcers/iscahemia

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8
Q

antibody associated with dermatomyositis and malignancy?

A

anti-p155

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9
Q

what levels are high with dermatomyositis?

A

CK

ALT

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10
Q

test done for IgA vasculitis?

A

biopsy for direct immunofluorence - perivascular IgA

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11
Q

patient has erythema nodosum and lupus pernio with a dry cough? likely diagnosis? histology?

A

sarcoidosis
LP = purplish rash on face
non-caseating epitheloid granulomas
exclude infection

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12
Q

DRESS diagnostic criteria?

A 
drug reaction with eosinophilia and systemic symptoms
fever ≥38.5
lymphadenopathy ≥2
hypereosinophilia
internal organs involvement
≥50↓ BSA erythema
facial odema
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13
Q

organ most commonly involved with DRESS?

A

liver

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14
Q

onset for DRESS?

A

2-6wks after drugs

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15
Q

name 4 drugs associated with DRESS?

A

ibuprofen
allopurinol
anti-epileptics
amoxicillin

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16
Q

first line tx for DRESS?

A

corticosteroids

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17
Q

pt recently had an allogenic stem cell transplant for AML and is presenting with erythematous rash covering ≥60↓ BSA and diarrhoea. they’ve also been put-on new drugs. Dx? other symptoms?

A

graft versus host disease
scleral icterus
diarrhoea and facial & acral rash make gvhd more likely than DRESS

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18
Q

pathogenesis of gvhd?

A

donor derived t lymphocyte activity against antigen sin inmmunocompromised recipient

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19
Q

causes of pruritus without a rash?

A 
lymphoma, polycythaemia
uraemia
cholestasis
iron excess/deficit
HIV
Hep ABC
cancer
drugs
psychogenic
old age
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20
Q

what can pruritus without a rash lead to?

A

nodular prurigo

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21
Q

pt presents with bleeding gums, corkscrew hairs and petechiae. Upon asking most of their meals are takeout. dx? other symptoms?

A

scurvy
spongy gingivae
follicular hyperkeratosis
perifollicular haemorrhage

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22
Q

pt presents with inflamed lips, desquamation of large areas of their skin and diarrhoea. upon examination they have. hepatomegaly. what are they deficient in? other symptoms?

A 
kwashiorkor - protein deficiency
cachexia
oedema
failure to thrive
cheilitis = inflammation of lips 
soft nails, dry hair
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23
Q

what triad is presenting zinc deficiency?

A

dermatitis, diarrhoea, depression

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24
Q

pt presents with ‘Casals necklace’ rash and painful fissures on their palms and soles. what are they deficient in? other sx?

A

vitamin b3 niacin
dermatitis, diarrhoea, dementia, death
photodistributed erythema
perianal, perioral and genital inflammation

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25
Q

pathogenies of carcinoid syndrome and symptoms?

A

due to metastases of a malignant carcinoid tumour → serotonin secretion
flushing, diarrhoea, bronchospasm, hypotension

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26
Q

symptoms of Stevens-Johnson syndrome/toxic epidermal necrolysis?

A

prodrome - flu like symptoms
lesions on trunk ≥ limbs/face
macule, blisters, erythema - targetoid
blisters merge and detach in karge sheets

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27
Q

how to differentiate between SJS/TEN?

A

SJS | SJS/TEN | TEN
BSA detachment ≤10 | 10-30 | ≥30
mortality ≤10| |≥30

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28
Q

causes of SJS?TEN?

A

abx - beta-lactams/sulphonamides
allopurinol
anti-epileptics
nsaids

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29
Q

pathogenesis of SJS/TEN?

A

cell-mediated cytotoxic reaction against epidermal cells

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30
Q

3 ddx for SJS/TEN?

A

SSS
thermal burns
cutaneous gvhd

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31
Q

what can be used to assess severity of sjs/ten?

A 
SCORTEN
age≥40
epidermal attachment %
serum urea glucose bicarb 
malignancy
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32
Q

complications of sjs/ten?

A 
death
blindness
dehyrdration
hypo/hyperthermia
renal tubular necrosis
liver and heart failure
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33
Q

pt has a rash covering more than 90↓ of their BSA. they have a hx of atopic eczema and have recently started some new meds. dx? other sx?

A

erythroderma
cause - eczema, psoriasis, drugs, sezary syndrome
edema, tachycardia, risk of sepsis, dehydration

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34
Q

how to treat erythroderma?

A

treat underlying cause
restore fluids, electrolytes, circulation and body temp
emollients
± steroids and abx

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35
Q

derm presentations of ckd?

A 
anaemia → mucous pallor and hair thinning
excoriations
prurigo
calciphylaxis
half half nails 
xerosis - dryness
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36
Q

what derm disease can lead to ckd?

A

anca associated vasculitis / sle

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37
Q

derm presentations of cld?

A 
excoriations
prurigo
muehrckes lines on nails
terry's nails
palmar erythema
spider telangiectasia
clubbing 
jaundice 
porphyria cutanea tarda
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38
Q

pt with DM presents with plaques that have a red-brown raised edge and a yellow brown centre. dx? tx?

A

necrobiosis lipoidica

topical /intralesional steroids

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39
Q

derm presentations of DM?

A 
necrobiosis lipoidica
Terrys nails
xerosis
granuloma annulare
xanthelesma/xanthomata
neuropathic ulcers
acanthosis nigricans
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40
Q

2 common derm presentations in acromegaly?

A

cutis gyrata verticis

acne

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41
Q

derm presentations of hiv?

A 
morbilliform rash
uticaria
pruritus
erythema multiforme
oral/genital ulceration
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42
Q

derm presentations of ibd?

A 
pyoderma gangrenosum
orofacial granulomatosis 
erythema nodosum (panniculitis)
aphthous ulceration 
psoriasis/pemphigoid
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43
Q

derm presentations of celiac disease?

A

dermatitis herpetiformis

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44
Q

what is hidradenitis suppurativa?

A

inflamed nodes, sterile abcess, sinus tracts, fistula, hypertrophic scars
affects axillary, anogenital & inframmary areas mostly

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45
Q

what diseases is pyoderma gangrenous associated with?

A

IBD
leukeamia
seronegative arthritis

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46
Q

skin diseases associated with malignancy?

A

dermatomyositis
pyoderma gangrenosum
erythema gyratum repens
paraneoplastic pemphigus

(urticaria, vasculitis, prurutis)

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47
Q

haemaorhagic docules can indicate what?

A

metastatic pancreatic carcinoma

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48
Q

mucosal melanosis can indicate what?

A

peutz-jegher syndrome

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49
Q

name 3 virulence factors that staph aureus has?

A

haemolysin
leukocidin
exfoliative toxin

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50
Q

virulence factors of strep pyogenes?

A

m protein → anti-phagocytic
HA capsule
erythrogenic exotoxins
streptolysins S & O

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51
Q

what kind of folliculitis is assoicted w HIV?

A

eosinophilic

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52
Q

recurrent cases of folliculitis is assoicted with what?

tx?

A

nasal Staph aureus
expressing panton-Valentin leukocidin

abx - flucloxacillin and erythromycin
furunculosis → incision and drainage

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53
Q

furuncle vs carbuncle?

A

furuncle = deep follicular abscess
carbuncle = connected adjacent furuncles
carbuncle more likely to lead to speticaemia and cellulitis

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54
Q

risk factors for developing recurrent furnucles or staphylococcal impetigo?

A 
immune defijency :
AIDS
hypogammaglobulinaemia
hyper IgE sybdrome
DM
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55
Q

pathogenies of panton Valentin leukocidin staph aureus?

A

B pore forming exotoxin

leukocyte destruction and tissue necrosis

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56
Q

cutaneous and extracuytaneous signs of panton Valentin leukocidin staph aureus?

A

cutaneous:
recurrent painful abscesses
folliculitis
cellulitis

extra:
necrotising pneumonia
necrotising fasciitis
purpura fulminan

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57
Q

risk factors for PVL staph aureus?

A 
5 Cs
close contact
contaminated items
crowding 
(un)cleanliness
cuts and grazes
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58
Q

PVL staph aureus management?

A

abx - tetracycline
chlorhexiidne body wash
nasal mupirocin ointment
treat close contacts

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59
Q

skin condition associated with hot tubs, swimming pools etc?

A

pseudomonal folliculitis

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60
Q

symptoms and mx of pseudomonal folliculitis?

A

diffuse truncal eruption of follicular erythematous papule
normally no tx
severe/recvurrent → oral ciprofloxacin

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61
Q

commonest causes of cellulitis?

A

strep pyogenes

staph aureus

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62
Q

what is cellulitis

A

infection of lower debris and subcutaneous tissue

tender swelling ill defined blanching erythema

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63
Q

2 types of impetigo?

A

non-bullous - strep

bulbous - staph → exfoliative toxins a&b → splint epidermis by targeting desmoglein 1

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64
Q

severe form of streptococcal impetigo?

A

ecthyma

punch out ulceration with erythema and thick crust

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65
Q

risk factor for SSSS?

A

neonates/infants

immunocompromised adults

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66
Q

pathogenesis of SSSS?

A

infection at distant site eg conjunctivitis → exfoliative toxin → cannot be removed quickly enough by kidneys → diffuse tender erythema → flaccid bullae → wrinkling and exfoliate → oozing erythematous base

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67
Q

what organism causes TSS?

A

group a staph aureus → pyrogenic exotoxin TSST-1

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68
Q

symptoms of TSS?

A 
fever
hypotension 
diffuse erythema 
thrombocytopenia 
desquamation post erythema 
gI muscular CNS renal hepatic involvement
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69
Q

pt has well demarcated brown scaly patches in their intertriginous areas. dx?

A

erythrasma

(corynebacterium)

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70
Q

pt has pitted erosions on their soles. dx? cause? mx?

A

pitted keratosis
corynebacterium
clindamycin

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71
Q

pt presents with a red swollen hand that has slowly been spreading. he is a fishmonger. dx?

A

erysipeloid

rf = raw contaminated fish and meat

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72
Q

pt presents with a painless necrotic ulcer on his finger. it looks swollen. he is a sheep farmer. dx? what would you find on lymph node exam?

A

anthrax (bacillus anthracis)

regional lymphadenopathy and pain

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73
Q

child presents with a tender superificla bullae on the volar fat pad of their finger. dx? causes?

A

blistering distal dactylitis

strep pyogenes / staph aureus

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74
Q

erysipelas causes? signs and symptoms? mx?

A

infection of deep dermis and subcutis
b haemolytic streptococci / staph aureus
prodrome - malaise fever headache
erythematous indurated plaque w cliff drop edge ± blistering
red streak on face/ limbs → lymphangitis
find portal of entry
IV abx

75
Q

scarlet fever causes? prodrome? skin sx?

A

URTI - erythoegnic toxin strep pyogenes
sore throat, headache, fever malaise, anorexia
blanching tiny pink spots on chest neck axillae → whole. body → sandpaper like texture

76
Q

complications of scarlet fever?

A 
otitis 
sinusitis
pneemonia
myocarditis
heaptitis
meningitis 
rheumatic fevre
glomerulonephritis
77
Q

presentation of necrotising fasciits? mx?

A

dusky induration → rapid painful necrosis of skin connective tissue and muscle
broad spectrum parenteral abx and surgical debridement
±mri

78
Q

necrotising fasciitis of the scortum?

A

fournies gangrene

79
Q

initial presentation of Lyme disease? other name? progression?

A 
borreliosis
erythema migrans → annular erythema 
multiple smaller secondary lesions 
neuroborreliosis → facial palsy, aseptic meningitis 
arthritis 
carditis
80
Q

what’s required for diagnosis of borreliosis?

A

high index of suspicion

serology not sensitive and histopathology is non-specific

81
Q

pt presents with a ulcerated lesion that is panful and they have painful regional lymopahdenopathy as well as fear headache and malaise. they mention they were recently bitten by a rodent (they work at the zoo). dx? causes?

A

ulceroglandualr form of tularaemia

francisella tularensis

82
Q

presentation of ecythma gangrenosum?cause?

A

red macule → oedematous → haemorhaggic bullae → ± ulcerate ? form an eschar
neutropenic pts
pseudomonas aeruginosa

83
Q

difference between ectyhma and ecthyma gangrenosum?

A

ecthyma → streptococcal infection

EG → pseudomonas aeruginosa

84
Q

primary syphillis presentation?

A

chancre - painless ulcer with firm indurated border

1 week later → painless regional lympoahdenopahty

85
Q

presentation of secondary syphilis?

A 
~50n days post chnacre
fever, malise, pruritius, irritis
rash
alopecia
mucous patches
lymphadenopathy 
hepatosplenomegaly 
condylomata lata
86
Q

rare manifestation of secondary syphilis?

A

lues maligna - pleomorphic skin lesions

87
Q

presentation of tertiary syphilis?

A

summa skin lesions
destroyed nasal cartilage
CVD
neurosyphilis

88
Q

treatment of syphilis?

A

IM benzylpenecillin

orał tetracycline

89
Q

2 types of leprosy and the difference?

A

lepromatous - multiple lesions , sensation and sweeting normal

tuberculoid - solitary/few lesions, annular, hairless, anhydrotic, numb

90
Q

3 ways cutaneous TB can be acquired?

A

exogenously
contagious endogenous spread
haematogenous/lymphatic endogenous spread

91
Q

investigations for cutaneous TB?

A

interferon gamma release assay
histology ZN stain
culture / PCR

92
Q

cutaneous manifestations of TB?

A 
tuberculous chnacre
TB verrucosa cutis 
scrofuloderma
orificial TB - nasal 
lupus vulgaris
military TB
tuberculous gumma
93
Q

risk factors for molluscum contagiosum? mx?

A

children
immunocmpromiised
curettage, imiquimod, cidofovir

94
Q

2 ddx for molluscum contagiosum?

A

basal cell caricoma

pyogenic granuloma

95
Q

2 types of HSV?

A

HSV-1 - direct contact w contaminated saliva / secretiions

HSV-2 - sexual contact

96
Q

symptoms of HSV?

A

recurrent vesicular eruptions favouring orolabial and genital regions
tender lymphadenopathy , malaise
ulceration, pustules, erosions w scalloped border
urinary retention → genital lesions v painful
aseptic meningitis

97
Q

what can cause reactivation of HSV?

A 
UV
stress
spontaneous
fever
local tissue damage
98
Q

emergency finding in HSV?

A

eczema herpeticum → can lead to encephalitis

monomorphic punched out erosions

99
Q

common presentation of HSV in children? misdiagnosis?

A

herpetic whitlow
more common in HSV1
pain, swelling and vesicles on digits
misdiagnosed as paronychia or dactylitis

100
Q

common presentation of HSV in wrestlers?

A

herpes gladiatorium

HSV1 - athletes lesions come into contact with one another

101
Q

cause of neonatal HSV?prresnattion? mx?

A

exposed during vaginal delivery especially if mother got hsv close to delivery time
onset between birth and 2 weeks
vesicles → bullae erosions
encephalitis → neurological deficits without treatment
IV antivirals

102
Q

risk factors severe/chronic HSV? presentation?

A

immunocompromised patients eg HIV/tx

chronic enlarging ulceration at multiplemsites ±resp/GI tract

103
Q

diagnosis and mx of HSV?

A

swab for pcr
oral acyclovir (or valacyclovir) 200mg 5xday in immunocompetent localised infection
or IV 10mg/kg TDS 7-19 days

104
Q

what virus presents in a dermatomal way?

A

varicella zoster virus

105
Q

causes of hand foot and mouth disease? difference?

A

coxsackie A16
enterovirus 71 - higher incidence of neurological involvement eg encephalitis
spread by oral oral route or oral faecal route

106
Q

presentattion of hand foot and mouth disease?

A

prodrome - fever, malaise, sore throat

red macules, vesicles and ulcers on buccal mucosa, tongue, palate, pharynx ± hands and feet

107
Q

what causes morbilliform eruptions?

A 
measles
rubella
ebv
cmv 
HHV6&7

leptospirosis
rickettsia

108
Q

causes of petechiae/purpura?

A 
coagulation abnormailites - ITP, DIC
vsculitis
infections
TEN
raynauds
HEPb, CMV, rubella
109
Q

what is gianotti-crosti syndrome? causes?

A

acrodermatitis of childhood (1-3yrs)
acute symmetrical erythematous papular eruption on face, extremities and buttocks
EBV, CMV, HHv6, coxsackie, hep B

110
Q

pt presents with a slapped cheek rash and a reticulated rash on chest and thighs. dx? causes?

A

erythema infectiosum

parvovirus b19

111
Q

child presents with a fever that’s lasted for 4 days and has now got small pink papule on their trunk and head. dx? causes?

A 
roseola infants (6th disease)
HHV6 and HHV7
112
Q

goat farmer presents with dome shaped, firm bullae on hands and forearms. dx? cause? mx?

A

orf
parapoxvirus
self resolving in 4-6 weeks

113
Q

teenager presents hypopigmentation, an erythematous macular eruptoion and some fine scales. They mention it gets wraps in the summer. dx? mx?

A 
pityriasis versicolor (superficial fungal)
topical azalea
114
Q

what is kerion?

A

inflammatory fungal infection → abscess of the scalp & posterior cervical lymphadenopathy
± secondary infection w staph aureus

115
Q

commonest cause of tinea capitis?

A

trichophyton tonsurans

116
Q

what are dermatophytes/

A

fungi that live on keratin

117
Q

causes of tinea pedis? (superficial fungal)

A

tricophyton rubrum → hyperkeratosis

tricophyton mentagrophytes → vesiculobullous

118
Q

what is the id reaction?

A

inflammatory reaction distant from the site of a dermatophyte infection
urticaria, hand dermatitis, erythema nodosum

119
Q

what is a majocchi granuloma?

A

follicular abscess when dermatophyte infection penetrates follicular wall into surrounding dermis

120
Q

risk factors for candidiasis?

A

occlusion, moisture, warm temp, DM

121
Q

presentation of candidiasis?

A

superficial fungal
erythema oedema , thin purulent discharge
intertriginous / oral mucosa
cause of valvovaginitis

122
Q

risk factors for aspergillosis?

A

neutropenia

corticosteroid therapy

123
Q

presentations of aspergillosis?

A

well circumscribed papule with necrotic bases and surrounding erythema
can invade blood vessels → thrombosis and infarction
can extend into bone, cartilage and fascia

124
Q

disease similar to aspergillosis?

A

fusarium

125
Q

presentation of mucormycosis? mx?

A

fever, headache, facial oedema, exophthalmus, orbital cellulitis, cranial nerve dysfunction

aggressive debridement
antifungal therapy §

126
Q

risk factors for mucormycosis?

A 
DM esp w DKA
malnutrition
uraemia 
neutropenia
steroids /abx
burns
hiv
127
Q

presentations of scabies?

A

red to flesh coloured pruritic papules
interdigital areas, wrists, genitals, axillae
burrow of fine white scale - diagnostic
hyperkeratosis in Norwegian scabies

128
Q

tx for scabies?

A

permethrin
oral ivermectin
2 cycles

129
Q

lice treteamnts?

A

permethrin
oral ivermectin
malathion

130
Q

body Louse prrsenation?

A

pruritic papules and hyperpigmentation

131
Q

presentation of bedbugs? tx?

A

itchy weals around a central punctum

treatment only if symptomatic , fumigation of home

132
Q

what is a melanoma?

A

malignant tumour from melanocytes
can be found on mucosal surfaces and uveal tract
leading cause of skin cancer deaths

133
Q

rfs for melanoma?

A 
family hx, MC1R variants
light skin red hair
sun exposure
immunosuppresiion
≥100/atypical malanocytic nevi
134
Q

broad pathogenesis of melanomas?

A 
AMPK pathway activated
KIT mutations - acral and mucosal
NRAS gene
BRAF gene - intermittent UV exposure 
CDKN2A mutations → AMPK & P16 (tumor suppressor)
135
Q

immunotherapy for melanoma? indications?

A

CTLA-4 blockade - ipilimumab (natural inhibitor of T cell activation) (BRAF negative)
PDL1 inhibitors eg nivolumab

BRAF & MEK inhibitor for mutated oncogene targeted therapy

if unresectable or metastatic

136
Q

5 subtypes of melanoma?

A 
superficial spreading **most common
nodualr
lentigo maligna
acral lentiginous
unclassifiable
137
Q

superficial spreading melanoma?

A

most common in light skinned ppl
men → trunk , women → legs
hypo/depigmentation = host immune system attacking = regression
horizontal growth then vertical

138
Q

nodular melanoma?

A

trunk, head, neck
m≥f
usually blue to black nodule
only vertical growth

139
Q

lentigo maligna melanoma? can progress to?

A

≥60yrs
chronically sun damaged skin , **face
slow growing, asymmetrical, macular, irregular border, brown/black
invasive lentigo maligna melanoma

140
Q

acral lentiginous melanoma?

A

palms, soles, around nails
incidence similar across all racial and ethnic groups
→ represents disproportionate no of melanomas diagnosed in afro-carribenas and asians

141
Q

self detection for melanomas?

A 
asymmetry
border irregularity
colour variegation
diameter ≥5mm
evolving
142
Q

what is garbe’s rule?

A

worried patient about lesion → do not ignore → low threshold for performing a biopsy

143
Q

3 ddx for melanomas?

A

basal cell carcinoma
sebhorreic keratosis
dermatofibroma

144
Q

what would indicate poor prognosis for melanoma?

A 
breslow thickness ≥1mm
male
lymph node involvement 
ulceration 
age
trunk/head/neck
145
Q

investigation for melanoma and positive findings?

A 
dermoscopy
asymmetry
multiple colours 
reticular/globular
starburst

also consider history and rfs

146
Q

melanoma managemnt?

A

primary excision down to subcutaneous fat with 2mm peripheral margin
wide excision margin determined by breslow depth

sentinel lymphoma node biopsy for pT1b+
PET-CT and brain MRI for stage 3 and 4

147
Q

broad tnm staging for melanoma?

A

T1 ≤1mm
T2 1-2mm
T3 2-4mm
T4 ≥4mm

a - no ulceration
b - ulceration

148
Q

major prognostic factor for melanoma?

A

ldh

↑ = worse prognosis

149
Q

rfs for keratinocyte displasia/carcinoma and types?

A

pale skin, UV damage

actinic keratoses (dysplasia)
Bowen’s disease (SCC in situ)
squamous cell carinoma (±metastasis)

basal cell carcinoma (no metastasis, locally invasive)

150
Q

pathogenesis of basal cell carcinoma?

A

UV radiation
tumour cells and mesenchymal stromal cells
up regulation of PDGF and its receptors
↑↑ metalloproteinases and collagenases → degrade preexisting dermis → tumour cells spread
loss of function in chromosome 8q
p53 mutations

151
Q

squamous cell carcinoma pathogenesis?

A

UV radiation

alterations in p53, CDKN2A, NOTCH1/2

152
Q

most common skin cancer?

A

basal cell carcinoma

153
Q

rfs for keratinocyte carcinomas?

A 
PUVA exposure
fair skin
genetics
nevus sebaceous 
organ tx & immunosuppression 
ionising radiation
154
Q

what is actinic keratoses?

A

limited to epidermis
head, neck, upper extremities
eryhtemaotus macule ± scale → thick papules, hyperkeratosis → ± cutaneous horn

155
Q

what is Bowens disease?

A

progression form actinic keratoses or de novo → SCC in situ
erythematous scaly plaque ± slightly elevated

can look like actinic keratoses, psoriasis or eczema

156
Q

treatment for actinic keratoses and Bowens disease?

A 
5-fluorouracil cream
cryotherapy
imiquimod cread
photodynamic therapy
curettage and cautery
excision
157
Q

presentations squamous cell carcinoma?

A 
erythematous to skin coloured
papule
plaque like
exophytic
hyperkeratotic 
ulceration
158
Q

high risk features of a SCC?

A

trunk and limbs ≥2cm, head/neck ≥1cm, periorificial
ill defined margins
rapidly growing
immunosuppression
previous radiotherapy or chronic inflammation
poorly differentiated, Clark level 4/5
beyond subcutaneous fat
pernineural, vascular or lymphatic invasion

159
Q

keratoacanthoma?

A

pseudomaligancy or variant of SCC
rapid enlarging papule with keratotic core
resolves slowly leaving atrophic core

160
Q

ix for scc?

A

clinical diagnosis often sufficient
±diagnostic biopsy
±US of regional lymph nodes

161
Q

ddx of scc?

A

bcc
viral wart
merkel cell carcinoma

162
Q

mx of SCC?

A

examine rest of skin and regional LNs
excision
radiotherapy if unresectable or high risk eg perineurial invasion
cemiplimab for metastatic SCC
skin monitoring and sun protection advice

163
Q

6 types of bcc?

A 
nodular **commonest
superficial 
morpheic
infiltrative 
basisquamous
micro nodular
164
Q

nodular BCC presentation?

A

shiny, pearly nodule/papule

165
Q

superficial BCC presentation?

A

well-circumscribed erythematous macule or the

166
Q

morpheic BCC presentation?

A

elevated/depressed induration
light pink to white
extensive local destruction

167
Q

basisquamous BCC presentation?

A

histological features of BCC and SCC

168
Q

micro nodular vs nodular BCC presentation?

A

clinically similar

micro nodular more destructive → high rates of recurrence and subclinical spread

169
Q

ix for BCC?

A

often clinical diganosis sufficient

±biopsy

170
Q

ddx for BCC?

A

SCC
Merkel cell carcinoma
adnexal carinoma

171
Q

BCC treatment?

A 
standard surgical excision
mohs micrographic surgery
-recurrent BCC
-agressive eg. micro nodular, invasive, morpheic 
-critical site 
bread loafing

5-fluorouracil, imiquimod, photodynamic therapy, curettage, radiotherapy, vismodegib (hedgehog pathway)

172
Q

cutaneous t-cell lymphoma common subtypes?

A

sezary syndrome

mycosis fungicides

173
Q

stages of mycosis fungicides CTCL?

A

patch (erythematous, fine scales, ±pruritus) → plaque → tumour stage

174
Q

genes in mycosis fungicides CTCL?

A

CDKN2A
PTEN
STAT3

175
Q

examination for MF CTCL?

A

type and extent of skin lesions
palpable of LNs?
skin biopsies
FBC

176
Q

treatment of MF CTCL?

A

plaque/patch stage → topical corticosteroids, photo/radiotherapy
nodal involvement → systemic chemo
brentuximab vedotin

177
Q

ddx for mycosis fungoides?

A

psoriasis
eczema
parapsoriasis

178
Q

sezary CTCL presentation?

A

triad of erythema, sezary cells and lymphadenopathy

179
Q

treatment for sezary CTCL?

A

extracorporeal photophoresis

± adjuvant PUVA & topical corticosteroids

180
Q

what is kaposi sarcoma?

A

HHV8
±immunosuppression
pink patches to dark plaques, nodules, polyps
chemo/radiothearpy ≥ surgery

181
Q

what is Merkel cell carcinoma associated with?

A

polyomavirus

182
Q

Merkel cell carinoma presentation?

A

solitary rapid growing nodule

firm dome shaped

183
Q

Merkel cell carinoma treatment?

A

surgery
radiation
anti PDL1 avelumab
anti PD1 pembrolizumab

BRS 2 (12 decks)

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