Dermatology 2 Flashcards
What is your spot diagnosis?
Lichen planus
How does lichen planus present?
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon may be seen
oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging
How may lichen planus be managed?
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
What is your spot diagnosis?
Lichen sclerosus
What is lichen sclerosus? How may it present?
an inflammatory condition that usually affects the genitalia and is more common in elderly females
Features
white patches that may scar
itch is prominent
may result in pain during intercourse or urination
How should lichen sclerosus be managed?
Management
topical steroids and emollients
Follow-up: increased risk of vulval cancer
A lipoma is a common, benign tumour of adipocytes that is generally found in subcutaneous tissue.
What are its key features?
How should it be managed?
smooth, mobile, painless lump
may be observed
if diagnosis uncertain, or compressing on surrounding structures then may be removed
Malignant transformation of lipoma to liposarcoma is very rare.
What might be the signs that this was happening?
Size >5cm
Increasing size
Pain
Deep anatomical location
What is your spot diagnosis?
Livedo Reticularis
What is Livedo Reticularis?
What may cause this?
a purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules
Causes:
idiopathic (most common)
SLE
antiphospholipid syndrome
Ehlers-Danlos Syndrome
What is your spot diagnosis?
Malignant melanoma
What are the main risk factors for developing melanoma?
Increasing age
Family history
High UV exposure- living close to the equator, outdoor occupation, use of sunbeds
Fitzpatrick Scale 1-2 skin type
High number of moles
Giant congenital melanocytic naevus
IBD
What are the 4 main subtypes of malignant melanoma?
In order of most to least common:
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Which is the most aggressive form of melanoma?
Nodular melanoma
Where does superficial spreading melanoma typically affect?
How does it present?
Arms, legs, back and chest
found in young people
presents as a growing mole
Where does nodular melanoma typically affect?
How does it present?
Sun exposed skin, middle-aged people
Red or black lump or lump which bleeds or oozes
What are the major and minor criteria for referral for suspected malignant melanoma?
The main diagnostic features (major criteria):
Change in size, shape or colour
Secondary features (minor criteria)
Diameter >= 7mm
Inflammation
Oozing or bleeding
Altered sensation
What is the single most important factor in determining prognosis of patients with malignant melanoma?
The invasion depth of a tumour (Breslow depth)
How may suspected malignant melanoma be investigated?
2ww referral
dermoscopy to visualise
excision biopsy
can do genetic testing
vitamin D levels measured in all patients
staging:
sentinel lymph node biopsy
staging CT
PET-CT
Outline melanoma stages 1-4
How should stage 0-2 melanoma be managed?
Surgical excision with margin of at least
0.5cm in stage 0 melanoma
1cm in stage I melanoma
2cm in stage II melanoma
Consider sentinel lymph node biopsy for staging if Breslow thickness >0.8mm or <0.8mm with ulceration
How should stage 3 melanoma be managed?
Consider completion lymphadenectomy if SLN +ve
Other options include lymph node dissection
Adjuvant targeted therapy (if BRAF mutation present) or immunotherapy can now be offered for patients with fully resected or unresectable stage III melanoma
Offer CT staging
How should patients with melanoma be followed up?
Patient education for all
Self-examination, sun protection, avoiding vitamin D depletion
Discharge if stage 0
Follow-up for up to 5 years (every 3 months initially), depending on stage
Personalised follow-up for Stage IV
What are milia?
small, benign, keratin-filled cysts that typically appear around the face
more common in newborns