Dermatology 3 Flashcards by Jess Marchal

Which skin cancer has a worse prognosis?

Squamous cell carcinoma

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Which skin cancer is more common?

Basal cell carcinoma

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What is the main risk factor for basal cell carcinoma?

UV exposure with skin type 1/2

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Describe a classic BCC

Pearly appearance with rolled edge and telangiectasia

Rodent ulcer

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DNA mutation in PTCH TSG causes which skin cancer?

Basal cell carcinoma

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What is a morphoeic BCC?

Ill-defined borders
Waxy
More aggressive

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What surgery is performed for recurring/high risk BCCs?

Mohs micrographic surgery

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How are BCCs normally treated?

Excision

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What are the main precursors to SCC?

Actinic keratoses (aka solar keratosis) - 10% progress to SCC
Bowen's disease

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What does an SCC look like?

A non-healing ulcer

Punched out and crusted

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How do you treat actinic keratoses?

Topical fluorouracil

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What causes moles and freckles?

Benign overgrowth of melanocytes from basal layer of epidermis

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When is a mole considered invasive?

If it penetrates the dermis

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How do you assess a pigmented lesion?

ABCDE assessment

Asymmetry
Border irregularity 
Colour variation
Diameter > 6mm
Evolving

Itching + bleeding

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Which scale measures skin types?

Fitzpatrick scale

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What is a slow growing patch of brown skin (often resembles a freckle)?

Lentigo maligna

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What can develop from lentigo maligna?

Lentino maligna melanoma = irregularly shaped brown macule that grows slowly

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Where do malignant melanomas most commonly metastasise to?

Lymph nodes
Liver
Lung
Bone 
Brain

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What is the management of acne?

Single / then combo: topical steroid - topical retinoids, benzoyl peroxide, topical abx

PO abx - tetracyclines / erythrmocyin
- For max 3 months

COCP eg dianette

PO isotretanoin in specialist

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What is a risk of dianette?

VTE

Compare venous vs leg ulcers

Venous

Painless
Above ankle
Due to chronic venous insufficiency
Features of venous insufficiency = oedema, brown pigmentation, lipodermatosclerosis, eczema

Artieral

Painful
Toes and heel
May be area of gangrene
Cold with no palpable pulses

What investigation may be done to investigate an arterial leg ulcer?

ABPI

ABPI normal range

1.0-1.2 normal
0.8-0.9 mild arterial disease
0.5-0.79 moderate
<0.5 severe

NB if >1.2 indicates calcification of vessel

What is the management of a venous ulcer?

Compression banding

Failure to heal after 12wks may need grafting

Where and when do neuropathic ulcers occur?

Commonly on plantar surface of metatarsal head and plantar surface of hallux DIabetic pt

What ulcer is associated with IBA / RA?

Pyoderma gangrenosum

Where does pyoderma gangrenosum arise and what does it look like?

Stoma sites Erythematous nodules or pustules which ulcerate

What is a Kaposi sarcoma?

Tumour of vascular and lymphatic endothelium

How does kaposi sarcoma present?

Purple cutaneous nodules

Who does kaposi sarcoma tend to affect?

Elderly males Those with HIV

What is a keloid scar?

Tumour like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

Who is most affected by keloid scars?

Darker skin Young Commonly sternum, shoulder, neck, face

What is the management of keloid scars?

Intra-lesional steroids eg triamcinolone | Excision occasionally needed

What is a ganglion?

Cyst arising from a joint or tendon sheath Usually back of wrist 3x more women

How long do ganglions last for?

Several months then usually disappear

What is a cherry hemangioma?

Campbell de Morgan spot Benign proliferation of mature capillaries

What is the most common cause of neck swelling?

Reactive lymphadenopathy

Which lump in the neck may move up when swallowing?

Thyroid swelling

What neck lump moves up with the protrusion of the tongue?

Thyroglossal cyst

What may cause dysphagia, regurgitation, halitosis, aspiration and a chronic cough?

Pharyngeal puch

What is a branchial cyst?

Mobile cystic mass that develops between sternocleidomastoid muscle and the pharynx Due to failure of the obliteration of the second branchial clet in embryonic development

What can cause a pulsatile neck mass which doesn't move on swallowing?

Carotid aneurysm

What is a cystic hygroma?

Error in development of lymph sacs causing a lump typically on left side of neck Noted at birth

What is an extra rib that forms above the first rib called?

Cervical rib | More in F

What can people with a cervical rib develop?

Thoracic outlet syndrome (10%)

What are some important questions to ask when someone presents with a groin mass?

Cough impulse? Pulsatile and expansile? Are both testes intrascrotal? Any lesions in the legs eg malignancy or infections Soft, small and very superficial (lipoma)?

Which groin hernia has the greatest risk of strangulation - direct / indirect / femoral hernia?

Femoral

Compare positions of direct and indirect inguinal hernia

Direct = medial to inferior epigastric artery Indirect = lateral to inferior epigastric artery