Dermatology 3 Flashcards
Which skin cancer has a worse prognosis?
Squamous cell carcinoma
Which skin cancer is more common?
Basal cell carcinoma
What is the main risk factor for basal cell carcinoma?
UV exposure with skin type 1/2
Describe a classic BCC
Pearly appearance with rolled edge and telangiectasia
Rodent ulcer
DNA mutation in PTCH TSG causes which skin cancer?
Basal cell carcinoma
What is a morphoeic BCC?
Ill-defined borders
Waxy
More aggressive
What surgery is performed for recurring/high risk BCCs?
Mohs micrographic surgery
How are BCCs normally treated?
Excision
What are the main precursors to SCC?
Actinic keratoses (aka solar keratosis) - 10% progress to SCC Bowen's disease
What does an SCC look like?
A non-healing ulcer
Punched out and crusted
How do you treat actinic keratoses?
Topical fluorouracil
What causes moles and freckles?
Benign overgrowth of melanocytes from basal layer of epidermis
When is a mole considered invasive?
If it penetrates the dermis
How do you assess a pigmented lesion?
ABCDE assessment
Asymmetry Border irregularity Colour variation Diameter > 6mm Evolving
Itching + bleeding
Which scale measures skin types?
Fitzpatrick scale
What is a slow growing patch of brown skin (often resembles a freckle)?
Lentigo maligna
What can develop from lentigo maligna?
Lentino maligna melanoma = irregularly shaped brown macule that grows slowly
Where do malignant melanomas most commonly metastasise to?
Lymph nodes Liver Lung Bone Brain
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
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
