Dermatology

Question 1

Features of SCC

Answer 1

Ulcerated lesion with hard raised everted edges
Sun exposed areas
Can evolve from actinic keratoses and bowen’s
Can metastasise but lymph node spread is rare

Question 2

Features of actinic keratoses

Answer 2

Irregular crusty warty lesions

Pre-malignant (1%/year)

Question 3

Treatment of Actinic keratosis

Answer 3

Cautery 
Cryotherapy 
5-FU
Imiquimod 
Phototherapy 

Should biopsy first

Question 4

Features of Bowen’s disease

Answer 4

Red/brown scaly plaques

SCC in situ

Question 5

Treatment of Bowen’s disease

Answer 5

Cautery 
Cryotherapy 
5-FU
Imiquimod 
Phototherapy 

Should biopsy first

Question 6

Features of basal cell carcinoma

Answer 6

Commonest cancer
Pearly nodule with rolled telangiectactic edge
May ulcerate
Sun exposed areas

Question 7

Methods of staging malignant melanoma

Answer 7

Breslow thickness

Clark’s staging

Question 8

Malignant melanoma metastasises to…

Answer 8

Liver

Eye

Question 9

Features of malignant melanoma lesion

Answer 9

Asymmetry 
Border (irregular) 
Colour (non-uniform)
Diameter over 6mm 
Evolving/Elevation

Question 10

Features of Seborrhoeic keratoses

Answer 10

large variation in colour from flesh to light-brown to black
have a ‘stuck-on’ appearance
keratotic plugs may be seen on the surface

Question 11

Management of seborrhoeic keratoses

Answer 11

reassurance about the benign nature of the lesion is an option
options for removal include curettage, cryosurgery and shave biopsy

Question 12

Features of Cherry haemangiomas

Answer 12

Cherry haemangiomas (Campbell de Morgan spots) are benign skin lesions which contain an abnormal proliferation of capillaries.

Features
erythematous, papular lesions
typically 1-3 mm in size
non-blanching
not found on the mucous membranes
Benign (no treatment needed)
More common with advancing age

Question 13

Characteristic features of:
Erythema nodosum
Pretibial myxoedema
Pyoderma gangrenosum

Answer 13

Erythema nodosum
symmetrical, erythematous, tender, nodules which heal without scarring
most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

Pretibial myxoedema
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

Pyoderma gangrenosum
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

Question 14

Drugs that worsen psoriasis

Answer 14

Beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

Question 15

Causes of Stevens Johnson syndrome

Answer 15

Idiopathic
bacteria: Mycoplasma, Streptococcus
viruses: herpes simplex virus, Orf
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill
connective tissue disease e.g. SLE
sarcoidosis
malignancy

Question 16

Features of keratoacanthoma

Answer 16

Keratoacanthoma is a benign epithelial tumour. They are more frequent in middle age and do not become more common in old age (unlike basal cell and squamous cell carcinoma)

Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin

Spontaneous regression of keratoacanthoma within 3 months is common, often resulting in a scar. Such lesions should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma. Removal also may prevent scarring.