Dermatology Flashcards
A 64 year old man presents with a lesion on his upper ear that has been present for months but has now begun to ulcerate. On examination: non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on the pinna.
What is the most likely diagnosis?
Basal call carcinoma Malignant melanoma – superficial spreading type Malignant melanoma – nodular type Non-healing scab Squamous cell carcinoma
Squamous cell carcinoma
A 32-year old scuba diver who lives in the Maldives had a seizure three days ago. He has no history of epilepsy but he’s had headaches for the past 5 months. The headaches are worse when he goes to bed. On examination, a dark irregular skin lesion is found on the back of his neck. An MRI scan shows multiple lesions across both cerebral hemispheres.
What is the most likely diagnosis?
Acoustic neuroma Glioblastoma multiforme Meningioma Metastases Neurofibromatosis type I
Metastases
A 76-year-old woman has recently attended her GP because of a ‘spot that won’t go away’. The lesion is on her nose and has rolled edges. The GP suspects a basal cell carcinoma.
What investigations are likely to be needed?
Dermatology referral/assessment - 2-week wait
Dermatology referral/assessment – routine
None – it is a non-dangerous chronic condition
None – GP to start treatment
Re-assessment in primary care periodically
Dermatology referral/assessment – routine
What are the risk factors for malignant melanoma
- excessive UV exposure
- skin type 1 (always burns, never tans)
- history multiple moles, atypical moles
- family history melanoma
- previous history melanoma
What is the presentation of a malignant melanoma
ABCDE Asymmetrical shape Boarder irregularity Colour irregularity Diameter >6cm Evolution of lesion (size, shape)
Symptoms: itch, bleeding
Legs in women
trunk in men
What melanomas are found in young/middle aged people with intermittent UV radiation
- surface spreading melanoma
2. Nodular melanoma
What melanoma is found on the face of the elderly patients with chronic UV exposure
Lentigo maligna melanoma
What are the investigations for a suspected malignant melanoma
- refer to dermatology with 2 week wait
- 1st step: dermatoscope
- Gold standard: full thickness excisional biopsy
What is the gold standard investigation for malignant melanoma
full thickness excisional biopsy
Malignant melanoma: What is the first step after a patient has been referred to secondary care
dermatoscope
What do you do if you find an atypical melanocytic lesion
take photographs and r/v at 3 months
Malignant melanoma: What are the investigation if there is metastases
- CXR
- liver ultrasound
- CT chest, abdomen, pelvis
- Brain MRI
What are the differentials for malignant melanoma
- seborrheic wart
- congenital naevi
3.
What are the differentials for malignant melanoma
- seborrheic wart
- congenital naevi
- junctional naevi
- compound naevi
- Intradermal naevi
What is basal cell carcinoma
slow growing invasive tumour of basal cells in the epidermis, rarely metastasises
What is the most common skin cancer
basal cell carcinoma
What are the risk factors for basal cell carcinoma
- excessive UV exposure
- Frequent/sever sunburn in childhood
- Skin type 1
- age
- males
- immunosuppression
- previous history of skin cancer
- family history of skin cancer
What is the most common type of basal cell carcinoma
nodular
Describe basal cell carcinomas (Nodular)
- Small
- skin coloured nodule
- surface telangiectasia (dilated veins - spider veins)
- pearly rolled edges
- +/- ulcerated centre (rodent centre)
What are the investigations for basal cell carcinoma
- Routine referral to dermatology - NOT 2 week week
- Examine with dermatoscope
- The lesion is then usually removed
What is the first line investigation for basal cell carcinoma
routine referral to dermatology - NOT 2 weeks wait
What is squamous cell carcinoma
locally invasive malignant tumour of the epidermal keratinocytes or its appendages, with potential to metastasise
Squamous cell carcinoma is a tumour of …
… keratinocytes (or it’s appendages)
What are the risk factors of squamous cell carcinoma
- excessive UV exposure
- pre-malignant skin conditions e.g. actinic keratoses
- chronic inflammation e.g. leg ulcer, wound scar (Marjolin’s ulcers)
- immunosuppression
- family history
Name a pre-malignant skin condition
actinic keratoses
What is the investigation for squamous cell carcinoma
- refer to dermatology (2 week wait)
- dermatoscope
- (biopsy) & excision
What are features of squamous cell carcinoma
- Keratotic
- Ill-defined nodule
- may ulcerate
- Non-healing lesion
- everted edges
A 4-year old girl presents to the GP with multiple lesions on her face. The lesions are raised and shiny, non-tender, non-erythematous, and 3 mm in diameter. They have an umbilicated centre. The patient is known to be HIV positive.
What is the most likely diagnosis?
Chicken pox Molluscum contagiosum Atopic eczema Eczema herpeticum Herpes simplex virus
Molluscum contagiosum
A 52-year-old woman presents to the GP with redness and swelling of her right cheek. On examination the area of erythema is well-demarcated and warm to the touch. Her temperature is 37.9oC and she feels unwell.
i) Most likely diagnosis?
Cellulitis Skin abscess Erysipelas Necrotising fasciitis Gum infection
Erysipelas
A 52-year-old woman presents to the GP with redness and swelling of her right cheek. On examination the area of erythema is well-demarcated and warm to the touch. Her temperature is 37.9oC and she feels unwell.
ii) Next steps?
Cold compress, reassure, home
Admit to intensive care unit
Take skin swabs, blood cultures, and give paracetamol
Draw around the lesion, give pain relief, oral fluids and antibiotics
Draw around the lesion, give pain relief, oral fluids and antibiotics
What is molluscum contagiosum
viral skin infection (molluscum contagiosum virus, pox virus)
