Dermatology

Question 1

What is the ABCDE approach when judging whether a lesion is likely to be malignant?

Answer 1

A = asymmetry
B = Borders (irregular)
C = colour (multicoloured)
D = diameter (>6mm)
E = evolution (the lesion is changing)

Question 2

What is the standard treatment for melanoma?

Answer 2

Excision with narrow margins followed by a wide local excision

Question 3

How do we grade melanoma?

Answer 3

Breslow thickness (mm)

Question 4

What are the indicators of a poor melanoma prognosis (name three)?

Answer 4

(Clinical)

• Increased age
• Site: back, upper arm, neck, scalp
• Males

(Histological)

• Increased Breslow thickness)
• Vertical Growth phase
• Ulceration
• Lymphovasuclae and perneural invasion)
• Increased mitotic rate
• Tumour infiltrating lymphocytes
• Microsatellitosis

Question 5

What is the melanoma “in situ” ?

Answer 5

Melanoma which has not breached the basement membrane

Question 6

What is the treatment for melanoma in situ?

Answer 6

Simple excision with narrow margins

Question 7

Name the types of melanoma?

Answer 7

• Superficial spreading melanoma
• Nodular melanoma
• Lentigo maligna melanoma
• Lentiginous melanoma
• Acral lentigionous melanoma (most common in dark skin but equal frequency for all races)
• Desmoplastic melanoma

Question 8

What are the risk factors for melanoma

Answer 8

MMRISK

M: moles - atypical, >5
M: moles - common
R: red hair
I: inability to tan
S: Sunburn
K: kindred

Other:

• occupation outside
• live in hot country
• don’t use SPF/use incorrectly