Dermatology (general) Flashcards
Melanoma of the skin: types
a) A benign growth of melanocytes is called a…?
b) Best prognosis of melanoma
c) Worst prognosis of melanoma; rapidly growing pigmented nodule which bleeds or ulcerates
d) Most common melanoma (70%); grows laterally before invading vertically through dermis
e) Change from mole to melanoma
f) Change from lentigo simplex
g) Arises as pigmented lesions on the palm, sole or under the nail and it usually presents late (if under nail, may be mistaken for trauma)
h) Non-pigmented version of nodular melanoma; resembles pyogenic granuloma
a) Melanocytic naevus (mole)
b) In situ melanoma
c) Nodular melanoma
d) Superficial spreading melanoma
e) Dysplastic melanocytic naevi (mild, moderate, severe)
f) Lentigo maligna melanoma
g) Acral lentiginous malignant melanoma
h) Amelanotic nodular melanoma
Melanoma.
a) In situ vs. invasive melanoma
b) Risk factors
c) Presentation: ABCDE + other associated features
d) Checklist that NICE advise to use in assessment
e) Management of non-malignant moles
f) Investigations of suspected melanoma
g) Staging - tumour size (T1 - T4)
h) Management
a) - In situ: in epidermis only (Clark scale Level 1), can be cured via excision
- Invasive: invades into dermis (Clark scale Levels 2 - 5), metastatic potential
b) - Multiple naevi, especially if atypical
- Fair skin, unable to tan, freckly complexion, redhead
- History of severe sunburn
- UV exposure, eg. sunbed use
- FHx or personal hx of melanoma
c) Asymmetry. Border irregular. Colour irregular. Diameter greater than 7 mm. Evolving - especially rapid growth or other change - Other: bleeding, itching, inflammation
d) 7-point checklist: (SSC COIL)
- Size increase, Shape irregular, Colour irregular (= 2 points each)
- Change in sensation (eg. itch), Oozing, Inflammation, Largest diameter > 7mm (= 1 point each)
- Score 3 or more* = 2 week wait
* or less but suspicion of cancer
e) - Advise to watch out for any new moles or changes to current moles
f) - 2 week wait to dermatology
- Assessment with dermatoscope
- Excision of suspicious lesion - biopsy and histology
- Staging: sentinel node biopsy, LFTs and liver USS, FBC, CXR, CT CAP
g) Breslow thickness (measured by histologist): T1: < 1mm thickness (depth) T2: 1 - 2 mm T3: 2 - 4 mm T4: > 4 mm
h) - Stage 1-2: excision
- Stage 3-4 (Metastatic): add immunotherapy (eg. iplimumab)
Iplimumab: mechanism of action
- Attaches to the cytotoxic T-lymphocyte associated protein 4 receptor (CTLA-4)
- This activates endogenous cytotoxic T-lymphocytes (CTL) to attack the cancer cells
Assessing skin cancer depth
a) Scale used in the TNM staging of melanoma
b) Scale used based on layer of skin penetrated (for BCC, SCC and melanoma)
a) Breslow scale - mm of depth
b) Clark scale (levels 1 - 5)
1. in situ – only in the epidermis
2. Invasion to the papillary dermis (superficial dermis)
3. Touching the reticular dermis (deep dermis)
4. Invading into the reticular dermis
5. Invasion into the subcutaneous fat (hypodermis)
Basal cell carcinoma
a) What are they?
b) Risk factors
c) Clinical features - sites, lesions
d) Referral
e) Management
f) Prevention advice
Syndrome causing multiple BCCs
a) Slow-growing, locally invasive malignant epidermal skin tumours (rarely metastasises)
b) UV radiation exposure, history of sunburn, FHx, Fitzpatrick skin type 1 (always burns, never tans)
c) - Sun-exposed areas of the head and neck
- Nodular (most common): skin-coloured smooth nodule with surface telangiectasia and pearly rolled edge, may have ulcerated centre
- Other types: superficial, morphoiec, pigmented, basosquamous
d) - Suspected BCC - usually routine referral
- Urgent referral if large/aggressive lesion or problematic site (eg. near eye or airway)
e) - Small lesions in non-cosmetic areas may be managed in primary care (minor ops)
- Options: surgical excision, cryotherapy, cautery and curretage, RT, photodynamic therapy, topical immunotherapy (eg. imiquimod)
f) Gorlin’s syndrome
g) - Avoid UV exposure in susceptible individuals
- Stay out of the sun between 10 am and 4 pm.
- Use high-factor sunscreens.
- Wear wide-brimmed hats, long-sleeved shirts and trousers
Squamous cell carcinoma.
a) What is it?
b) Risk factors
c) Pre-malignant conditions that may develop into SCC
d) Presentation
e) Investigations
f) Referral and management
a) Malignant tumour of epidermal cells with potential to invade and metastasise; less common than BCC
b) UV exposure, fair skin types, radiation/RT, xeroderma pigmentosum (often have cancer in childhood), FHx, chemical carcinogens, HPV, immunosuppression
c) Bowen’s disease, keratoacanthoma, solar (actinic) keratosis
d) - Often presents as a non-healing ulcer or growth, possibly with prior solar keratosis; head and neck
e) - Biopsy sent for histology
- Enlarged nodes - biopsy
- If worried about mets - CT CAP for staging
f) - 2-week wait for suspected SCC
- Options (as for BCC): excision, cryotherapy, cautery and curettage, RT, immunotherapy (eg. imiquimod)
Seborrhoeic warts.
a) Appearance
b) Risk factors
c) Management
a) Warty-looking benign lesions that appear ‘stuck on’ to the skin; often pigmented; usually on trunk and face
b) Older age, sun exposure
c) Usually no treatment required
- May be removed cosmetically (excision, cryo, etc.)
- Suspicious / evolving lesion - possible 2-week wait
Skin metastases
Malignant melanoma
Breast cancer
Psychiatric comorbidities of skin disease
Depression, suicide, anxiety, substance misuse
Autoimmune condition causing hair loss
- associated with what other conditions?
a) Alopecia areata
b) Vitiligo, pernicious anaemia, T1DM, Addisons, immune thrombocytopenia
Leg ulcers.
a) Types
b) Non-healing ulcer- consider…?
a) Arterial, neuropathic, vasculitic, malignant
b) Bowen’s disease or SSC
Drug hypersensitivity reactions
Beware minor skin reactions (e.g. to penicillin) - on repeat exposure, they could have a life-threatening reaction
Cutaneous lymphoma
T-cell
B-cell
