Dermatology_Medicine

Question 1

Melanoma - criteria for 2WW?

Answer 1

• Asymmetry
• Border (irreg)
• Colour
• Diameter (>7mm)
• Exposed area/evolving/elevated

Question 2

Melanoma Ix? Mx? What does nodal involvement indicate?

Answer 2

Ix: excision biopsy with Breslow thickness

Nodal involvement = stage 3+

Mx:

• Suspicion of nodal involvement/mets –> excision biopsy + SLNB ± mets screening
• No nodal involv/mets –> excision biopsy:
  
  • Breslow ≤2mm = stage 1
  • Breslow ≥2mm –> SLNB:
    
    • -ve = stage 2
    • +ve = mets screen:
      
      • -ve = stage 3
      • +ve = stage 4
• Stage 1/2 –> follow-up & advice
• Stage 3 –> LND + adjuvant chemo
• Stage 4 –> resect (if possible), chemo, metastasectomy, palliative input

Question 3

Multiple flat, light brown plaques with waxy surface along scalp + back - Dx?

Answer 3

Seborrhoeic keratosis

Question 4

Multiple scaly, thick plaques on sun-exposed regions - Dx?

Answer 4

Acitinic/Solar keratosis (pre-malignant)

Question 5

Hard, raised growth with an ulcerated centre that began as boil - Dx?

Answer 5

Keratoacanthoma

Question 6

Red swollen leg DDx?

Answer 6

Cellulitis/Erysipelas

Venous thrombosis (DVT)

Chronic venous insufficiency

Question 7

Purpuric erruption DDx?

Answer 7

Meningococcal septicaemia

DIC

Vasculitis

Acitinic purpura

Question 8

Changing pigmented lesion ddx?

Answer 8

Melanocytic naevi

Seborrhoeic wart

Malignant melanoma

Question 9

Itchy eruption DDx?

Answer 9

Eczema - atopy/exacerbating factors

Scabies - contacts with Hx

Urticaria - precipitant

Lichen planus - FHx/drug-induced

general Mx: antihistamines, CS

Question 10

Acne vulgaris - drug Tx?

Answer 10

• Single topical therapy: topical retinoid or benzoyl peroxide
• Topical combination therapy (choose 2 or more): topical retinoid, benzoyl peroxide, topical antibiotic
• Add oral antibiotics: tetracycline, macrolide, trimethoprim
• (Sometimes COCP as alternative in women)
• Oral isotretinoin