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MBBS IV - Junior Clerkship WCS > JC81 (Surgery) - Skin ulcers > Flashcards

JC81 (Surgery) - Skin ulcers Flashcards

1
Q

Constituents and layers of skin epidermis

A 
Epidermis
• Stratified squamous epithelium
o Stratum corneum (keratin layer)
o Stratum granulosum
o Stratum spinosum
o Stratum basale
  • Langerhans cells as antigen presenting cells
  • Melanocytes
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2
Q

Constituents and layers of skin dermis

A

• Collagen and elastin fibers

• Adnexal structures
o Pilosebaceous unit
o Eccrine glands
o Apocrine glands

• Histiocytes and mast cells
o Antigen presenting cells
o Component of reticuloendothelial system

• Arterioles/ Venules/ Lymphatics

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3
Q

Constituents and layers of subcutis

A
  • Adipose tissues

* Arterioles/ Venules/ Lymphatics

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4
Q

List lesions derived from epidermis

  • Benign
  • Premalignant
  • Malignant
A 
Benign: 
Skin tags/ papilloma
Warts 
Senile seborrheic keratosis 
Keratoacanthoma

Pre-malignant:
Solar keratosis
Bowen’s disease (SCC in-situ)

Malignant:
SCC
BCC

Melanocytes: Benign pigmented naevi, Malignant melanoma

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5
Q

List lesions derived from dermis and skin appendages

A 
Dermis: 
Acrochordon (skin tag)
Pyogenic granuloma 
Histocytoma 
Keloids 
Kaposi's sarcoma 
Dermatofibrosarcoma protuberans

Skin appendages:
Epidermal/ sebaceous cysts
Dermoid cysts
Skin appendage tumors

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6
Q

List lesions derived from hypodermis and deep subcutis

A 
Lipoma, Liposarcoma 
Neurofibroma, Neurosarcoma 
Neurofibromatosis 
Schwannoma 
Ganglion cyst
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7
Q

List vascular lesions from subcutis of skin

List neural lesions from subcutis of skin

A

Vascular:
Campbell de Morgan spots/ Cherry angioma
Spider naevi
Angioma

Nerves:
 Glioma
 Neuroma
 Schwannoma

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8
Q

Describe lesion

A

Bulla/ Blisters

Circumscribed collection of free fluid below epidermis

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9
Q

Describe lesion

A

Macule

Circular, flat discoloration under 1cm in diameter
Well-circumscribed

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10
Q

Describe lesion

A

Nodule

Circular, Elevated lesion
Solid
May involve subcutis
>1cm in diameter

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11
Q

Describe lesion

A

Patch

Circumscribed, Flat discoloration
>1cm in diameter

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12
Q

Describe lesion

A

Papule

Superficial
Solid
Elevated and circumscribed lesion
<0.5cm in diameter

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13
Q

Describe lesion

A

Plaque

Superficial
Elevated, Solid, Flat lesion
Circumscribed
>1cm diameter

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14
Q

Describe lesion

A

Pustule

Pus-containing vesicles
• Yellowish and whitish
• Collection of polymorphs

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15
Q

Describe lesion

A

Vesicle

Circular, collection of free fluid <1cm in diameter

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16
Q

Differentiate petechiae, purpura and ecchymosis

A

 Subcutaneous bleeding
 Extravasation of red blood cell
 Red and non-blanchable

Petechiae = 1-2mm 
Purpura = >3mm 
Ecchymosis = >1cm
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17
Q

Causes of scales, crust, keloid, ulcer

A

Scales
 Accumulation of excess keratin

Crust
 Dried serum and exudate

Keloid
 Hypertrophic scarring

Ulcer
 Circumscribed loss of tissue

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18
Q

Describe lesion and name

Cell of origin
Cause

A

Papilloma

Description:

  • skin colored lesions
  • Irregular keratinized
  • smooth raised plaque to papilliferous pedunculated polyp
  • Simple overgrowth of all layers of skin with a central vascular core
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19
Q

Describe lesions

Cause
Tx

A

Corns and callouses

Cause: Chronic trauma/ irritation causes thickening of stratum corneum

Corn - smaller, well-demarcated, square-shouldered
Callous - Larger, diffuse, slope shouldered

Tx: Surgical removal, Keratolytic agent (salicylic acid)

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20
Q

List 3 common cystic lesions

A

Epidermoid/ sebaceous cyst

Implantation dermoid

Dermoid cyst

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21
Q 
Describe lesion 
Cause
Content of lesion 
Associated condition if multiple 
Tx
A

Epidermoid cyst/ Sebaceous cyst

  • Retention cyst due to obstruction of the sebaceous duct
  • True cyst with epithelial lining from hair follicles
  • Spherical and attached to skin with Punctum

Contains cheesy keratin material

Multiple cysts: Gardner’s syndrome (FAP associated with extracolonic manifestation)

Tx - surgical excision

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22
Q

Describe lesion

Cause

A

Implantation dermoid

Epidermal cyst

  • epidermal fragment driven into dermis by penetrating injury
  • History of trauma or scarring
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23
Q

Describe lesions

A

Top: Milia
- Small 1-2mm epidermal cysts on face

Bottom: Pilar cyst
- Trichilemmal cyst, slow-grwoing firm cyst on scalp

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24
Q

Name lesion

A

Multiple epidermal cysts

> > Steatocystoma multiplex

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25
Q

Describe and name lesion

Cause
2 main etiologies and physical difference
Tx

A

Dermoid cyst / Sequestration dermoid

Cause: formed by epidermal cells being sequestrated beneath skin

Etiologies:

  1. Congenital: inclusion of embryonic epithelium at sites of embryonic fusion (midline of scalp, external angle of eye, lower mandible)
  2. Acquired: Epithelium driven beneath skin by puncture wound leads to formation of cystic lesions

Congenital - soft and may transluminate
Acquired - hard and firm

Tx: Surgical excision

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26
Q

List 3 Keratotic lesion

A

Seborrheic keratosis
Actinic keratosis
Keratoacanthoma

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27
Q

Describe and name lesion

Demographics
Cell of origin
Diagnostic features
Tx options

A

Seborrheic keratosis/ Basal cell papilloma/ Senile warts

  • Brown-black, Raised plateau of hypertrophic greasy skin,
  • well-demarcated, plaque-like papules, Waxy with papuliferous surface

Demographic: elderly >70

Cell of origin: Benign overgrowth of the basal layer of epidermis

Dx features:

  • Can be picked off using blunt forceps
  • Leser-Trelat sign: acanthosis nigricans + skin tags + senile warts appear with GI/ lung cancer
Tx: 
o Cryotherapy*
o Curettage/ shave excision
o Electrodesiccation
o CO2 laser ablation
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28
Q

Describe lesion

Areas of skin affected

Tx

A

Actinic keratosis/ Solar keratosis/ Senile keratosis

  • UV-exposed skin
  • Dry, scalpy, crusty surface with erythematous base
  • Early lesions are flat papules
  • Hyperkeratosis and acanthosis with malignant potention

Tx:

  • Excision
  • Currettage
  • Cryosurgery
  • 5-FU cream
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29
Q

Describe and name lesion

Typical area of involvement
Growth pattern

Tx

A

Keratoacanthoma/ Molluscum sebaceum

  • Dome/ nodular, flesh-colored nodule
  • Central crater filled with keratin plug

Area: Common on the face but can occur anywhere with sebaceous glands/ hair-bearing sun-exposed skin

Growth: rapid growth for few weeks, then static and involution

Tx: Excisional biopsy (exclude SCC) and Surgical excision

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30
Q

Naevi

Cause
3 types

A

Developmental abnormality with hyperplasia of incompletely differentiated tissue elements

Types:

  • Melanocytic naevus (Moles)
  • Strawberry naevus (Infantile haemangioma)
  • Sebaceous naevus
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31
Q

Describe lesion

4 subtypes based on age of presentation

A

Melanocytic naevi

Junctional: in children, flat, dark pigmentation

Compound: Young adult, raised, varied pigmentation

Intradermal: old age, dome-shaped, flesh-colored

Congenital: large, dark, raised, thick, hairy

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32
Q

Risk factors of melanocytic naevi malignant transformation

A 
Dysplastic naevus with diameter >2mm 
Family history of skin cancer
Previous skin cancer 
Giant congenital melanocytic naevus (whole trunk black)
Age >50
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33
Q

Ddx melanocytic naevi

A

Melanoma
BCC
Seborrheic keratosis

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34
Q

Describe lesion

Compare sporadic vs familial subtypes

A

Dysplastic naevi

  • Irregular border
  • Speckled pigmentations

Sporadic: a/w caucasians with fair skin with excessive sunlight exposure and freckles
Familial: Dysplastic naevus syndrome, high risk of malignant transformation

35
Q

Describe and name lesion

Cell of origin
Cause
Tx

A

Dermatofibroma (histiocytoma, sclerosing angioma)

  • Site: Most commonly located in lower extremities
  • Size: Usually nodules 0.3 – 1.0 cm but giant lesions > 3 cm have also been described
  • Color: Hyperpigmented
  • Consistency: Firm
  • Associated symptoms: Pruritus
  • Classically dimple when pitched

Cause: History of trauma/ insect bites causing proliferation of fibroblasts, fibrosis and iron pigmentation

Tx:
o Surgical excision
o Cryotherapy with liquid nitrogen

36
Q

Describe lesion

Histological features

Tx

A

Dermatofibrosarcoma protuberans (DFSP)

Painless, indurated plaque with irregular nodules
Diffuse, skin-colored

Histology: cord/ nests of cells invade into adjacent soft tissue

Tx: Wide excisional margin +/- RT

37
Q

Describe and name lesion

  • Cell of origin
  • Presentation
  • Special signs
  • Tx
A

Neurofibroma

Origin: neuromesenchymal origin including Schwann cells, perineurial cells, fibroblasts and mast cells

Presentation: asymptomatic or Tingling sensation in nerve distribution

  • Site: Any subcutaneous tissue, common in forearm
  • Size: Papules or nodules < 2 cm in diameter
  • Shape: Fusiform or sessile/ pedunculated with long axis lying along the length of limb
  • Color: Hyperpigmented
  • Number: Can be solitary but often multiple
  • Composition: Firm and rubbery

Signs:
o Tinel sign = Symptoms of pain and paraesthesia can be elicited
o Button-hole sign = Applying direct pressure may make some neurofibroma seem to retract into the skin

Tx: surgical excision

38
Q

Name lesion

Cause

A

Neurofibromatosis

AD NF-1 and NF-2 mutation

Multiple nodules with cafe au lait pigmentation
Possible malignant transformation
Acoustic neuroma

39
Q

Lipoma

Content
Tx
Malignant features

A

Content: Matured adipocytes in fibrous capsule

Tx: Conservative, excision, liposuction

Malignant features: Pain, rapidly enlarging, skin changes, firm consistency

40
Q

Compare vascular tumor vs vascular malformation in skin

  • Age of onset
  • Size changes
  • Example
A

Vascular tumors

  • Common tumor of infancy, but not present at birth
  • Rapidly increase in size disproportionate to body size, then involution
  • e.g. Strawberry naevus

Vascular malformation

  • Present at birth
  • Grows proportionally to body size
  • Degenerate or hypertrophy (AVM)
  • e.g. arteriovenous malformation, AV fistula
41
Q

Name lesion

Demographic
Growth pattern
Complications
Tx options

A

Haemangioma/ Strawberry naevus

Growth:
• Rapid proliferation of blood vessels in the first year of life (followed by)
• Gradual regression of vascular component with replacement of fibrofatty tissues

Cx:
ulceration and permanent disfigurement
compromise vital organ function including eyes, CNS and circulatory system

Tx: 
Serial observation (wait for involution)
Topical or intralesional corticosteroids 
Topical β-blockers
Pulsed-dye laser (PDL)
Excisional surgery
42
Q

Complications of skin haemangioma

A

Critical compromised blood flow:

  • Bleeding
  • Ulceration
Mass effect: 
- Periorbital hemangioma: Upper eyelid affected: 
>> Stimulus-deprivation amblyopia
>> failure to develop binocular vision 
>> Corneal distortion and astigmatism
  • Airway hemangioma&raquo_space; Airway obstruction
43
Q

Skin examination methods

A

• Dermoscopy

• Diascopy
o Pressing a glass slide onto skin

• Wood’s light
o Examination of difference in pigmentation

44
Q

Biochemical/ serum tests for skin diseases

A

• Serology
o Anti-skin antibodies (pemphigoid and pemphigus)
o ANA, anti-dsDNA, anti-ENA, anti-Jo1
o Anti-HIV

  • Skin swab (bacterial/ virus)
  • Skin scraping (fungus/ scabies mites)

• Skin prick test
o Type I hypersensitivity reaction
o Intradermal injection of common allergens
o Allergens in atopic dermatitis

• Skin patch test
o Type IV hypersensitivity reaction
o Allergens in contact dermatitis

45
Q

Biopsy techniques for soft tissue mass

A

Fine needle aspiration (FNA)

Core-needle biopsy

Incisional biopsy
o Gold standard for lesion > 3 cm

Excisional biopsy
o Gold standard for lesion < 3 cm or for tumours that are probably benign

46
Q

Describe lesion and name

Cause
Types

A

Viral warts

  • Site: Common on hands or areas touched by hands including face, arms and knees
  • Size: < 1 cm in diameter
  • Shape: Hemispherical papule
  • Color: Greyish-brown
  • Surface: Rough and hyperkeratotic
  • Composition: Firm

Cause: human papilloma virus (HPV) infection

Types: 
o Common warts (Verruca vulgaris)
o Plantar warts (Verruca plantaris)
o Flat warts (Verruca plana)
o Periungual warts
o Anogenital warts
47
Q

Viral warts

  • Area of body affected by HPV type 1, 6 and 11
  • Predisposing conditions
A

o HPV Type 1 commonly infects the soles of feet causing plantar warts
o HPB Type 6 and 11 commonly infects the anogenital region causing anogenital warts

Predisposing conditions include eczema (atopic dermatitis) and immunodeficiency (AIDS/ organ transplantation)

48
Q

Viral warts

Treatment

A

Choices of treatment
o Topical salicylic acid* (exfoliates affected epidermis and stimulate local immunity)
o Cryotherapy with liquid nitrogen*
o Surgical excision

49
Q

Describe and name lesion

Typical areas of involvement
Ddx
Etiologies
Tx

A

Acrochordon (skin tag)

  • sites of friction particularly the neck, axilla, inframammary and inguinal region
  • MUST be differentiated from neurofibroma

Etiologies:

  • DM and obesity
  • Crohn’s disease (perianal skin tags)

Tx:
o Excision under LA
o Cryosurgery with liquid nitrogen
o Electrodessication

50
Q

Describe and name lesion

Areas of involvement
Ix and Tx

A

Pyogenic granuloma

  • Benign vascular tumour of the skin or mucous membranes
  • Pyogenic: Surface is often infected and ulcerated
  • Granuloma: Capillary loops grow vigorously and forms a protruding mass of tissue
  • Rapidly growing lump which bleeds easily and discharges serous and purulent fluid

Site: Common on body parts liable to injury such as hands and face

Ix: Excisional biopsy
Tx: Surgical excision, Curettage/ shave excision, Cryotherapy, Injection sclerotherapy, Electrocauterization

51
Q

Describe and name lesion

Cell of origin
Common areas of involvement
Tx

A

Ganglion cyst

Origin: Fluid-filled swelling overlying a joint or tendon sheath
Benign lesions usu. painless, but may lead to pain, weakness and loss of function

Site: Near joint capsules and tendon sheaths
o Dorsal side of the wrist (70%) (most common)
o Volar side of the wrist over scaphotrapezoid joint (20%)

Tx:

  • Conservative with either observation or non-surgical treatment such as aspiration
  • Surgical removal with excision
52
Q

5 types of ulcer edges with examples

A
  1. Sloping - Ischemic venous ulcer/ Healing ulcer/ Traumatic ulcer
  2. Punched-out - Ischemic ulcer/ Deep trophic ulcer/ Syphilitic ulcer
  3. Undermined edge - destroys subcutis quicker than spread - Tuberculous ulcers
  4. Rolled edge - central necrosis with fast periphery growth - BCC
  5. Everted edge - Fast growing infiltrating cellular disease - Squamous cell carcinoma/ Ulcerated adenocarcinoma
53
Q

3 types of ulcer base

A

Granulation tissue
o Red sheet of delicate capillary loops and fibroblasts covered by a thin layer of fibrin or plasma

Dead tissue (i.e. slough)

Tumour
o Base of a squamous cell carcinoma is the malignant tissue itself
o May be slightly vascular or necrotic

54
Q

Differentiate the two sets of lesions

A

Left: Hypertrophic scar

  • Confined within boundaries of scar
  • Site: Any location
  • Develops quickly after injury/ scarring with involution after a year

Right: Keloid scar

  • Extends beyond boundaries of scar
  • Head and neck, upper check and back
  • Develops for years after injury/ scarring with no involution
55
Q

List types of skin vascular tumors

A

• Infantile hemangioma

• Congenital hemangioma
 RICH = Rapidly involuting congenital hemangioma
 NICH = Non-involuting congenital hemangioma

  • Pyogenic granuloma
  • Tufted angioma
  • Kaposiform hemangioendothelioma
56
Q

List types of skin vascular malformations

A

• Capillary malformation
o Port-wine stains
o Nevus simplex (Macular stain)

• Arteriovenous malformation

• Lymphatic malformation
o Macrocystic lymphatic malformation (Cystic hygroma)
o Microcystic lymphatic malformation (Lymphangioma circumscriptum)

• Venous malformation

57
Q

Describe and name the lesion

Common affected areas
Cause
Associated conditions
Tx

A

Port-wine stain
• Low-flow vascular malformations of dermal capillaries and post-capillary venules

Association conditions
o Glaucoma
o Spinal dysraphism
o Soft tissues and bone overgrowth

Site: Common on the face, neck, shoulder and buttock
• Lesion on the face tends to follow the distribution of trigeminal nerve branches (CN V)
• Typically with unilateral or segmental distribution that spares the midline

Tx: Pulsed dye laser (PDL) therapy

58
Q

Describe and name lesion

Cause
Sites

A

Macrocystic lymphatic malformation (Cystic hygroma)
- Presents at birth as a large poorly delimitated, translucent, soft mass

Lymphatic malformations (LM) are benign low-flow vascular lesions composed of dilated lymphatic channels or cysts
Caused by failure of lymphatic channel fusion

Sites: commonly in cervicofacial region, axilla or lateral chest wall

59
Q

List 2 types of lymphatic malformations

A

Macrocystic lymphatic malformation (Cystic hygroma)
• Defined as single or multiple cysts each ≥ 2 cm3

Microcystic lymphatic malformation (Lymphangioma circumscriptum)
• Defined as single or multiple cysts each < 2 cm3

60
Q

Treatment of lymphatic malformations

A

Non-surgical treatment
• Injection sclerotherapy
• Radiofrequency ablation (RFA)

Surgical treatment
• Surgical excision

61
Q

Differentiating features between angiolipoma and lipoma

A

Angiolipoma

  • benign tumour of adipocytes typically occurring in adolescents and young adults
  • Resembles lipoma but are usually painful and tender

Lipomas are not painful or tender

62
Q

Positive signs of Lipoma

A

Surface: Smooth* or lobulated*

Mobility: Mobile in all direction*
• Slip sign*: Edge is soft, compressible and thin which might slip away from the examining fingers

Tenderness: Non-tender*

63
Q

Treatment of lipoma

A

Local excision
• Linear excision along skin creases
• Surgical removal of fat cells and fibrous capsule

Liposuction
• May be considered in large lipoma

64
Q

Complications of sebaceous cysts

A

Sebaceous horn
• Slow discharge of sebum from wide punctum hardens to form a conical spike

Cock’s peculiar tumour
• Infection and ulceration of cyst wall leading to an infected, open, granulating, edematous sebaceous cyst

65
Q

Tx of sebaceous cysts

A

ALL sebaceous cysts are recommended to be excised - Prevent sebaceous cysts from being infected

Elliptical incision for sebaceous cyst to include punctum
Complete excision of cyst and contents

66
Q

SCC of skin

  • Common locations
  • Cell of origin
  • Spread modalities
A

Location of SCC
• Head and neck (55%)
• Dorsum of hands and forearms (18%)
• Legs (13%)

Malignant tumour arising from the epidermis forming the superficial keratinous squamous layer

Mode of spread
• Local spread: Infiltration into epidermis, dermis, adjacent tissues
• Lymphatic spread: Regional lymph nodes is the MOST common site of metastasis
• Hematogenous spread

67
Q

List benign tumors of epidermal appendages

A

Hair follicle:
- Trichofolliculoma, Trichoepithelioma, Trichilemmoma

Sebaceous gland:
- Sebaceous adenoma

Sweat gland
- Cylindroma, Syringoma

68
Q

List pre-malignant skin conditions to SCC

A

Bowen’s disease (SCC-in-situ)
-“Erythroplasia of Queyrat” when penis is involved

Solar keratosis (SCC-in-situ)
- multiple erythematous scaly macules or papules on sites of chronic sun exposure

Marjolin’s ulcer
- long-standing benign ulcers or scars
o Commonest ulcer = Venous ulcer
o Commonest scar = Burns

69
Q

Bowen’s disease

Description
Histological feature
Tx

A

Thick, reddish brown, scaly patch with irregular borders

Histological: Dysplastic cells confined to basal lamina

Tx: Excision, Radiotherapy, Topical 5-FU, Cryotherapy, Photodynamic therapy

70
Q

Paget disease of nipple

Cell of origin
Associated disease
Ix
Tx

A

Mammary ducts to nipple epidermis

Erythema and eczematous lesion of nipple, frequent erosion and ulceration

Associated breast CA

Ix: Incisional biopsy
Tx: Breast CA

71
Q

List 3 common malignant skin cancers

A

SCC
BCC
Malignant melanoma

72
Q

SCC

Risk factors
Classical description
Preferred metastasis
Tx

A

RF:

  • Excessive UV exposure
  • Carcinogens: RT, Arsenic or chromium
  • Non healing wounds or unstable scars
  • Congenital: xeroderma pigmentosa and Albinism
  • Immunosuppression

Classical description

  • Irregular ulcer with everted edge, exophytic growth
  • Non-tender

Metastasis: Lymphatic preferred, haematogenous

Tx:

  • topical 5-FU, RT
  • Wide excision, reconstruction
  • Block LN dissection
73
Q

Basal cell carcinoma

Clinical subtypes
Metastatic potential

A 
Pigmented (common in HK)
Nodular/ Ulcerative 
Superficial 
Cystic 
Morpheaform (Sclerosing)

Rarely spread by LN or blood (c.f. SCC)

74
Q

BCC

Risk factors

A

Non-modifiable factors
• Aging
• White ethnicity
• Family history of BCC

Modifiable factors
• UV light exposure (most important)
• Arsenic exposure
• Ionizing radiation
• Immunosuppression
• Medical conditions
o Gorlin’s syndrome (Basal cell nevus syndrome)
o Xeroderma pigmentosum (XP)
75
Q

BCC

Positive signs/ features
Common sites

A

Site: Most common on the face (70%)

Shape: Nodule/ Pigmented nodule/ Ulcer/ Deep eroding ulcer (rodent ulcer) *
Edge: Rolled edge. Pearly-white edge and well-defined (characteristic)*
Tenderness: Non-tender*
Attached to overlying skin*
Freely mobile over deep structures*

76
Q

BCC

Treatment options

A 
Chemotherapy
• Topical 5-FU
• Topical Imiquimod
Photodynamic therapy
Radiotherapy

Surgical treatment
• Surgical excision***
• Electrodessication and curettage (ED&C)
• Mohs micrographic surgery (MMS)

77
Q

Melanoma

  • Cell of origin
  • Areas of involvement
  • Metastatic potential
A

Origin: Melanocytes in basal epidermis

Areas:

  • UV-exposed area
  • Mucous lining, choroid of eye, meninges, soft tissue

Metastatic: LN and hematogenous

78
Q

Melanoma Clinical subtypes

A

Superficial spreading (Most common): from pre-existing pigmented nevus

Nodular melanoma (most aggressive)

Lentigo maligna melanoma (least aggressive)

Acral lentiginous melanoma: on palms and soles

Subungal melanoma

79
Q

Two prognostic system for melanoma

A

Breslow scale (thickness and survival)

Clark’s level of invasion (skin histological layer and survival)

Both correlate with LN metastases and survival
Thinner lesion = better prognosis

80
Q

Cardinal symptoms of malignant transformation of pigmented nevus/ mole

A

Increase in size, shape or thickness

Changes in surface
• Loss of normal skin markings (creases) over the mole
• Becomes rough and scaly

Changes in color
• Darker as malignant melanocytes produce more melanin

Itchiness

Bleeding
• Late and slight sign
• Overlying epithelium becomes anoxic as tumour cells multiply

Evidence of local or distant spread
• Spread diffusely to surrounding skin to produce a brown halo around the primary lesion

81
Q

ABCDE acronym (New York University 1985) to identify melanoma at early stage

A

• Asymmetry
o If a lesion is bisected then one half is not identical to the other half

• Border irregularities

• Color variegation
o Presence of multiple shades of red, blue, black, gray or white

• Diameter ≥ 6 mm

• Evolution (Enlarging/ Elevation)
o Lesion that is changing in size, shape, color or a new lesion

82
Q

Melanoma

Diagnostic Ix

A

excisional biopsy:
Full-thickness excisional biopsy of suspicious lesions with 1 – 3 mm margin of normal skin

Sentinel lymph node biopsy (SLNB)
• Lymphatic mapping with SLNB for prognosis and staging

83
Q

Melanoma

Tx

A 
Checkpoint inhibitors*
• CTLA-4 inhibitor
• Anti-programmed cell death 1 (PD-1) antibodies
Cytokines
• Interferon-α (IFN-α)
• Interleukin-2 (IL-2)
Intralesional BCG therapy

Surgery:
Surgical resection with adequate margin ± BLock Lymph node dissection

84
Q

Compare benign skin tumors and malignant skin tumors

  • Size
  • Surface
  • Border
  • Elevation
  • LN
A 
Benign:
Stable in size 
No ulceration or bleed 
Well-demarcated border 
Flat 
No enlarged regional LN 
No satellite lesions

Malignant = opposite of everything

MBBS IV - Junior Clerkship WCS (131 decks)

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