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Leg Ulcers & skin cancer/lesions Flashcards

1
Q

What conditions are associated with leg ulcers?

A 
Varicose veins 
DVT
Clotting problems 
Peripheral vascular disease
Arterial disease 
Diabetes
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2
Q

What is the first line investigation for leg ulcers?

A

ABPI

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3
Q

What is a normal range of ABPI?

A

0.8-1.3

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4
Q

What ABPI range would indicate vascular disease?

A
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5
Q

What ABPI would indicate calcification?

A

> 1.5

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6
Q

What secondary investigation might be used if calcificationin a leg ulcer is suspected?

A

Duplex

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7
Q

Management of venous ulcers

A

Control pain (gabapentin, amytripptilline)
Non-adherent dressing
De-sloughing agent if necessary (e.g. hydrogel)
4 layer compression bandaging
Leg elevation

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8
Q

How long does 4 layer bandaging aim to have the ulcer healed by?

A

12 weeks

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9
Q

Where to venous ulcers tend to develop?

A

Around the malleoli

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10
Q

Where are diabetic ulcers and arterial ulcers commonly found?

A

Around pressure sites on the feet such as the heel or where shoes rub

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11
Q

What must be considered in a leg ulcer that isn’t healing?

A

Malignancy

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12
Q

Description of venous ulcer

A

Shallow edge

“Like a beach”

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13
Q

Description of arterial ulcer

A

Very sharp
Cliff-like edges
“Punched-out”

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14
Q

Which skin cancers tend to be caused by prolonged UV exposure?

A

SCC

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15
Q

Which skin cancers tend to be caused by intermittent sunburn?

A

CCC

Melanoma

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16
Q

Risk factors for skin cancer

A 
Sun exposure 
Genetic predisposition 
Immunosuppression 
HPV infection 
Other environmental carcinogens 
Phototoxic drugs
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17
Q

Examples of phototoxic drugs

A 
Voriconazole 
Thiazide diuretics 
NSAIDs 
Anti-TNF
Azathioprine
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18
Q

What tyoe of melanin do skin type 1’s have more of?

A

Phaeomelanin

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19
Q

What absorbs melanin more efficiently phaeomelanjn or eumelanin?

A

Eumelanin

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20
Q

What is the ACBDE of diagnosing melanoma?

A 
A - Assymetry 
B - Border
C - Colour 
D - Diameter 
E - Evolution
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21
Q

Clinical presentation of basal cell carcinoma

A 
Slow growing lump or non-healing ulcer 
Painless 
'Pearly' or translucent 
Visible, aborizing blood vessels 
Central ulceration - "rodent ulcer" 
Can present as scaly plaque - "superficial" 
Can be infiltrative - "morphoeic"
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22
Q

Pattern of spread of BCC

A

Locally invasive but rarely metastasise

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23
Q

Examples of precursors to SCC

A

Acinitic keratoses
Bowen’s disease
Keratocanthoma
Viral precursors

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24
Q

What is Bowen’s disease.

A

Squamous cell carcinoma in-situ

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25
Appearance of Bowen's disease
Scaly patch/plaque Irregular border No dermal invasion
26
Which HPV type are viral precursors of SCC associated with?
Type 16
27
Clinical presentation of SCC
Hyoerkeratotic (crusted) lump or ulcer Arises on sun damaged skin Grows relatively past May be painful and/or bleed
28
Risk of metastasis in SCC
5%
29
Adverse prognostic featured of SCC
Thickness >4mm Lymphatic/vascular soace invasion Perineurak spread
30
EArly jn embryogenesis melanoblasts migrate from the neural crest to______
Skin Uveal tract Leptomeninges
31
What melanin causes red hair?
Phaemelanjn
32
How many defective copies of MC1R are needed to cause freckling?
One
33
How many defective copies of MC1R are needed to cause freckling & red hair?
Two
34
What are freckles?m
Patchy increases in melanin pigmentation
35
What are actinitic lentigines also known as?
'Age' or 'liver' spots
36
Types of leg ulcer?
``` Venous Arterial Diabetic Vasculitic Malignant ```
37
Which lesions tend to be 'giant-garment' type lesions?
Congenital melanocytic naevi
38
What has more malignant potential accquired or congenital melanocytic naevi?
Congenital
39
How big are dysplastic naevi?
Generally >6mm
40
Do familial or sporadic dysplatic naevi have a higher risk of melanoma?
Familial
41
What are blue naevi made of?
pigment rich dendritic spindle cells
42
What is the usual age range for spitz naevi?
43
Do spitz naevi tend to be premalignant or benign?
Benign
44
Is malignant melanoma more common in males or females?
Females (2:1)
45
Which lesions tend to be 'giant-garment' type lesions?
Congenital melanocytic naevi
46
What has more malignant potential accquired or congenital melanocytic naevi?
Congenital
47
How big are dysplastic naevi?
Generally >6mm
48
Do familial or sporadic dysplatic naevi have a higher risk of melanoma?
Familial
49
What are blue naevi made of?
pigment rich dendritic spindle cells
50
What is the usual age range for spitz naevi?
51
Do spitz naevi tend to be premalignant or benign?
Benign
52
Is malignant melanoma more common in males or females?
Females (2:1)
53
What features would make you suspect melanoma?
``` New pigmented lesion develops in adulthood Irregular pigmentation Change in shape Ulceration Bleeding Satellite nodules ```
54
What are the 4 main types of melanoma?
Superficial spreading Acral/mucosal Lentigo Nodular
55
Where on the body is superficial melanoma usually found?
Trunk of men | Legs of women
56
What is the growth pattern of auperficial spreading melanoma?
Horizontal growth phase Vertical growth phase (only VGP melanomas can metastasise)
57
Where are acral/mucosal melanomas usually found?
Palms Soles Nails
58
Where is nodular melanoma usually found?
Trunk of elderly patients
59
Growth pattern of nodular melanoma?
No horizontal growth phase | Only VGP - more aggresive
60
Which grading of melanom has the best prognosis?
pTis
61
Which grading of melanoma has the worst prognosis?
pT4
62
Adverse prognostic factors for melanoma
``` Ulceration (suffi b) High mitotic rate lymphovascular invasion Satellites Sentinel node involvement ```
63
What is the first phase of malignant melanoma spread?
local dermal lymphatics (satellite deposits)
64
What is the treatment for regional lymph node metastasis of MM?
Radical lymphadenectomy
65
\If a melanoma is in-situ how far around should the excision be made?
5mm
66
If the melanoma is invasive but
1cm
67
If the melanoma is invasive and >1mm thick how much clearance should be left around the lesion?
2cm
68
What genetic therapies are avaliable for melanoma?
Imatinib | for c-kit or BRAF
69
What are seborrheic keratosis?
very common benign proliferations of epidermal keratinocytes
70
Clinical presentation of seborrhoiec keratoses
``` Brown/black greasy lesions Often on trunk Usually multiple 'STUCK-ON' APPEARANCE Often 'warty' but may be flat Regular border ```
71
Management of seborrhoeic keratoses
Reassurance | freeze, currete or shave
72
Appearance of dermatofibroma
Deep (dermal), brown/grey, firm nodules
73
What is talon noir?
Subcorneal haematoma
74
Features of pyoderma gangrenosum
Typically on lower limbs Initially small red papule later, depp, red. mecrotic ulders with violaceous border May be accompanied by systemic symptoms
75
Causes of pyoderma gangrenosum
50% idiopathic IBD RA, SLE
76
First line management of pyoderma gangrenosum
Oral steroids first line | Other immunosupression in difficult cases
77
What is the difference between ephilides & lentigines?
``` Ephilides = increased production of melanin, same number of melanocytes Lentigines = increased number of melanocytes ```
78
Why do halo naevi have hyeprpigmentation around them?
Autoimmune benign process
79
What is hutchinsons sign?
pigmented extension into nail fold

AY Dermatology (11 decks)

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