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AY Dermatology > Leg Ulcers & skin cancer/lesions > Flashcards

Leg Ulcers & skin cancer/lesions Flashcards

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Dermatology Board Prep 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
Q

Appearance of Bowen’s disease

A

Scaly patch/plaque
Irregular border
No dermal invasion

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26
Q

Which HPV type are viral precursors of SCC associated with?

A

Type 16

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27
Q

Clinical presentation of SCC

A

Hyoerkeratotic (crusted) lump or ulcer
Arises on sun damaged skin
Grows relatively past
May be painful and/or bleed

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28
Q

Risk of metastasis in SCC

A

5%

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29
Q

Adverse prognostic featured of SCC

A

Thickness >4mm
Lymphatic/vascular soace invasion
Perineurak spread

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30
Q

EArly jn embryogenesis melanoblasts migrate from the neural crest to______

A

Skin
Uveal tract
Leptomeninges

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31
Q

What melanin causes red hair?

A

Phaemelanjn

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32
Q

How many defective copies of MC1R are needed to cause freckling?

A

One

33
Q

How many defective copies of MC1R are needed to cause freckling & red hair?

A

Two

34
Q

What are freckles?m

A

Patchy increases in melanin pigmentation

35
Q

What are actinitic lentigines also known as?

A

‘Age’ or ‘liver’ spots

36
Q

Types of leg ulcer?

A 
Venous 
Arterial 
Diabetic 
Vasculitic
Malignant
37
Q

Which lesions tend to be ‘giant-garment’ type lesions?

A

Congenital melanocytic naevi

38
Q

What has more malignant potential accquired or congenital melanocytic naevi?

A

Congenital

39
Q

How big are dysplastic naevi?

A

Generally >6mm

40
Q

Do familial or sporadic dysplatic naevi have a higher risk of melanoma?

A

Familial

41
Q

What are blue naevi made of?

A

pigment rich dendritic spindle cells

42
Q

What is the usual age range for spitz naevi?

A
43
Q

Do spitz naevi tend to be premalignant or benign?

A

Benign

44
Q

Is malignant melanoma more common in males or females?

A

Females (2:1)

45
Q

Which lesions tend to be ‘giant-garment’ type lesions?

A

Congenital melanocytic naevi

46
Q

What has more malignant potential accquired or congenital melanocytic naevi?

A

Congenital

47
Q

How big are dysplastic naevi?

A

Generally >6mm

48
Q

Do familial or sporadic dysplatic naevi have a higher risk of melanoma?

A

Familial

49
Q

What are blue naevi made of?

A

pigment rich dendritic spindle cells

50
Q

What is the usual age range for spitz naevi?

A
51
Q

Do spitz naevi tend to be premalignant or benign?

A

Benign

52
Q

Is malignant melanoma more common in males or females?

A

Females (2:1)

53
Q

What features would make you suspect melanoma?

A 
New pigmented lesion develops in adulthood
Irregular pigmentation 
Change in shape 
Ulceration 
Bleeding 
Satellite nodules
54
Q

What are the 4 main types of melanoma?

A

Superficial spreading
Acral/mucosal
Lentigo
Nodular

55
Q

Where on the body is superficial melanoma usually found?

A

Trunk of men

Legs of women

56
Q

What is the growth pattern of auperficial spreading melanoma?

A

Horizontal growth phase
Vertical growth phase
(only VGP melanomas can metastasise)

57
Q

Where are acral/mucosal melanomas usually found?

A

Palms
Soles
Nails

58
Q

Where is nodular melanoma usually found?

A

Trunk of elderly patients

59
Q

Growth pattern of nodular melanoma?

A

No horizontal growth phase

Only VGP - more aggresive

60
Q

Which grading of melanom has the best prognosis?

A

pTis

61
Q

Which grading of melanoma has the worst prognosis?

A

pT4

62
Q

Adverse prognostic factors for melanoma

A 
Ulceration (suffi b)
High mitotic rate 
lymphovascular invasion 
Satellites
Sentinel node involvement
63
Q

What is the first phase of malignant melanoma spread?

A

local dermal lymphatics (satellite deposits)

64
Q

What is the treatment for regional lymph node metastasis of MM?

A

Radical lymphadenectomy

65
Q

\If a melanoma is in-situ how far around should the excision be made?

A

5mm

66
Q

If the melanoma is invasive but

A

1cm

67
Q

If the melanoma is invasive and >1mm thick how much clearance should be left around the lesion?

A

2cm

68
Q

What genetic therapies are avaliable for melanoma?

A

Imatinib

for c-kit or BRAF

69
Q

What are seborrheic keratosis?

A

very common benign proliferations of epidermal keratinocytes

70
Q

Clinical presentation of seborrhoiec keratoses

A 
Brown/black greasy lesions 
Often on trunk 
Usually multiple 
'STUCK-ON' APPEARANCE 
Often 'warty' but may be flat 
Regular border
71
Q

Management of seborrhoeic keratoses

A

Reassurance

freeze, currete or shave

72
Q

Appearance of dermatofibroma

A

Deep (dermal), brown/grey, firm nodules

73
Q

What is talon noir?

A

Subcorneal haematoma

74
Q

Features of pyoderma gangrenosum

A

Typically on lower limbs
Initially small red papule
later, depp, red. mecrotic ulders with violaceous border
May be accompanied by systemic symptoms

75
Q

Causes of pyoderma gangrenosum

A

50% idiopathic
IBD
RA, SLE

76
Q

First line management of pyoderma gangrenosum

A

Oral steroids first line

Other immunosupression in difficult cases

77
Q

What is the difference between ephilides & lentigines?

A 
Ephilides = increased production of melanin, same number of melanocytes 
Lentigines = increased number of melanocytes
78
Q

Why do halo naevi have hyeprpigmentation around them?

A

Autoimmune benign process

79
Q

What is hutchinsons sign?

A

pigmented extension into nail fold

AY Dermatology (11 decks)

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