List II - Less Common 'Know of' Conditions Flashcards
1
Q
What is solar keratosis also known as?
A
- Actinic keratosis
2
Q
What are the clinical features of actinic keratosis?
A
- Actinic keratosis is viewed as a premalignant lesion because there are atypical keratinocytes present in the epidermis
- In a person with 7 actinic keratosis, the risks of subsequent SCC is of the order of 10% at 10 years
- Primary lesion is a rough erythematous papule with a white to yellow scale
- Lesions are typically clustered at sites of chronic sun exposure
3
Q
What does actinic keratosis look like?
A
- A flat or thickened papule or plaque
- White or yellow; scaly, warty or horny surface
- Skin coloured, red or pigmented
- Tender or asymptomatic
4
Q
What is the treatment of actinic keratosis?
A
- Actinic keratoses are usually removed because they are unsightly or uncomfortable, or because of the risk that skin cancer may develop in them
5
Q
What are the treatment options for actinic keratosis?
A
- Cryotherapy using liquid nitrogen
- Shave, curettage and electrocautery
- Excision
- Field treatments
- Diclofenac - gel BD for 3 months
- 5-fluorouracil BD for 2 to 8 weeks
- Imiquimod cream 2 to 3 times weekly for 4 to 16 weeks
- Photodynamic therapy
- Ingenol mebutate gel 2 to 3 applications
6
Q
What is a keloid scar?
A
- Tumour like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound
7
Q
What are the predisposing factors for developing a keloid scar?
A
- Ethinicity: More common in people with dark skin
* Occur more commonly in young adults, rare in the elderly
8
Q
What are the common sites of keloid scars?
A
- Order of decreasing frequency:
- Sternum
- Shoulder
- Neck
- Face
- Extensor surface of limbs
- Trunk
9
Q
How can the risk of Keloid scars be reduced in clinical practice/surgery?
A
- Keloid scars are less likely if the incisions are made along relaxed skin tension lines
- Langer lines were historically used to determine the optimal incision line
- Better cosmetic results are seen when following Langer lines than skin tension lines
10
Q
What are the management options for keloid scars?
A
- Early keloids may be treated with intra-lesional steroids e.g. triamcinolone
- Excision may sometimes be required
11
Q
What is a ganglion?
A
- Presents as a cyst arising from a joint or tendon sheath
- Most commonly seen around the back of the wrist and are 3 times more common in women
- Ganglions often disappear spontaneously after several months
12
Q
What is Kaposi’s sarcoma?
A
- Associated with HIV
- Caused by human herpes virus 8 (HHV-8)
- Presents as purple papules on the skin or mucosa (e.g. GI and respiratory tract)
- Skin lesions may later ulcerate
- Respiratory involvement may cause massive haemoptysis and pleural effusion
- Management is with radiotherapy and resection
13
Q
How is HHV8 transmitted?
A
- Sexual contact
14
Q
What are the types of kapossi’s sarcoma?
A
- Classic - older males, slow growing, affects legs
- Endemic - young adult males, africa, aggressive
- Epidemic - AIDS, affects different body parts such as skin, mouth, GI tract and lungs
- Immunosuppression related - skin, develops following organ transplantation
15
Q
What is the treatment of Kaposi’s sarcoma?
A
- Treatment directed at underlying cause
- HIV - HAART
- Cytotoxic chemotherapy agents
16
Q
What are the vascular skin lesions?
A
- Pyogenic granuloma
- Port wine stain
- Haemangioma
- Angiosarcoma
- Microvenular hemangioma
- Angioserpiginosum
17
Q
What is a pyogenic granuloma?
A
- Relatively common benign skin lesion
- (may also be known as eruptive haemangioma)
- Unknown cause but has a number of linked factors:
- Trauma
- Pregnancy
- More common in women and young adults
18
Q
What are the features of pyogenic granuloma?
A
- Most common sites are head/neck, upper trunk and hands
- Lesions in the oral mucosa are common in pregnancy
- Initially small red/brown spot
- Rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
- Lesions may bleed profusely or ulcerate
19
Q
What is the management of pyogenic granuloma?
A
- Pregnancy associated lesions often resolve spontaneously post partum
- Other lesions persist - removal methods include curettage and cauterisation, cryotherapy, excision
20
Q
What is a port wine stain?
A
- Vascular birth marks that tend to be unilateral
- Deep red of purple in colour
- Unlike other vascular birthmarks such as salmon patches and strawberry haemangiomas, they do not spontaneously resolve, can become darker and raised over time
- Treatment is with cosmetic camoflage or laser therapy
21
Q
What is associated with the port wine stain?
A
- Sturge-Weber syndrome
- Port wine stain externally on the face and head with trigeminal nerve involvement internally
22
Q
What is a haemangioma?
A
- AKA strawberry naevus / capillary haemangioma
- Usually not present at birth but may develop rapidly in the first month of life
- Appear as erythematous, raised and multilobed tumours
- Typically increase in size until around 6-9 months before regressing over the next few years (around 95% resolve before the age of 10 years)
23
Q
What are the common sites of a haemangioma?
A
- Face, scalp and back
* Rarely present in the upper respiratory tract leading to potential airway obstruction
24
Q
Who do haemangiomas affect?
A
- Around 10% of white infants
- Female infants, premature infants and those of mothers who have undergone chorionic villous sampling are more likely to be affected
25
What are the potential complications of haemangiomas?
* Mechanical e.g. obstructing visual fields or airway
* Bleeding
* Ulceration
* Thrombocytopenia
26
If treatment is required for haemangioma e.g. visual field obstruction, what are the treatments?
* Propanolol is increasingly replacing systemic steroids
| * Topical beta-blockers such as timolol are sometimes used
27
What is cavernous haemangioma?
* Type of deep capillary haemangioma
28
What is an angiosarcoma?
* Aggressive neoplasm mainly divided into 3 variants:
- Angiosarcoma of the head and scalp, lyphoedema-associated angiosarcoma and radiationinduced angio-sarcoma
- Characterised by a tendency to metastasize to regional lymph nodes and lungs
- Prognosis is poor
- Clinically, early lesions develop as ill defined violaceous to bluish areas with an indurated border and advanced lesions become elevated or nodular and occasionally ulcerated
29
What is the appearance of angiosarcoma?
* Homegenous pattern with combinations of colurs i.e. whitish, pinkish, reddish, bluish or violaceous
* White lines at the nodular parts
30
What is a cherry haemangioma?
* 'Campbell de Morgan spots' are benign skin lesions which contain an abnormal proliferation of capillaries
* More common with advancing age and affect men and women equally
31
What is the appearance of Campbell de Morgan spots?
* Erythematous, papular lesions
* Typically 1-3 mm in size
* Non-blanching
* Not found on the mucous membranes
As they are benign, no treatment is usually required
32
What is a mircovenular haemangioma?
* Acquired, slowly growing, asymptomatic, benign vascular tumour that usually presents on the upper limbs, forearms or trunk of young to middle aged adults
* Appears as sharply circumscribed, bright red, solitary lesions varying in size from 0.5 to 2 cm
33
What is the appearance of a microvenular haemangioma?
* Diffuse erythema with multiple well-demarcated small red globules of different sizes
* Peripheral fine pigment network
34
What is angioma serpiginosum?
* Benign vascular disorder, characterised clinically by multiple minute, red to purple. grouped macules distributed in a serpiginous or gyrate pattern
* Numerous small, relatively well demarcated, round to oval red lacunae
