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Joints, bones and skin > Malignant melanoma/cutaneous warts/benign tumours/back pain > Flashcards

Malignant melanoma/cutaneous warts/benign tumours/back pain Flashcards

1
Q

Breslow thickness that means large chanec of metastases

A

<1mm

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2
Q

Risk factors malignant melanoma

A

Sun exposure
Sunbed use under 25 esp
Fair skin - fitzgerald type I, freckles Red hair
Naevi - atypical mole syndrome
FH, prev cancer histtory
Immunosupressed

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3
Q

How to describe a mole

A

A-E
Asymmetrical/symmetrical
Borders
Colour - more than one
Diameter - over 5mm
Evolving - change over time

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4
Q

What features of melanoma get 2 points?

A

Change in shape
Irergular shape or colour

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5
Q

What features get 1 score? (minor) in melanoma

A

Largest diameter
Inflammation
Oozing
Change in sensation

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6
Q

Other concerning features of melanoma that are not on checklist

A
  • New mole after puberty
  • Change in longstanding mole
  • Moles 3 + colours
  • New pigmented line in nail
  • 8 weeks over
  • Lost shape or symmetry
  • Itch = not considered a feature alone or bleeding
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6
Q

Other concerning features of melanoma that are not on checklist

A
  • New mole after puberty
  • Change in longstanding mole
  • Moles 3 + colours
  • New pigmented line in nail
  • 8 weeks over
  • Lost shape or symmetry
  • Itch = not considered a feature alone or bleeding
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7
Q

What is an amelonoma melonoma?

A

No pigmentation

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8
Q

Breslow thickness related to survival with melanoma

A

Tumor over 3mm depth = 40% survival 5 years

1-3mm = 70%

Below = 90%

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9
Q

What is melonoma? + types

A

Malignanat tumour from melanocytes
Superifical spreading
Lentigo
Acral lentiginous

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10
Q

Facros for melanoma

A

A personal history of skin cancer, melanoma, or atypical naevi.
A family history of melanoma.
Pale skin (Fitzpatrick Skin Type I and II) that burns easily.
Red or light-coloured hair (for example, blonde).
High freckle density.
Light coloured eyes (for example, blue eyes).
History of sunburn, particularly blistering sunburn in childhood.
A large number of moles, or large congenital naevi.
Sun exposure — the risk is higher with intermittent sun exposure than cumulative chronic exposure.
Use of tanning beds or sun beds, particularly if 10 or more sessions.
Increasing age — the incidence of malignant melanoma increases with age during adolescence and is highest in the elderly.
Outdoor occupation.
Immunosuppression.
Genetic syndromes with skin cancer predisposition (for example, xeroderma pigmentosum)

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11
Q

What is the ugly ducklng sign?

A

Atypical melanocytic lesions different from surrounding moles

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12
Q

Investigations melanoma

A

Dermatoscope
Palpate lymph nodules on exam
Biopsy

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12
Q

7 point checklist for melanoma - what is a score

A

Over 3
Major:
Change in size
Irregular shape
Irregular colour
Minor:
Largest diameter 7mm or more
Inflammation
OOzing
Change in sensation incl ithc

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12
Q

7 point checklist for melanoma - what is a score

A

Over 3
Major:
Change in size
Irregular shape
Irregular colour
Minor:
Largest diameter 7mm or more
Inflammation
Oozing
Change in sensation incl ithc

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13
Q

Differentials melanoma

A

Angiomas and hemangiomas
Angiokeratomas
Dermatofobromas
Freckles
Kaposis sarcoma - malignant growth of blood vessels Lentigines -
Moles
Pigmented BCC
Pyogenic granulomas
Seborrheic keratoses

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13
Q

Differentials melanoma

A

Angiomas and hemangiomas
Angiokeratomas
Dermatofobromas
Freckles
Kaposis sarcoma - malignant growth of blood vessels Lentigines -
Moles
Pigmented BCC
Pyogenic granulomas
Seborrheic keratoses

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14
Q

When refer sus melanoma?

A

Score of 3 + on weighted 7 point checklist
Dermoscopy suggests
Nail changes or lesino under nail
Biopsy confirmed

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15
Q

Precursors for squamous cell carcinoma

A

Acitinic keratosis, Bowens disease

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16
Q

What impaired immune functions can cause SCC?

A

Solid organ transplants
Chronic lymphatic leukaemia
Rheumatoid arthritis - DMARD or biologic
Xeroderma pigmentosa

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17
Q

Chronic inflammatory skin conditions

A
  • Hypertrophic lichen planus
  • Chronic ulcers
  • Lichen sclerosis
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18
Q

Features of squamous cell carcinoma of skin?

A

Raised lesion on skin

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19
Q

Basal cell carcinoma

A

Ulcer with raised rolled edge
Prominent fine blood vessels around a lesion or nodule on skin
Pearly or waxy nodules

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20
Q

Diagnosis of BCC

A

Excision biopsy

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21
Q

What do seborrheuc keratosis look like?

A

Proud, brown plaqurs - look stuck on

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22
Q

Why are seborrheic keratosis pigmented?

A

Keratinocytes proliferate receive more melanin from melanocytes (but originates in keratinocytes)
Keratinocytes on top of each other appear darker
Small cysts of keratin on surface
Horn cysts

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23
Q

Which is most common skin tumour?

A

Benign basal tumour

24
Q

What does SCC look like?

A

Lump with horn on tip
Well differentiated
Base of horn

25
Q

What can a poorly differentiated SCC look like?

A

BCC

26
Q

What is rate of growth of SCC?

A

Rapid growing in 3 months

27
Q

Which skin tumours are painful

A

SCC and BCC

28
Q

Which age group are more likely BCC?

A

Younger people

29
Q

Distribution of BCC

A

and present most frequently on the trunk and shins

30
Q

Morphology of BCC

A

Expand slowly as a red / pink patch
Develop a very fine raised ‘whipcord’ edge
As they enlarge the surface becomes more fragile developing focal erosions and crust

31
Q

Who is likely to get SCCs

A

Patients with xeroderma pigmentosum, albinism or epidermolysis bullosa can develop lesions at a very young age
Phototherapy
Men
Excessive exposure to sunlight
Immunosupressive therapy
Chronic inflammation
Older people

32
Q

Distribution of SCC?

A

Sun exposed sites
Backs of hands and forearms, upper part of face, lower lip and pinna

32
Q

Distribution of SCC?

A

Sun exposed sites
Backs of hands and forearms, upper part of face, lower lip and pinna

33
Q

Morphology SCC?

A

Firm to palpate
Nodular
PLaque like
Verocous

34
Q

Well differentiated vs poorly differentiated

A

Well = slower growing, keratotic surface in early stages, ulcerate, shed later, eventually csues elser indurated, eroded margin, purulent exuding surface that bleeds rather easily
Poorly diff - organisation diminsihes - keratin is sparse or absent.

35
Q

Treatment for skin cancers

A

Surgical excision
Chemo/radiotherapy for metastases

36
Q

Treatment for acitniic keratosis

A

fluorouracil. imiquimod ingenol mebutate or diclofenac
Freezing therapy
Scraping
Laser therapy
Photodync#amic therapy

37
Q

What virus causes verrucas

A

HPV

38
Q

What HPVs increase risk of cervical cancer?

A

16+18

39
Q

Treatment for verrucas?

A

Salicyclic acid
Cryotherapy
Managed in primary care

40
Q

When to refer verrucas?

A
  • Persistent
  • Large
  • Quick growing, changes
  • Facial
  • Complications of immunosupression
  • Uncertain if wart or different lesion
41
Q

Exogenous eczema

A
  • Contact dermatitis
  • Photosensitive
  • Lichen simplex - eczema due to scratching
  • Asteatotic - crazy paving
42
Q

Endogenous eczema

A
  • Atopic eczema
  • Discoid
  • Eczema due to venous insufficiency - varicose/venous
43
Q

What is the conus medularis?

A

Where spinal tracts end
After this is cauda equina

44
Q

What is anterior lithiasis?

A

Anterior displacement of vertberal body relative to one below

45
Q

What is spondylosis?

A

Arthritis of the spine

46
Q

What is major cause of spinal stenosis?

A

Thickening of the ligamentum flavum

47
Q

What is radiculopathy?

A

imparment of nerve root → radiating pain. Pain, muscle weakness, numbness, itngling

48
Q

Red flags cauda equina

A

saddle anaesthesia, numbness, tingling, reduced tone anal sphinvtre, ass with lower leg weakness

49
Q

Cauda equina vs sciatica sides

A

Cauda equina is bilateral, sciatica is unilateral

50
Q

Visceral causes of back pain

A
  • Waves of pain
  • Aortic aneurysm
  • Chronic PID
  • Prostatitism
  • Endometriosis
  • Nehrolithiasis ‘Pulonephrosism’
  • Perenephric avscess
51
Q

5 top places metastases to spine originate from

A

lung, prostate, breast, kidney. thyroid
Multiple myeloma in older patients

52
Q

SCAM for lesions

A

Site
Size and shape
Colour
Ass symtpoms painful, necrotic
Margin and morphology

53
Q

What does BCC develop from?

A

Basal cell layer of epidermis

54
Q

3 types of BCC

A

Nodulaar - pearly shiny nodules, rolled borders
Superficial - pink, well defined, scaly
Morpheaform - infiltrating. Ill defined pale scar
(pigmented - melanin present0

55
Q

What is a superficial spreading melanoma

A

Flat pigemneted lesion w asymetrical or irregular borders
Most comon type
Epidermis for long periods

56
Q

WHat is a nodular melanoma

A

Atypical nodule - ulcerate an dbleed easily
Pigemented or non pigemented

57
Q

What is a lentigo maligna melanoma

A

Develops from preinvasive phase phase lentigo maligna
Irregular shaped brown macule grows slowkly and darkend/becomes irregular
Initially horizontal growth but can -> nodules and vertical growth
>60s esp head and neck

58
Q

Acral lentiginous melanoma what is it

A

Most common on soles of feet, plams, nail beds
Falt pigemented area, slow increasing size
smooth then thicker and irregular, dry or warty
More common in darker skin types and >40s

59
Q

What is lentifos maligna

A

Hutchinsons melanotic freckle
Precurose to lentigo maligna melanoma
Slow growing or hcanging patch of discoloured skin in situ
face or neck - 5-20 years growth

60
Q

Rare melanomas

A

Desmoplastic.
Malignant blue naevus.
Mucosal.
Neurotropic.
Ocular melanoma.
Spitzoid.

61
Q

When refer 2ww pathway fro melanoma

A

They have a suspicious pigmented lesion with a weighted 7-point checklist score of 3 or more.
Dermoscopy suggests melanoma.
There are nail changes, such as a new pigmented line in the nail (especially if there is associated damage to the nail), or a lesion growing under the nail.
They have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear.
There is any doubt about the lesion, or there is a history of recent change.

Consider if:
A pigmented or non-pigmented skin lesion that suggests nodular melanoma.
Any major feature in the 7-point checklist, or any features of the ABCDE system.

62
Q
A

Joints, bones and skin (31 decks)

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