Malignant melanoma/cutaneous warts/benign tumours/back pain Flashcards
Breslow thickness that means large chanec of metastases
<1mm
Risk factors malignant melanoma
Sun exposure
Sunbed use under 25 esp
Fair skin - fitzgerald type I, freckles Red hair
Naevi - atypical mole syndrome
FH, prev cancer histtory
Immunosupressed
How to describe a mole
A-E
Asymmetrical/symmetrical
Borders
Colour - more than one
Diameter - over 5mm
Evolving - change over time
What features of melanoma get 2 points?
Change in shape
Irergular shape or colour
What features get 1 score? (minor) in melanoma
Largest diameter
Inflammation
Oozing
Change in sensation
Other concerning features of melanoma that are not on checklist
- 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
Other concerning features of melanoma that are not on checklist
- 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
What is an amelonoma melonoma?
No pigmentation
Breslow thickness related to survival with melanoma
Tumor over 3mm depth = 40% survival 5 years
1-3mm = 70%
Below = 90%
What is melonoma? + types
Malignanat tumour from melanocytes
Superifical spreading
Lentigo
Acral lentiginous
Facros for melanoma
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)
What is the ugly ducklng sign?
Atypical melanocytic lesions different from surrounding moles
Investigations melanoma
Dermatoscope
Palpate lymph nodules on exam
Biopsy
7 point checklist for melanoma - what is a score
Over 3
Major:
Change in size
Irregular shape
Irregular colour
Minor:
Largest diameter 7mm or more
Inflammation
OOzing
Change in sensation incl ithc
7 point checklist for melanoma - what is a score
Over 3
Major:
Change in size
Irregular shape
Irregular colour
Minor:
Largest diameter 7mm or more
Inflammation
Oozing
Change in sensation incl ithc
Differentials melanoma
Angiomas and hemangiomas
Angiokeratomas
Dermatofobromas
Freckles
Kaposis sarcoma - malignant growth of blood vessels Lentigines -
Moles
Pigmented BCC
Pyogenic granulomas
Seborrheic keratoses
Differentials melanoma
Angiomas and hemangiomas
Angiokeratomas
Dermatofobromas
Freckles
Kaposis sarcoma - malignant growth of blood vessels Lentigines -
Moles
Pigmented BCC
Pyogenic granulomas
Seborrheic keratoses
When refer sus melanoma?
Score of 3 + on weighted 7 point checklist
Dermoscopy suggests
Nail changes or lesino under nail
Biopsy confirmed
Precursors for squamous cell carcinoma
Acitinic keratosis, Bowens disease
What impaired immune functions can cause SCC?
Solid organ transplants
Chronic lymphatic leukaemia
Rheumatoid arthritis - DMARD or biologic
Xeroderma pigmentosa
Chronic inflammatory skin conditions
- Hypertrophic lichen planus
- Chronic ulcers
- Lichen sclerosis
Features of squamous cell carcinoma of skin?
Raised lesion on skin
Basal cell carcinoma
Ulcer with raised rolled edge
Prominent fine blood vessels around a lesion or nodule on skin
Pearly or waxy nodules
Diagnosis of BCC
Excision biopsy
What do seborrheuc keratosis look like?
Proud, brown plaqurs - look stuck on
Why are seborrheic keratosis pigmented?
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
Which is most common skin tumour?
Benign basal tumour
What does SCC look like?
Lump with horn on tip
Well differentiated
Base of horn
What can a poorly differentiated SCC look like?
BCC
What is rate of growth of SCC?
Rapid growing in 3 months
Which skin tumours are painful
SCC and BCC
Which age group are more likely BCC?
Younger people
Distribution of BCC
and present most frequently on the trunk and shins
Morphology of BCC
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
Who is likely to get SCCs
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
Distribution of SCC?
Sun exposed sites
Backs of hands and forearms, upper part of face, lower lip and pinna
Distribution of SCC?
Sun exposed sites
Backs of hands and forearms, upper part of face, lower lip and pinna
Morphology SCC?
Firm to palpate
Nodular
PLaque like
Verocous
Well differentiated vs poorly differentiated
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.
Treatment for skin cancers
Surgical excision
Chemo/radiotherapy for metastases
Treatment for acitniic keratosis
fluorouracil. imiquimod ingenol mebutate or diclofenac
Freezing therapy
Scraping
Laser therapy
Photodync#amic therapy
What virus causes verrucas
HPV
What HPVs increase risk of cervical cancer?
16+18
Treatment for verrucas?
Salicyclic acid
Cryotherapy
Managed in primary care
When to refer verrucas?
- Persistent
- Large
- Quick growing, changes
- Facial
- Complications of immunosupression
- Uncertain if wart or different lesion
Exogenous eczema
- Contact dermatitis
- Photosensitive
- Lichen simplex - eczema due to scratching
- Asteatotic - crazy paving
Endogenous eczema
- Atopic eczema
- Discoid
- Eczema due to venous insufficiency - varicose/venous
What is the conus medularis?
Where spinal tracts end
After this is cauda equina
What is anterior lithiasis?
Anterior displacement of vertberal body relative to one below
What is spondylosis?
Arthritis of the spine
What is major cause of spinal stenosis?
Thickening of the ligamentum flavum
What is radiculopathy?
imparment of nerve root → radiating pain. Pain, muscle weakness, numbness, itngling
Red flags cauda equina
saddle anaesthesia, numbness, tingling, reduced tone anal sphinvtre, ass with lower leg weakness
Cauda equina vs sciatica sides
Cauda equina is bilateral, sciatica is unilateral
Visceral causes of back pain
- Waves of pain
- Aortic aneurysm
- Chronic PID
- Prostatitism
- Endometriosis
- Nehrolithiasis ‘Pulonephrosism’
- Perenephric avscess
5 top places metastases to spine originate from
lung, prostate, breast, kidney. thyroid
Multiple myeloma in older patients
SCAM for lesions
Site
Size and shape
Colour
Ass symtpoms painful, necrotic
Margin and morphology
What does BCC develop from?
Basal cell layer of epidermis
3 types of BCC
Nodulaar - pearly shiny nodules, rolled borders
Superficial - pink, well defined, scaly
Morpheaform - infiltrating. Ill defined pale scar
(pigmented - melanin present0
What is a superficial spreading melanoma
Flat pigemneted lesion w asymetrical or irregular borders
Most comon type
Epidermis for long periods
WHat is a nodular melanoma
Atypical nodule - ulcerate an dbleed easily
Pigemented or non pigemented
What is a lentigo maligna melanoma
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
Acral lentiginous melanoma what is it
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
What is lentifos maligna
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
Rare melanomas
Desmoplastic.
Malignant blue naevus.
Mucosal.
Neurotropic.
Ocular melanoma.
Spitzoid.
When refer 2ww pathway fro melanoma
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.
