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Year 5 Conditions > Skin 2 > Flashcards

Skin 2 Flashcards

1
Q

what is the most common skin cancer

A

basal cell carcinoma - common, locally invasive, kertionycte cancer

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2
Q

aetiology of BCC

A

DNA mutation in the patched tumor suppressor gene (PTCH) gene

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3
Q

RF for BCC

A 
elderly males 
previous BCC
sun damage
actinic keratoses 
repeated prior episodes of sunburn 
fair skin, blue eyes and blonde or red hair 
thermal burn 
inherited BCC
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4
Q

clinical features of BCC

A
  • raised rolled edge pearly lesion
  • telangiectasia - may be one the surface and the center may break open to form a scab
  • sore can bleed and form a scab and heal
  • slowly growing plaque or nodule
  • skin-colored, pink, or pigmented
  • spontaneous bleeding or ulceration
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5
Q

investigation of BCC

A
  • Diagnosis of clinical suspicion
  • Dermatoscope
  • Excision biopsy – gold standard diagnosis.
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6
Q

which subtype of BCC is the most common on the face

A

nodular BCC

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7
Q

which subtype of BCC is the most common on the younger adults

A

superficial BCC

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8
Q

which subtype of BCC is the most common to spread through perinerual means

A

morphoeic BCC

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9
Q

mx of BCC

A

Routine referral (3 months) unless delay may have significant impact e.g. size and site of lesion.

Types of treatment
• Excision.
• Mohs micrographically controlled excision: involves examining carefully marked excised tissue under the microscope, layer by layer, to ensure to complete excision - tissue sparing or head and neck
• Superficial skin surgery
• Cryotherapy
• Photodynamic therapy:
• Imiquimod cream: immune response modifier
• Fluorouracil cream: topical cytotoxic agent
• Radiotherapy

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10
Q

what is a squamous cell carcinoma

A

A proliferation of atypical transformed keratinocytes in the skin with malignant behaviour which ranges from in-situ tumours to invasive metastatic disease.

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11
Q

what are the different types of SCC

A
  • actinic keratoses - precursor
  • SCC in situ (bown disease) - confined to outer layer of skin
  • invasive SCC - spread into deeper layers of the skin
  • metastatic SCC - spread to other parts of the body
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12
Q

what are the different variants of SCC

A

keratoacanthoma - rapidly growing dome shaped nodule with a central kertin filled crater –> known as a well differentiated SCC

Verrucous carcinoma: Lesions appear as exophytic, fungating, verrucous nodules, or plaques on skin or mucosa.

Marjolin ulcer - aggressive, ulcerating SCC that arises in chronic wounds, burns, scars, or ulcers

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13
Q

aetiology of SCC

A

• DNA mutation in protooncogenes and tumour suppressor genes.
• Actinic keratoses- most common precursor.
 Sun exposed sites- face, hands, ears.

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14
Q

risk factors of SCC

A
  • Male
  • UV light exposure
  • Ionising radiation
  • Burns
  • Inherited skin conditions.
  • Immunosuppression
  • Fairs kin
  • HPV
  • Previous SCC
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15
Q

clinical features of SCC

A

• Squamous cell carcinoma insitu– BOWEN’S DISEASE.
 One or more slowly enlarging erythematous of skin coloured plaques.

• Invasive Squamous cell carcinoma
 Fast growing lesion.
 Occur in a actinic keratosis on within SCC in-situ
 Irregular keratinous nodule or a firm erythematous plaque and frequently ulcerates and bleeds

• Metastatic
 Bone pain.
 Hepatomegaly.

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16
Q

investigation of SCC

A

diagnosisc of clinical featuers
dermatoscope
biopsy - full thickness keratinocyte atypia

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17
Q

management of SCC

A

Urgent 2-week suspected cancer pathway.

Squamous cell carcinoma in situ
	1st line- cryotherapy, electrodessication/curettage, photodynamic therapy
	2nd line- fluorouracil, imiquimod
	Surgical excision or Mohs surgery
	radiotherapy

Invasive squamous carcinoma
 1st line: surgical excision or Moh’s surgery.
Metastatic SCC
 Surgery + radiotherapy + chemotherapy.

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18
Q

what is melanoma

A

cancer of uncontrolled growth of melanocytes (pigment cells)

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19
Q

aetiology of melanoma

A
  • DNA mutation of oncogene/ tumour suppressor genes resulting in uncontrolled melanocyte growth
  • melanocytes present in the skin, eye and CNS
  • the gene associated with familial melanoma is CDKN2A which encodes the P16 and p14ARF gene
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20
Q

what are the different types of melanoma

A
  • Superficial spreading Melanoma  most common, any sight but preference for torso in men or legs in woman, average diagnosing age between 30 and 50
  • nodular Melanoma  second most common , any side to, diagnosis in 60s, rapid vertical growth and later stage and diagnosis
  • Lentigo Maligna Melanoma  Most commonly diagnosed > 60 yrs old on sun damaged
  • Acral lentiginous melanoma  most common in people with darker skin types, palms, soles and nail apparatus
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21
Q

clinical features of melanoma

A
  • Most common on back or leg.
  • First sign- freckle or mole.
  • Variation in colour from tan, dark brown, blue, red and light grey.
  • May be areas of regression that are the colour of normal skin, white and scarred.
  • Can be itchy and tender
  • Can be amelanotic
  • Hutchinson’s sign (nail sign= blackness in the nail)
  • Bluish white veil of melanoma.
  • fixed lymphadenopathy
  • A-E tool  asymmetry of lesion, border irregularity, colour variability, diameter > 6mm, evolution
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22
Q

investigation of melanoma

A 
Diagnosis of clinical features
Dermatoscopic features
Biopsy – diagnostic.
Sentinel lymph node biopsy 
Serum lactate dehydrogenase  used to classify metastatic disease  can be elevated 
CXR  may show pulmonary mets 
CDKN2A genetic test
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23
Q

management of melanoma

A

Non-Metastatic
In-situ (melanoma confined to epidermis)
• 1st line: surgical excision
• 2nd line: topical therapy (imiquimod)

Breslow < 1mm to > 4mm
• Surgical excision +/- lymph node biopsy.

Metastatic
• Surgical excision
• Chemotherapy and radiotherapy and immunotherapy.

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24
Q

what is a leg ulcer

A

a break in the skin below the knee which has not healed within 2 weeks

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25
which is the most common leg ulcer
venous ulcer - 80%
26
what is the aetiology of venous leg ulcer
due to pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phlebitis etc)
27
RF for venous leg ulcers
``` inc age obesity immobility limited range of ankle function previous ucler personal/Fhx of varicose veins female multiple pregnancies AV fistula Hx of leg fractures or trauma prolonged standing ```
28
clinical features of venous leg ulcers
* Large, shallow ulcers with a granulated base and irregular borders * Pain, heaviness, aching swelling and itching of the affected leg. * More likely to bleed * Pain relieved by elevation and worse on hanging • Features of venous insufficiency:  Oedematous flushed skin  Hyperpigmented skin  Varicose eczema  Lipodermatosclerosis (champagne bottle leg)  Atrophe blanches - ivory-colored stellate scars on the legs
29
investigation of venous leg ulcers
diagnosis is usually clinical - assess the ulcer, take photographs if possible and appropriate - signs of infection - eg cellulitis signs, fever, inc pain, rapid extension of the area of ulceration, inc exusdate - examine both legs for venous insufficiency - examine lying and standing to assess for varicose veins - Doppler USS - will demonstrate venous insufficiency - ABPI > 1 = no arterial disease
30
management of venous leg uclers
• Treating underlying cause (arterial or venous disease) • Assess need for immediate referral: alternative diagnosis, ulcer is recurrent, • Conservative: leg elevation + lifestyle (weight reduction) • Compression therapy • Pentoxifylline to aid ulcer healing treat associated symptoms - oedema - compression, leg elevated, regular exercise - itchy skin (varicose veins) - emollient and topical corticosteroid good wound care - debridement - cleaning - dressing - antibiotics where infected - skin craft in severe and appropriate cases
31
what is the cause of an arterial ulcer
ulceration as a manifestation of peripheral vascular disease
32
RF for arterial ulcer
``` smoking diabetes hypertension hyperlipaemia inc age FHX obesity physical activity ```
33
clinical features of an arterial ulcer
• Hx: intermittent claudication (pain on walking) or critical limb ischemia (pain at night) ``` • Smaller, shallow ulcer with regular borders, no granulation tissue and less bleeding (no healing due to no blood supply). • Painful (more than venous ulcers) • Pain at night when legs elevated • Pain wore on elevating the leg and improved by hanging. • Signs of PVD  Absent pulses  Pallor  Hair loss  Necrotic toes ```
34
investigation of arterial ulcer
examine the ulcer - size, location, depth examine for signs of arterial insufficiency - pale, hairless, necrotic toes ABPI (diagnostic) - > 0.9 = normal, 0.8-0.5 = moderate, < 0.5 = severe) • Anatomical location of any arterial disease; duplex ultrasound, CT Angiography, and / or Magnetic Resonance Angiogram (MRA).
35
mx of an arterial ulcer
* URGENT VASCULAR REVIEW (as ulcers develop in critical limb ischemia) * Conservative: lifestyle changes: smoking, increased exercise * Medical: CVD risk modification: statin + antihypertensive therapy. * Surgical: Angioplasty or bypass grafting
36
what is the aetiology of a neuropathic ulcer
occurs as a result of peripheral neuropathy - result in loss of protective sensation, leading to repetitive damage
37
clinical features of a neuropathic ulcer
• Varied size, punched out painless ulcers. • Hx peripheral neuropathy  Glove and stocking pattern. • Burning and tingling in the legs • Affects pressure point areas (metatarsal heads or heels, bottom of the feet)
38
investigation of a neuropathic ulcer
Assess the ulcer • Assess for peripheral neuropathy  10g monofilament  128Hz tuning fork: vibration sensation. blood glucose, B12 swab and if bone visible - X-ray to exclude osteomyelitis ABP - > 0.9
39
mx of neuropathic ulcer
* Diabetic foot clinical * Optimize diabetes control: lifestyle and medication * Regular chiropody * Appropriate footwear * If ischaemia consider surgical debridement.
40
what is a solar keratosis
it is a scaly spot found on sun damaged skin that is a precursor to SCC
41
clinical features of solar keratosis
- can be solitary or multiple - sites of sun exposure eg back of hands, face, upper trunk, neck - a flat or thickened plaque or papule white or yellow scaly, warty or horny surface skin coloured red or pigmented tender or asymptomatic
42
what is another name foe solar keratosis
acintic keratosis
43
investigation and management of solar kertaosis?
clinical diagnosis dematoscope and biopsy used to exclude SCC removal due to risk of SCC
44
what is a keloid scar
firm, smooth, hard growth due to spontaneous scar formation. It can arise soon after an injury or develop months later and is typically much larger than the wound itself
45
clinical features of a keloid scar
scar formation at site of wound (ear piercing, tattoo, burns, insect bites and spots) ``` shinny hairless raised above surrounding skin hard and rubbery red or purple uncomfortable itchy ```
46
investigation and management of a keloid scar
* Diagnosis of clinical features | * Treatment can be nothing or reduction or removal.
47
what is a ganglion
sac-like swelling or cyst formed from the tissue that lines a joint or tendon (synovium/synovial fluid)
48
causes of ganglion
mostly unknown arthritis
49
clinical features of a ganglion
most commonly found in wrist and ankles painless localised jelly-like swelling examples = a baker's cyst in the knee
50
differentials for a ganglion
lipoma | malignancy
51
investigation and management of a ganglion
clinical diagnosis X-ray used to determine joint involvment Tx - self-limiting, massage, aspiration and surgery
52
what is a vascular lesion of the skin?
common abnor of the vasculature in and underlying the skin
53
what is a telangiectasis
small, dilated blood vessles near surface of the skin
54
what is a angiokeratoma
small red or blue lesions caused by caillaries
55
what is cherry angioma
red lesions of collected blood vessels that look like a red mole
56
what is spider angioma
a cluster of a blood vessel with a central red spot and vessels that radiate outwards
57
what is a granuloma faciale
lesion of the face ranging from skin coloured to purple that is caused by inflamed blood vessels
58
what is a hemangioma
a rubbery, bright red mark of blood vessels often presented at birth
59
what is keratosis pilaris
small, light-colored bumps that result from a build up of certain
60
what is a pyogenic granulma
an eruptive hemangioma ranging from pink to purple caused by irritation, hormones or trauma
61
what is a venous lake
a drak blue to purple lesion found on sun exposed areas, often in the elderly
62
what is a kaposi sarcoma
a disease of the endothelial cells of blood vessels and lymphatic system. no longer classified as sarcoma as it is due to multicentric vascular hyperplasia
63
what is the cause of kaposi sarcoma
Kaposi sacroma herpesvirus (KSHV)
64
what are the different types of kaposi sarcoma
classic - associated with DM HIV associated Kaposi sarcoma African kaposi Sarcoma Iatrogenic Kaposi sarcoma (immunosuppression mediation)
65
what is the most common type of kaposi sarcoma
HIV associated Kaposi sarcoma
66
what are the clinical features of Kaposi sarcoma
red/purple macules, papules and nodules anywhere on the mucous membranes lining the mouth, throat, lymph nodes and other organs lesions are small and painless but can ulcerate and become painful internal - discomfort and welling - bleeding - haematemsis - haematochezia - melaena - bowel obstruction - SOB - swollen legs
67
investigation and management of Kaposi sarcoma
* Skin biopsy: diagnostic | * Treatment: treat the causes (HIV), localized therapy, systemic therapy (anti-cancer drugs)

Year 5 Conditions (19 decks)

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