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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
Q

which is the most common leg ulcer

A

venous ulcer - 80%

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26
Q

what is the aetiology of venous leg ulcer

A

due to pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phlebitis etc)

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27
Q

RF for venous leg ulcers

A 
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
Q

clinical features of venous leg ulcers

A
  • 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
Q

investigation of venous leg ulcers

A

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
Q

management of venous leg uclers

A

• 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
Q

what is the cause of an arterial ulcer

A

ulceration as a manifestation of peripheral vascular disease

32
Q

RF for arterial ulcer

A 
smoking 
diabetes 
hypertension 
hyperlipaemia 
inc age 
FHX 
obesity 
physical activity
33
Q

clinical features of an arterial ulcer

A

• 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
Q

investigation of arterial ulcer

A

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
Q

mx of an arterial ulcer

A
  • 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
Q

what is the aetiology of a neuropathic ulcer

A

occurs as a result of peripheral neuropathy - result in loss of protective sensation, leading to repetitive damage

37
Q

clinical features of a neuropathic ulcer

A

• 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
Q

investigation of a neuropathic ulcer

A

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
Q

mx of neuropathic ulcer

A
  • Diabetic foot clinical
  • Optimize diabetes control: lifestyle and medication
  • Regular chiropody
  • Appropriate footwear
  • If ischaemia consider surgical debridement.
40
Q

what is a solar keratosis

A

it is a scaly spot found on sun damaged skin that is a precursor to SCC

41
Q

clinical features of solar keratosis

A
  • 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
Q

what is another name foe solar keratosis

A

acintic keratosis

43
Q

investigation and management of solar kertaosis?

A

clinical diagnosis
dematoscope and biopsy used to exclude SCC

removal due to risk of SCC

44
Q

what is a keloid scar

A

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
Q

clinical features of a keloid scar

A

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
Q

investigation and management of a keloid scar

A
  • Diagnosis of clinical features

* Treatment can be nothing or reduction or removal.

47
Q

what is a ganglion

A

sac-like swelling or cyst formed from the tissue that lines a joint or tendon (synovium/synovial fluid)

48
Q

causes of ganglion

A

mostly unknown

arthritis

49
Q

clinical features of a ganglion

A

most commonly found in wrist and ankles

painless localised jelly-like swelling

examples = a baker’s cyst in the knee

50
Q

differentials for a ganglion

A

lipoma

malignancy

51
Q

investigation and management of a ganglion

A

clinical diagnosis

X-ray used to determine joint involvment

Tx - self-limiting, massage, aspiration and surgery

52
Q

what is a vascular lesion of the skin?

A

common abnor of the vasculature in and underlying the skin

53
Q

what is a telangiectasis

A

small, dilated blood vessles near surface of the skin

54
Q

what is a angiokeratoma

A

small red or blue lesions caused by caillaries

55
Q

what is cherry angioma

A

red lesions of collected blood vessels that look like a red mole

56
Q

what is spider angioma

A

a cluster of a blood vessel with a central red spot and vessels that radiate outwards

57
Q

what is a granuloma faciale

A

lesion of the face ranging from skin coloured to purple that is caused by inflamed blood vessels

58
Q

what is a hemangioma

A

a rubbery, bright red mark of blood vessels often presented at birth

59
Q

what is keratosis pilaris

A

small, light-colored bumps that result from a build up of certain

60
Q

what is a pyogenic granulma

A

an eruptive hemangioma ranging from pink to purple caused by irritation, hormones or trauma

61
Q

what is a venous lake

A

a drak blue to purple lesion found on sun exposed areas, often in the elderly

62
Q

what is a kaposi sarcoma

A

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
Q

what is the cause of kaposi sarcoma

A

Kaposi sacroma herpesvirus (KSHV)

64
Q

what are the different types of kaposi sarcoma

A

classic - associated with DM
HIV associated Kaposi sarcoma
African kaposi Sarcoma
Iatrogenic Kaposi sarcoma (immunosuppression mediation)

65
Q

what is the most common type of kaposi sarcoma

A

HIV associated Kaposi sarcoma

66
Q

what are the clinical features of Kaposi sarcoma

A

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
Q

investigation and management of Kaposi sarcoma

A
  • Skin biopsy: diagnostic

* Treatment: treat the causes (HIV), localized therapy, systemic therapy (anti-cancer drugs)

Year 5 Conditions (19 decks)

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