Skin Lesion Flashcards
A 70 year old man has a basal cell carcinoma affecting his temple. Following excision and histopathological assessment, which of the factors outlined below has the greatest bearing on prognosis?
Pathological subtype Completeness of excision Lymphocytic infiltrate Lymphovascular invasion Mitotic index
Completeness of excision
Incompletely excised BCC have upwards of 30% recurrence rates. Systemic spread with these lesions is rare and it is usually local recurrence that is the main problem.
A 22 year old man presents with an infected sebaceous cyst. The cyst itself is swollen, discharging pus and has some surrounding erythema. What is the most appropriate treatment?
Excision of the cyst of closure of the defect with interrupted 3/0 silk
Excision of the cyst and closure of the defect with subcuticular 4/0 undyed nylon
Incision and drainage with excision of the cyst wall and packing of the defect
Incision and drainage with conservation of the cyst wall and packing of the defect
Administration of oral co-amoxiclav and definitive surgery once the infection has cleared
Incision and drainage with excision of the cyst wall and packing of the defect
The correct treatment for an infected sebaceous cyst is incision and drainage with removal of the cyst wall. Conservation of the cyst wall will invariably lead to recurrence. Under no circumstances should an infected wound like this be primarily closed. The administration of antibiotics without drainage of sepsis is futile.
An 83 year old lady presents with multiple patches of pigmented irregular, superficial lesions over the torso. They do not bleed but have become increasingly itchy. What is the best course of action?
Shave biopsy Excisional biopsy Trucut biopsy Incisional biopsy Wide surgical excision
Shave biopsy
This is most likely to be seborrhoeic warts. These are usually superficially sited and are best managed with shave biopsy and cautery.
A 70 year old lady presents with a number of skin lesions that she describes as unsightly. On examination she has a number of raised lesions with a greasy surface located over her trunk. Apart from having a greasy surface the lesions also seem to have scattered keratin plugs located within them. What is the most likely diagnosis?
Keratoacanthoma Pilar cysts Dermatofibroma Seborrhoeic keratosis Epidermoid cyst
Seborrhoeic keratosis
Seborrhoeic keratosis may have a number of appearances. However, the scaly, thick, greasy surface with scattered keratin plugs makes this the most likely diagnosis.
A 34 year old gardener presents with a lesion affecting the dorsum of his right hand. It has been present for the past 10 days and occurred after he had been pruning rose bushes. On examination, he has a raised ulcerated lesion which bleeds easily on contact. What is the diagnosis?
Keratoacanthoma Pyogenic granuloma Basal cell carcinoma Squamous cell carcinoma Amelanotic melanoma
Pyogenic granuloma
Trauma is a common precipitant of pyogenic granuloma and contact bleeding and ulceration are common.
A 68 year old farmer presents with a skin lesion on his forehead. It has been present for the past 6 months and has grown slightly in size during that time. On examination, he has an ulcerated lesion with pearly white raised edges that measures 2cm in diameter. What is the most likely diagnosis?
Keratoacanthoma Squamous cell carcinoma Pyogenic granuloma Basal cell carcinoma Bowens disease
Basal cell carcinoma
The raised pearly edges in an ulcerated lesion at a sun exposed site makes BCC most likely.
A 65 year old man presents with a 5cm ulcerated area over his medial malleolus. It has been present for many years and the nurses have complained that it is not healing with simple bandages. What is the best course of action?
Perform a core biopsy Perform a punch biopsy Arrange a split thickness skin graft Undertake an incisional biopsy Arrange for wide surgical excision and skin grafting
Perform a punch biopsy
A 21 year old lady presents with a nodule on the posterior aspect of her right calf. It has been present at the site for the past 6 months and occurred at the site of a previous insect bite. Although the nodule appears small, on palpation it appears to be nearly twice the size it appears on examination. The overlying skin is faintly pigmented. What is the most likely cause?
Pilar cyst Dermatofibroma Spitz naevus Seborrhoeic wart Basal cell carcinoma
Dermatofibroma
Dermatofibromas may be pigmented and are often larger than they appear. They frequently occur at sites of previous trauma.
A 22 year old man is investigated for weight loss. A duodenal biopsy taken as part of his investigations shows total villous atrophy and lymphocytic infiltrate. He has a skin lesion that has small itchy papules. What is the most likely underlying diagnosis of the skin lesion?
Pyoderma gangrenosum Dermatitis herpetiformis Bullous pemphigoid Acanthosis nigricans Pemphigus vulgaris
Dermatitis herpetiformis
The patient has coeliac disease and this is classically associated with dermatitis herpetiformis.
Which of the skin lesions listed below are most likely to resemble a malignant melanoma?
Spitz naevus Dermatofibroma Squamous cell carcinoma Bowens disease Seborrhoeic wart
Spitz naevus
Spitz naevi can often resemble melanoma and are best excised.
A patient with Crohns disease has a purple coloured skin lesion near an ileostomy site. What is the most likely diagnosis?
Pyoderma gangrenosum Pemphigus vulgaris Metastatic Crohns disease Dermatitis herpetiformis Bullous pemphigoid
Pyoderma gangrenosum
Pyoderma gangrenosum may occur in Crohns disease. Cutaneous involvement of granulomas a.k.a metastatic crohns is recognized but very rare and much less likely and therefore not the correct answer.
A 89 year old woman presents with long standing seborrhoeic warts of her abdominal wall , they have caused troublesome itching. What is the best treatment?
Administration of topical steroids
Shave excision and cautery
Excision and primary closure
Excision and skin graft
Excision biopsy
Shave excision and cautery
These lesions are often extensive and superficial. Shave excision will suffice, material must be sent for histology.
A 30 year old man cuts the corner of his lip whilst shaving. Over the next few days a large purplish lesion appears at the site which bleeds on contact. What is the most likely diagnosis?
Pyogenic granuloma Keratoacanthoma Melanoma Squamous cell carcinoma Adenocarcinoma
Pyogenic granuloma
Pyogenic granulomas often appear at sites of trauma.
A 53 year old man presents with a nodule on his chin. He is concerned because it has grown extremely rapidly over the course of the preceding week. On examination, he has a swollen, red, dome shaped lesion with a central defect that contains a keratinous type material. What is the most likely cause?
Actinic keratosis Bowens disease Pyogenic granuloma Keratoacanthoma Squamous cell carcinoma
Keratoacanthoma
Keratoacanthomas are characterised by a rapid growth phase. This may mimic amelanotic melanoma (although such rapid growth is rare even in these lesions). The keratin core is the clue as to the true nature of the lesion.
A 29 year old man presents with a lump in his scalp. It is located approximately 4cm superior to the external occipital protuberance. It feels smooth and slightly fluctuant and has a centrally located small epithelial defect. What is the most likely underlying diagnosis?
Cocks peculiar tumour Dermoid cyst Sebaceous cyst Merkel cell tumour Seborrhoeic wart
Sebaceous cyst
Sebaceous cysts are most frequently located in the scalp and have an associated central punctum. They may become infected and develop superficial ulceration in which case they are known as ‘Cocks Peculiar Tumour’. The presence of a punctum is highly suggestive of a sebaceous cyst and are not typically found in the other lesions described.
