Skin Lesions Flashcards

1
Q

A 72 year old man presents with a large nodule on his face. It is friable. There is no regional lymphadenopathy. He is lost to follow up and re-attends several months later. On this occasion the lesion has been noted to resolve with scarring. What is the most likely lesion?

	Pyogenic granuloma
	Keratoacanthoma
	Melanoma
	Basal cell carcinoma
	Dermatitis artifacta
A

Keratoacanthomas may reach a considerable size prior to sloughing off and scarring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A 22 year old woman presents with a newly pigmented lesion on her right shin, it has regular borders and normal appearing dermal appendages. However, she reports a recent increase in size. What is the best course of action?

	Excision biopsy
	Excision with 0.5cm margin
	Excision with 2cm margin
	Shave biopsy and cautery
	Incision biopsy
A

Excision biopsy

Lesions bearing normal dermal appendages and regular borders are likely to be a benign pigmented naevi. Therefore diagnostic and not radical excision is indicated. Incision biopsy should not be done.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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
A

Spitz naevi can often resemble melanoma and are best excised.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A 72 year old man is investigated for weight loss. On examination, he is deeply jaundiced and cachectic. He also has a dark velvety lesion coating his tongue. What is the most likely diagnosis?

	Acanthosis nigricans
	Mycosis fungoides
	Bullous pemphigoid
	Squamous cell carcinoma
	Bacterial infection
A

Acanthosis nigricans
Brown to black, poorly defined, velvety hyperpigmentation of the skin.
In the context of a malignant disease, acanthosis nigricans is a paraneoplastic syndrome and is then commonly referred to as acanthosis nigricans maligna. Involvement of mucous membranes is rare and suggests a coexisting malignant condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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
A

This is most likely to be seborrhoeic warts. These are usually superficially sited and are best managed with shave biopsy and cautery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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
A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 58 year old lady presents with changes that are suspicious of lichen sclerosus of the perineum. What is the best course of action?

Wide excision of the area and split thickness skin grafts
Punch biopsy
Excision of area with 0.5cm margin
Excision of the area and full thickness skin grafts
Excision of the area with 2cm margin
A

Punch biopsies are a useful option for obtaining a full thickness tissues sample with minimal tissue disruption. In this situation, the other differential would be AIN or VIN and punch biopsies would be useful in distinguishing these.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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
A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A 89 year old women 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
A

These lesions are often extensive and superficial. Shave excision will suffice, material must be sent for histology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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
A

Dermatofibromas may be pigmented and are often larger than they appear. They frequently occur at sites of previous trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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
A

This is likely to be a venous ulcer and should usually be managed with compression bandaging if there is no arterial compromise. Long standing lesions may be complicated by the development of malignancy and for this reason a punch biopsy of long standing or non healing lesions is advisable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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
A

The raised pearly edges in an ulcerated lesion at a sun exposed site makes BCC most likely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A 28 year old man undergoes an ileocaecal resection and end ileostomy for Crohn’s disease. One year later he presents with a deep painful ulcer at his stoma site. What is the most likely diagnosis?

	Bullous pemphigoid
	Pemphigus vulgaris
	Pyoderma gangrenosum
	Squamous cell carcinoma
	Poorly fitting appliance
A

Pyoderma gangrenosum is associated with inflammatory bowel disease (this patient had a stoma for crohns!). It is commonly found on lower limbs and described as being painful, the size of an insect bite and growing. It looks like a margherita pizza (with a red base and yellow topping!) Treatment involves steroids. It would be rare for a poorly fitting appliance to cause a deep painful ulcer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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
A

Pyogenic granulomas often appear at sites of trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which of the following statements relating to sebaceous cysts is false?

When infected are also known as Cocks peculiar tumour
Typically contain pus
Are usually associated with a central punctum
Most commonly occur on the scalp
They will typically have a cyst wall
A

Sebaceous cysts usually contain sebum, pus is only present in infected sebaceous cysts which should then be treated by surgical incision and drainage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of the following statements relating to Keloid scars is untrue?

They have a predilection for sternal , mandibular and deltoid area wounds
They are confined to the margins of the original injury
They often recur following excision
May occur even after superficial injury
They may be treated by injection of triamcinolone
A

Keloids (by definition) will tend to extend beyond the margins of the wound and in wounds of any depth.

17
Q

A 73 year old man presents with a 1.5cm ulcerated basal cell carcinoma on his back. What is the best course of action?

	Excision with 0.5cm margin
	Excision with 2cm margin
	Excision biopsy
	Incision biopsy
	Excision with 3cm margin
A

A small lesion such as this is adequately treated by local excision. The British Association of Dermatology guidelines suggest that excision of conventional BCC (<2cm) with margins of 3-5mm have locoregional control rates of 85%. Morphoeic lesions have higher local recurrence rates.

18
Q

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
A

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.

19
Q

A 72 year old man presents with a lesion on his back. Its appearances are as shown below:

What is the most likely diagnosis?

	Amelanotic malignant melanoma
	Squamous cell carcinoma
	Merkel Cell tumour
	Basal cell carcinoma
	None of the above
A

The lesion has all the characteristic features of a basal cell carcinoma. Including raised surface and overlying telangectasia. Amelanotic melanomas are rare lesions and usually have a more ulcerated appearance. Since the question is directed towards the most likely diagnosis the correct answer is basal cell carcinoma.

20
Q

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
A

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.

21
Q

A 28 year old female presents with a small nodule located on the back of her neck. It is excised for cosmetic reasons and the histology report states that the lesion consists of a sebum filled lesion surrounded by the outer root sheath of a hair follicle. What is the most likely cause?

	Pilar cyst
	Seborrheoic keratosis
	Dermatofibroma
	Atypical naevus
	Spitz naevus
A

Pilar cysts may contain foul smelling cheesy material and are surrounded by the outer part of a hair follicle. Because of their histological appearances they are more correctly termed pilar cysts than sebaceous cysts.

22
Q

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
A

Trauma is a common precipitant of pyogenic granuloma and contact bleeding and ulceration are common.

23
Q

A 23 year old lady presents with an itchy, bleeding pigmented lesion on her right thigh. What is the best course of action?

	Core biopsy
	Punch biopsy
	Incisional biopsy
	Excision biopsy
	Wide excision
A

This may represent a malignant melanoma. Complete excision is required to allow accurate histological assessment. If the diagnosis is confirmed then re-excision of margins may be required. Clearly if the lesion is benign then no further action is required.