Skin path/tumour

Question 1

what are the two types of inflammatory skin disease

Answer 1

infectious or non infectious

Question 2

what are the three clinical stages of eczema/dermatitis

Answer 2

acute - skin red, serous exudate
subacute - skin is red, less exudate, itchier, crusting
chronic - skin thick and lethargy, scratching

Question 3

what is spongiosis and what is it associated with

Answer 3

eczema

spongiosis - intercellular oedema within epidermis which leads to chronic inflammation

Question 4

what are the 4 types of eczema

Answer 4

atopic - type 1 hypersens - associated with asthma and rhinitis

contact irritant dermatitis - from acid detergent

contact allergic dermatitis - allergic to irritant - nickel, rubber

dermatitis of unknown cause

Question 5

what is psoriasis

Answer 5

red oval plaques on extensor surfaces, fine silvery scale

Question 6

which disease would you see auspitz sign

Answer 6

psoriasis

small bleeding points after removal of scale layers

Question 7

what is the classic histology of psoriasis

Answer 7

psoriasiform hyperplasia

collection of neutrophils in scale

Question 8

what is the cause of psoriasis

Answer 8

massive cell turnover or autoimmune

PSORS gene in MHC of chromosome 6p2

Question 9

what are the two types of lupus erythematous

Answer 9

DLE - discoid - skin only

SLE - systemic-visceral disease - maybe skin involvement

Question 10

what are the clinical features of lupus erythematous

Answer 10

red scalp patches on sun-exposed areas - butterfly rash on cheeks and nose (SLE)

Question 11

what is the cause and histology of lupus erythmomatosus

Answer 11

autoimmune affecting connective tissue
mainly kidneys as well

thin atrophic epidermis with thickened basement membrane

Question 12

what are the symptoms of dermatomyositis

Answer 12

peri-ocular oedema and erythema (heliotropic rash)

myositis - proximal muscle weakness

Question 13

how do you tell the difference between LE and dermatomyositis

Answer 13

negative immunoflourescnce for LE band in derma

Question 14

what is the definition and two types of bullous disease

Answer 14

formation of fluid filled blisters

pemphigus or pemphigoid

Question 15

describe the two types of bullous disease

Answer 15

pemphigus - intra-epidermal bulla, superficial, loss of cohesion between keratinocytes
autoantibodies against intracellular membrane

pemphigoid - sub epidermal, deep - autoantibodies to glycoprotein in basement membrane - do not rupture and common in elderly

Question 16

what is dermatitis herpetifromis and what is it associated with

Answer 16

small intensely itchy blisters on extensor surface - associated with coelliac disease

Question 17

what do these 5 skin lesions look like and what systemic disease are they a sign of

dermatomyositis 
dermatitis herpetiformis
ancanthosis nigricans 
necrobiosis lipodica
erythema nodosum
erythema marginatum

Answer 17

visceral cancer

coeliac disease

dark warty lesions in armpits - internal malignancy

red and yellow plaque on legs - DM

red tender nodules on shins - infection elsewhere

Rheumatic fever

Question 18

what is the most common malignant tumour of the skin

Answer 18

basal cell carcinoma

Question 19

what is the cause of basal cell carcinoma and clinical features

Answer 19

sun exposure - gorlins syndrome increases risk

early nodule, late ulceration - morphoeoic BCC

Question 20

what are the causes of squamous cell carcinoma and clinical features

Answer 20

UV radiation, hydrocarbon exposure, chronic ulcers, immunosuppressed, drugs

features - ulcerated crusted surface

Question 21

what can actinic keratosis lead to

Answer 21

squamous cell carcinoma

Question 22

where do melanocytes derive from

Answer 22

neural crest

Question 23

what is the function of melanocytes

Answer 23

produce melanin which is transferred to epidermal cells to protect the nucleus

Question 24

what are naevi/moles and what are the types

Answer 24

local benign collections of melanocytes - superficial (congenital or acquired), deep - blue naevi

Question 25

what is a mongolian spot

Answer 25

a deep mole

Question 26

describe atypical mole syndrome

Answer 26

families with increased incidence of melanoma, multiple atypical moles

Question 27

what are the risk factors of melanoma and how does it compare to BCC and SCC

Answer 27

much rarer and very dangerous

sun exposure, family history of atypical mole syndrome, giant congenital naevi

Question 28

what are 4 types of melanoma

Answer 28

lentigo maligna melanoma
acral lentiginous melanoma
superficial spreading melanoma
nodular melanoma

Question 29

what is the most common melanoma in the UK vs afro carribean people

Answer 29

superficial spreading melanoma UK

acral lentiginous melanoma - afrocarribian

Question 30

what condition are BRAF mutations assisted with

Answer 30

superficial spreading melanoma

Question 31

what is the most important factor in melanoma

Answer 31

breslow thickness

the thicker the mm then less the 5yr survival

Question 32

what factors other than thickness are important in melanoma

Answer 32

BANS - back, arms, neck, scalp - have poorer prognosis
satellites - black deposits going up arm
sentinel node

Question 33

how do you treat melanoma

Answer 33

surgery

BRAF inhibitors