Week 3 - F - Skin lesions quiz - mainly different benign lesions (moles, seborrhoeic warts), precursor lesions, cancer

Question 1

Q1. Proliferation of which cell is responsible? melanocytes basal keratinocytes suprabasal keratinocytes fibroblasts merkel cells

Answer 1

Proliferation of basal keratinocytes is responsible as this appears to be a basal cell carcinoma Risk factors -intense/intermittent sun exposure and sunbeds Presentation - slow growing lesions , often repeatedly scab but do not heal, may itch or bleed, usually painless . Rolled up pearly edges, central ulceration and telangiectasia

Question 2

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Answer 2

Surgical excision - Moh’s surgery Basal cell carcinoma - usually surgical excision If superficial BCC - can give imiquimod, or crytotherapy or photodynamic therapy

Question 3

Q3. What is the most likely diagnosis? squamous cell carcinoma basal cell carcinoma viral warts actinic keratoses seborrhoeic keratoses

Answer 3

Actinic keratoses

Question 4

What treatment would be most appropriate for actinic keratoses in this patient?

Answer 4

Topical treatment with 5-flourouracil (cytotoxic)

Question 5

What is the diagnosis?

Answer 5

Seborrhoeic keratosis (seborrhoeic wart, basal cell papilloma)

Question 6

Q6. What is the most likely diagnosis? chronic infection repeated trauma squamous cell carcinoma (SCC) basal cell carcinoma (BCC) brain tumour

Answer 6

Basal cell carcinoma - neglected BCC

Question 7

How is a neglected BCC typically managed?

Answer 7

Would probably manage with radiotherapy a very difficult to excise

Question 8

Q7. What is the most likely diagnosis? dysplastic naevus malignant melanoma intradermal melanocytic naevus seborrhoeic wart (basal cell papilloma) Bowen’s disease What is the management?

Answer 8

Malignant melanoma - risk factors - intermittent and intense sun exposure URGENT EXCSION A - asymmetrical B - border is irregular C - multiple colours D - diameter is approx 1cm (>6mm) E - has evolved in size and colour

Question 9

Which of the following would you expect to find histologically? - Full thickness dysplasia of keratinocytes within epidermis - Atypical melanocytes extending up through the epidermis - Inflammatory infiltrate in the upper dermis associated with epidermal spongiosis - Positive immunofluorescence at basal layer - Keratinocytes in vertical growth phase into dermis

Answer 9

Full thickness dysplasia of keratinocytes within epidermis - looks like Bowen’s disease Typically presents as an erythematous scaly plaque

Question 10

What is the most likely diagnosis?

Answer 10

Squamous cell carcinoma - Chronic sun exposure - farmer Immunosupressed Previously had treatment here - precursor Hx Faster growth than BCC, may be painful and/or bleeding Uusally hyperkeratotic lump or ulcer (ears, dosrum of hand, scalp)

Question 11

Which of the following statements regarding SCC is FALSE? These may arise de novo, or from existing areas of AK or Bowen’s disease SCC can metastasise Surgical treatment should be avoided in this anatomical site Immunosuppression is a recognised risk factor for development Topical imiquimod (immune modulator) is a recognised therapy

Answer 11

Surgical treatment should be avoided in this anatomical site - FALSE (high risk site for metastase - ears, lips, mucous membranes) These may arise de novo, or from existing areas of AK or Bowen’s disease - TRUE SCC can metastasise - TRUE Immunosuppression is a recognised risk factor for development - TRUE Topical imiquimod (immune modulator) is a recognised therapy - TRUE

Question 12

Q11. Which of the following is most reassuring ? well defined border size lack of symptoms unchanging What is the most likely diagnosis?

Answer 12

Unchanging Most likely diagnosis is blue naevus (rare)

Question 13

What is the most appropriate management? Reassure – this is normal Cryotherapy Excise urgently Monitor regularly Excise but not urgently

Answer 13

Re-assure this is normal Looks like a compound melanocytic naevi - normal for moles to become elvated as they mature (junctional –> compound –> intradermal)

Question 14

Which of the following statements is true? The nodule is most likely SCC The nodule indicates that metastasis has occurred The nodule is suggestive of vertical growth phase The nodule is most likely haemangioma The nodule is most likely BCC

Answer 14

The nodule is suggestive of vertical growth face Looks like it could be a lentigo malignommealnoma - growing on sun damaged area and evolving

Question 15

Proliferation of which cell is responsible? melanocytes basal keratinocytes suprabasal keratinocytes fibroblasts merkel cells

Answer 15

Basal keratinocytes - looks like a superficial basal cell carcinoma

Question 16

What is your diagnosis? Basal cell cancer Basal cell papilloma Amelanotic melanoma Dermatofibroma Melanoma

Answer 16

Dermatofibroma - overgrowth of fibrous tissue of dermis Typically presents on limbs as firm lumps with some pigmentation and fairly static - may have itch

Question 17

What is your diagnosis? Basal cell cancer Viral wart Squamous cell cancer Haemangioma Melanoma

Answer 17

Basal cell cancer Slow growing, pearly rolled up edges with central ulceration and telangiectasia and bleeding Sun exposure

Question 18

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Answer 18

Basal cell papilloma (aka seborrhoeic keratosis aka seborrhoeic wart) May itch Common on face and trunk (back and chest)

Question 19

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Answer 19

Melanoma ABCD approach… Asymmetry Irregular border Varied colour Large size - >6mm Looks like superficial spreading which may have uclerated in the middle, potential for vertical growth phase

Question 20

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Answer 20

Hemangioma