Week 3.5 Flashcards
What are chronic leg ulcers
open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
What causes arterial leg ulcers
Peripheral arterial disease causing insufficient blood supply to lower limbs
Peripheral arterial disease often caused by
Atherosclerosis - narrows the peripheral arteries so less blood flow
Presentation of arterial ulcers
Deep
Punched out appearance (like someone made a hole)
Surrounding skin is cold and white
Intermittent claudication
Pain at night
Absent peripheral pulses
What may patients describe that they do at night to relief the pain caused by arterial ulcers
hang their legs off the end of the bed
What is claudication
Muscle pain triggered by activity and relieved by rest
Investigations for arterial leg ulcers
ABPI
Doppler ultrasound
What is the ABPI for arterial leg ulcers
< 0.9
Management for arterial leg ulcers
Statin
Antiplatelet
Treat hypertension
(the aim is to reduce the modifiable risk factors)
Which type of leg ulcer is the most common
Venous leg ulcer
What causes venous leg ulcer
Chronic venous insufficiency
Describe the pathophysiology of chronic venous insufficiency
- Elevation in venous pressure in legs causing veins to dilate and valves to become insufficient
- This causes varicose veins to develop
- The increased hydrostatic pressure in the vessels causes red blood cell leakage into tissues
- this causes venous dermatitis, swelling
- Skin does not heal well from the dermatitis due to poor blood supply hence it breaks down and forms an ulcer
Venous ulcers usually occur in
Above the medial malleolus = gaiter area
Presentation of venous ulcers
Superficial, shallow
larger than arterial ulcers
Warm
Exudative - oozing
Haemosiderin deposition (brown pigment)
Varicose veins
Investigations for venous ulcers
Clinical
ABPI and doppler ultrasound to exclude arterial cause
Management for venous ulcers
4 layer compression bandaging
Compression stockings
Pain relief
Leg elevation
What is the 4 layer compression bandaging
Graduated pressure - highest at the ankle lowest at the knee
Most common type of skin cancer
Basal cell carcinoma
Basal cell carcinoma arise from
Basal keratinocytes
Where does basal cell carcinoma usually occur on
Sun exposed sites such as head and neck
Risk factors for BCC
Sun exposure
History of frequent / severe sun burn
Genetics
Skin type I and II
Immunosuppression
Increasing age
Ionizing radiation
Outdoor occupations / hobby
What genetic conditions are associated with BCC and SCC
Xeroderma pigmentosum
Albinism
4 Types of BCC
Nodular
Superficial
Infiltrative
Pigmented
Features of BCC
Usually does not metastasize
Slow growing tumours
Presentation of Nodular BCC - TURP
Telangiectasia
Ulceration at the center
Rolled edge
Pearly white
What is the ulceration at the center of nodular BCC called
Rodent ulcer
Presentation of superficial BCC
Erythematous plaque
Dry / crusted
May have bluish-tinge
Presentation of infiltrative BCC
Thickened plaque
Whitish
Not well demarcated
Where does infiltrative BCC usually occur
Upper trunk
Face
Pigmented BCC often looks like
Melanoma
Pigmened BCC often present in
Dark skin
Investigations for BCC
Visual inspection
Narrow excision for histology
Management for BCC
Wide excision
Curettege / cautery
Superficial BCC and low risk of BCC can be managed with non-surgical treatments
Non-surgical treatments for BCC
Cryotherapy
Radiotherapy
Topical imiquimod
Precursors of squamous cell carcinoma
Bowen’s disease
Actinic keratosis
Where does squamous cell carcinoma arise from
Supra-basal keratinocytes
Risk factors for squamous cell carcinoma
Skin type I or II
Sun exposure
Genetics
Premalignant conditions
Immunosuppression
Ionising radiation
Smoking
Increasing age
SCC is most common among which group of people
Immunosuppressed population
Where can SCC arise from
Sun exposed sites
Chronic leg ulcers
Sites of burns
Chronic lupus vulgaris
What is lupus vulgaris
Cutaneous tuberculosis skin lesions
Prognosis of SCC
generally well if detected early
Poor prognosis if metastasised
Presentation of SCC
Irregular red nodule
Ulceration
Warty lump
May be painful
May bleed
Difference between SCC and BCC
SCC grows faster than BCC
SCC can metastasise whereas BCC doesn’t usually spread
SCC arise from supra-basal keratinocytes whereas BCC arise from basal keratinocytes
