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Lucy Knox - Year 2.5 > 225 - Malignant Melanoma > Flashcards

225 - Malignant Melanoma Flashcards

1
Q

Name 3 common skin commensals

A

Staph epidermidis
Staph hominis
Micrococci

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2
Q

Which 2 bacteria commonly cause cutaneous infections?

A

Staph Aureus

Strep Pyogenes

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3
Q

What sort of cutaneous infection does Staph aureus cause?

A 
Superficial ones
Impetigo
Folliculitis
ecthyma
Abscess/carbuncles/furuncles/boils
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4
Q

What sort of cutaneous infection does Strep Pyogenes cause?

A

Deeper infections
Cellulitis
Abscess
Nectrotising fasciitis

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5
Q

What is the treatment for staph/strep cutaneous infectioms?

A

Staph - Flucloxacillin

Strep - Penicillin

Or Erythromycin

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6
Q

What sort of cutaneous infection can be caused by a mycobacterium?

A

Fisktank granulmoa - eg. mycobacterium marinus

Red scaly plaques

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7
Q

What sort of cutaneous infections are caused by spirochaetes

A

Syphilis (Primary- painles lesion on heals, then secondary rash on hands, then tertiary neuro problems)

Lyme disease - Borrelia burgotferi, transmitted by tick
Rash that spreads. Use doxy

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8
Q

What is Erythrasma cause by?

A

Diptheroid skin commensal - Corynebacterium minutissimum

Red/brown dry patches in flexures

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9
Q

Fungal infections can cause cutaneous infections - What types are there?

A

Yeasts - Candida albicans - thrush/intertrigo…

Pityriasis versicolour - malassezie furfur

Dermatophytes - tinea corpis/pedis/ungum..

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10
Q

How do you treat fungal cutaneous infections?

A

Imidazoles - clotrimazole
Terbinafine

Lots of choice

Systemic - Itraconazole

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11
Q

What sort of cutaneous manifestations does Herpes simplex cause?

A

Highly contagious, direct contact spread
Penetrates epidermis

HSV I and II - Primary on skin, oral or genital
Reoccurs as coldsore of genitals

VZV - Zoster: Primary chicken pox (crops of vesicles), can reoccur as shingles

Complications:
Can cause Eczema herpitcum, Herpes enchephalitis, Keratoconjunctivitis

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12
Q

What cutaneous manifestation does HPV have?

A

Viral warts - dif types in dif locations

Treat: paring down/excision
They spontaneously resolve in 6-12 months
Can use salicylic acid / cryotherapy

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13
Q

What cutaneous manifestation does the Pox virus have?

A

Molluscum contagiosum

(in sheep = Orf)

Contagious, umbilicated papules associated w. atopic dermatitis, contain jelly like material

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14
Q

What is Erythema nodosum? What is it a cutaneous manifestation of?

A

Erethmatous tender nodules, usually on shins, more common in women

Causes:
TB, OCP, Pennicillin, Pregnancy, IBD…

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15
Q

What is Pyoderma Gangrenosum? What is it a cutaneous manifestation of?

A

Ulcer with irregular boarders, violaceous edge _ necrotic areas. Very painful

Causes:
RA, IBD, Haematological disease, Wegnar’s, PAPA syndrome

Can manage with immunosuppression therapy

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16
Q

What is a malar eruption/butterfly rash? What is it a cutaneous manifestation of?

A

Red patches across cheeks + photosensitivity

Systemic Lupus Erythematous

Also: mouth ulcers, urticaria, hair thinning

+ve ANA, ENA, anti dsFNS, anti-sm

Manage - sun protection, camouflage, topical steroids, antimalarials

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17
Q

What is Scleroderma? What is it a cutaneous manifestation of?

A

Localised skin hardening/thickening

Cause?
Morphea = only on skin -> can follow lyme disease, pregnancy, radiotherapy.

Systemic Sclerosis = systemic autoimmune disease against connective tissue

Increase in dermal collagen + ECM = thickening

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18
Q

What is Dermatomyositis?

A

Inflammation of coluntary muscles + a rash
2x as common in women

Get red/bluish-purple patches on sun exposed sites
Heliotrope rash on eyelids
Gottron's papules on bony prominances
Calcinosis
Raynauds

Investigations - CK, ANA, Skin biopsy, Muscle biopsy, EMG…

Manage - Systemic steroids, immunosupression, Ca channel blockers, sun protection

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19
Q

What is Pseudoxanthoma Elasticum (PXE)

A

Recessive disorder - affecting elastic tissue of skin, blood vessels + eyes - abnormal collagen
Ca accumulates in elastic fibres of skin/blood vessels/eyes/heart

  • > small yellow papules / patches
  • > Soft, lax, wrinkled skin - at neck first

No skin management, but can address vessel complications (eg. mitral valve prolapse..)

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20
Q

What is neurofibromatosis?

A

Genetic disorder: skin bone soft tissue + nervous system.

Type 1: Cafe au lait spots, neurofibromas, axillary freckling, iris tumour (Lisch nodule)

Type 2: Brain + spinal cord tumour
Auditory nerve tumour

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21
Q

Name 4 cutaneous markers for malignancy

A

Peutz-Jegher’s syndrome - dark spots on lips, mouth, anus, and polps in GI tract.

Paraneoplastic Pempigus - autoimmune disorder due to tumour, painful blisters + denuded areas in mouth, skin, oesophagus

Acanthosis Nigricans - Darkened thickened skin in neck, armpit, groin

Sweet syndrome - Tender lesions - papules + vesicles. Acute neurophilic dermatoses

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22
Q

What are 2 pre-malignancy changes seen in skin cancer?

A

Actinic/Solar Keratoses - discreet rough scaly patches in sun exposed areas

Bowen’s disease - single patch of red, scaly skin, often on lower leg, expands over time

Both can be removed - cryotherapy, chemo cream, photodynamic therapy..

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23
Q

What are the 2 types of non-melanocytic skin cancer?

A

Squamous cell carcinoma
- Less common, where pre-malig changes were, fast growing, can be on lip from smoking/sun, risk of metastasis increases with size/immunocompromised state.

Basal Cell Carcinoma - most common tumour in white pop. Locally invasive, rarly metastasize. 80% head/neck.

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24
Q

What are the risk factors for BCC?

A 
Cummulative sun exposure
Fair skin
Age
Radiotherapy damage
Aresnic
Tars
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25
Q

What do BCCs look like?

A 
Nodular-cystic
Purly, telangetic vessels
Central dip/ulcer
Soft
Bleed easily

Can be pigmented with a rolled, smooth, shiny boarder

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26
Q

How do you treat a BCC?

A

Surgical excision gold standard

Radiotherpahy
Cryotherapy or PDT or curitage if superficial.

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27
Q

What is Moh’s micrographic surgery?

A

Histology os checked to ensure you’ve cut out edge during surgery.

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28
Q

Describe malignant melanoma

A

Serious, malignant potential.
More in females. Incidence doubled last decade.

  • New black/brown mole, or old one that has changed in size/shape/colour.
29
Q

What are 4 types of malignant melanoma?

A

Superficial spreading - horizontal growth
Nodular - vertical growth - lumpy
Acral - lentigenous - under nail
Lentigo maligna - face/scalp, sun linked, elderly

30
Q

What treatment is available for malignant melanomas?

A 
Surgery - with 1-3cm margin
Sentinal lymph node biopsy
Adjuvant interferon
Chemo
New therapies: for mets
- BRAF inhibitors - vemurafenib
- immune therapy - ipilimumab
31
Q

What is uricaria/angioedema?

A

Looks like nettle sting - raised areas, red around, lasts a day. Angioedema - severe joined up, diffuse swelling.

50% ideopathic, 50% trigger - allergens, viral,NSAIDS…

Treat: antihistamines, steroids, fluids if needed.

32
Q

What is toxic epidermal necrolysis?

A

Type IV cell mediated immune response
Reaction to drug
Ketitonocyle apoptosis

STOP DRUG eg. allopurinol, carbamazopine

33
Q

What is necrotising fasciitis?

A

Severe infection spreading along fascial planes
V painful, tense swelling, feverish, hard woody purplish skin

Lots of different bacteria can cause tissue necrosis

Urgent surgical debridement needed

34
Q

What is staphylococcal scalded skin syndrome?

A

V red, flaking skin
Staph exfoliative toxin
Flucloxacillin essential + emolliants

35
Q

What is anaphylaxis?

A

Systemic release of histamine -> oropharyngeal oedema + extreme urticaria. Rapidly fatal

Treatment:
Adrenaline 1:1000 IM
? intubation + ventilation
Fluid bolus
Steroids + antihistamines
36
Q

What are 3 autoimmune blistering disorders?

A 
Bullois pemphigoing (intact bulla)
Pemphogus Vulgaris (fragile bulla)
Dermatitis herpetiformis (on extensor surfaces)
37
Q

What is an infective blistering disorder?

A

Bullous impetigo

Exfoliative toxin

38
Q

What is the treatment for blistering disorders?

A

Pop blisters
Prevent infection - iodine dressings
Barrier restoration - emollient

39
Q

What is eczema?

A

Itchy, red, inflammation of skin

Types?

  • Endogenous: atopic, seborrhoeic, discoid, venous
  • Exogenous - allergic, irritant, photo-reactive

Treatment: Emollient + Steroid
- avoid irritation, use soap substitute..

40
Q

What will investigations show in eczema?

A

If allergic - IgE RAST testing for type I

- Patch testing for Type IV allergy

41
Q

What is a weak topical steroid?

A

Hydrocortisone

Help Every Busy Dermatologist

42
Q

What is a moderate topical steroid?

A

Eumovate

Help Every Busy Dermatologist

43
Q

What is a potent topical steroid?

A

Betnovate

Help Every Busy Dermatologist

44
Q

What is a very potent topical steroid?

A

Dermovate

Help Every Busy Dermatologist

45
Q

What is the normal pH of skin?

A

5.5

46
Q

What is acne vulgaris?

A

Disorder of pilosebaceous units - increased sebum excretion, hyperkeratosis + blockages of follicle opening, colonisation of ducts with propionibacterium acnes, release of inflam mediators

47
Q

What are the 3 severities of acne vulgaris?

A

Mild: comedonal - black + white heads

Mod: papules + pustules

Severe - Nodulocystic

48
Q

What is the treatment for acne vulgaris?

A

Topical:
Benzolyl Peroxide
Retinoids
Antibiotics

Systemic:
Antibiotics (tertracycline/erythromycin)
OCP
Isoterinoin (Roaccutaine)

49
Q

What is Rosacea?

A

Chronic inflam. facial dermatosis

  • Erythema + pustules, comes and goes.

In older group than acne.

Treat: top metronidazole cream, systemic tetracycline

50
Q

What are papulosquamous eruptions? What can cause them?

A

Red, scaly, marginated, dry eruptions.

Inflam : lichen planus, pityriasis alba, pityriasis lichenoides

Infective: Pityriasis versicolour, pityriasis rosea, tinea corporis

51
Q

What is Hidradenitis suppurative?

A

Acne inversa

Female, overweight, smoker

Treat with antibiotics

52
Q

What is Psoriasis?

A

A papulo-squamous skin disorder

Well demarkated, scaly, red plaques

53
Q

What are the features of chronic plaque psoriasis?

A

On extensor surfaces, red scaly plaques that are itchy and sore, have a silver sheen.

54
Q

What are the features of flexural psoriasis?

A

Later in life onset
Well demarcated, red-glazed plaques
Not scaly
Occurs within flexures

55
Q

What is Gluttate Psoriasis?

A

Raindrop like, small circular or oval plaques on trunk.

Often after strep URTI

56
Q

How do you treat psoriasis?

A 
Topical - Emollients, 
mild/mod steroids, 
vit D analogues (cacipotiol)
Coal tar
Dithranol (accumulated in mitochondria - less proliferation)
Tazarotene (reduce keratinocyte prolif)
57
Q

What associated factors are seen in someone with Psoriasis?

A

50% get nail changes - pitting, onycholysis, thickening, subungual hyperkeratosis

5-10% get Psoriatic arthritis

58
Q

When does atopic eczema usually present?

A

Under 2 years, around 4-6 months - around weaning.

59
Q

What is the key dysfunction in eczema?

A

A barrier dysfunction

60
Q

In addition to emollients and topical steroids, what can you give in moderate eczema?

A

Topical calcineurin inhibitors + bandaging

61
Q

In addition to emollients and topical steroids, what can you give in severe eczema?

A

Phototherapy

Systemic therapy - cyclosporin, Asothyoprine

62
Q

What can be used in a child older than 2 years in addition to topical steroids or if steroids are unsuitable?

A

Topical immunomodulators - eg. Elidel cream or Protopic.

Affect the immune response + have local antiinflam response.

Don’t cause thickening or atrophy

63
Q

What is the prognosis of atopic eczema?

A

60-70% of children clear by teens

Dry sensitive skin persists

64
Q

Describe the course of measles

A

Prodrome period of 10-12 days
Fever, conjunctivitis, coryza(cold) and cough
2-3 days get Koplik’s spots in mouth
4-5 days get rash - ill defined, macula rash, head first

65
Q

Describe rubella

A

Less severe than measles, slight fever, sore throat
Rash from head down
Tender lymph nodes

  • congenital rubella - can cause blindness if in pregnancy
66
Q

What causes hand-foot and mouth disease?

A

Coxsachie enterovirus

Small flat blisters on hands and feet + mouth ulcers

67
Q

What is the offical name for headlice?

A

Pediculosis Capitis

68
Q

What is Scabies?

A

A mite - sarcoptes Scabei

Spread by direct physical contact, burrows in skin
Must treat whole family and close contacts with Permethrin 5% cream, applied from neck down twice a week apart.

Lucy Knox - Year 2.5 (15 decks)

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