Skin Lesions Flashcards
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
Keratoacanthomas may reach a considerable size prior to sloughing off and scarring.
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
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.
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
Spitz naevi can often resemble melanoma and are best excised.
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
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.
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
This is most likely to be seborrhoeic warts. These are usually superficially sited and are best managed with shave biopsy and cautery.
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
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.
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
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.
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
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.
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
These lesions are often extensive and superficial. Shave excision will suffice, material must be sent for histology.
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
Dermatofibromas may be pigmented and are often larger than they appear. They frequently occur at sites of previous trauma.
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
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.
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
The raised pearly edges in an ulcerated lesion at a sun exposed site makes BCC most likely.
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
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.
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
Pyogenic granulomas often appear at sites of trauma.
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
Sebaceous cysts usually contain sebum, pus is only present in infected sebaceous cysts which should then be treated by surgical incision and drainage.
