Derm Flashcards by Wasim Silmi

What are the three skin cancers

Squamous cell carcinoma
Basal cell carcinoma
Melanoma (+melanocytic lesions)

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What are the infectious causes of skin lesions (5)

Cellulitis 
Erysipelas
Erythema nodosum
Erythema multiforme
Molluscum contagiosum

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What are the three types of lesions

Flat
Fluid filled
Raised

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What are the 2 types of flat lesions

Macule (small)

Patch (large)

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What are the 3 types of fluid filled lesions

Vesicle - blister <0.5cm in diameter
Pustule
Bulla - blister more than 0.5cm in diameter

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What are the 2 types of raised lesions

Papule - less than 0.5cm diameter

Nodule - more than 0.5cm in diameter

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Define SqCC

cancer of keratinocytes in epidermis

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What does the epidermis consist of (3 main things)

SqC
Basal cells
Melanocytes

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RF of SqCC (4)

UV light
Actinic keratosis (pre-cancerous condition)
FHx
Lighter skin

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Describe the lesion in SqCC (5)

Hyperkeratotic

Scaly/Crusty

Ulcerated

Non-healing

Rolled edges

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Invasion of SqCC and ability to metastasise

Local invasion (e.g. into dermis)

Can metastasise

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Define basal cell carcinoma

cancer of keratinocytes in epidermis (in stratum basale

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RF of BCC (3)

UV light
FHx
Lighter skin

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Describe the lesion in BCC (5)

Nodule

Pearly edges

Rolled edges

Central ulcer
(rodent ulcer)

Central fine
telangiectasia

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What are the four sub-types fo BCC and describe each

Nodular - most common
Superficial - flat shape
Morpheic - yellow waxy plaque, scar like
Pigmented - coloured

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Define melanoma

cancer of melanocytes in epidermis

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RF of melanoma (3)

UV light
FHx
Lighter skin

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Invasion of BCC and ability to metastasise

Slow growing
Local invasion
(e.g. into dermis)

DOESN’T TYPICALLY METASTASISE

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Invasion of melanoma and ability to metastasise

Local invasion (e.g. into dermis)

Can metastasise

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Describe the lesion in a melanoma (9 (5+4))

Asymmetry

Border
(irregular)

Colour
(pigmented)

Diameter >6mm

Evolution
(size/shape)

May bleed, itchy, ulcerate, crust over

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Subtypes of melanoma (4)

Superficial spreading - most common
Lentigo maligna - flat lesions on (elderly)
Nodular - domed shape, rapid growth
Acral lentiginous - palms, soles and nail beds, most common in non-caucasians

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Which population is more prone to acral lentiginious

Non-caucasians

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Which population is more prone to lentigo maligna

elderly

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Which skin cancers are urgent referral vs routine referral

Melanoma - urgent referral
SqCC - urgent referral
BCC - routine referral

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What is used to measure melanoma invasion

Skin biopsy | (Clark Level/Breslow Thickness

Define melanocytic lesion

BENIGN neoplasms of melanocytes in epidermis

Describe a melanocytic lesion (3 and 4 things they do not do)

Symmetrical Flat Regular borders (i.e. not ABCDE) Does not bleed, itchy, ulcerate, crust over

What should you be aware of with melanocytic lesions

Rarely can transform into melanoma

What is a sign of chronic eczema

Lichenification

RF of eczema (4)

``` PMHx/FHx of atopy Food allergies Hay fever Asthma Immunocompromise ```

6 subtypes of eczema

``` Atopic dermatitis Contact dermatitis Discoid dermatitis Seborrheic dermatitis Dyshidrotic Eczema herpeticum ```

What type of reaction is atopic dermatitis and which Ig and where does it occur

Type I hypersensitivity (Ig-E mediated) Flexures

What type of reaction is contact dermatitis and what are common causes

Type IV hypersensitivity (delayed) Often nickel/latex Two types: Irritant and allergic

Common population of discoid dermatitis and what do the lesions look like

Middle-aged/elderly | Coin-shaped plaques

Describe seborrhoea dermatitis and the distribution

Yellow, greasy scaly rash Distribution: eyebrows, nasolabial, scalp (cradle cap)

Describe dyshidrotic (pompholyx) and the distribution

Itchy/painful blisters | Distribution: palms + plantars i.e. hands + feet

What causes eczema herpeticum (type of virus)

MEDICAL EMERGENCY (Can disseminate) Superimposed HSV-1

Which is AI, eczema or psoriasis

Psoriasis

Define psoriasis

auto-immune condition characterised by hyperproliferation of keratinocytes

RF of psoriasis

PMHx/FHx of psoriasis

Triggers of psoriasis (3)

Stress Smoking Alcohol

Oncholysis DDx (4)

Psoriasis Fungal infection Trauma Thyrotoxicosis

Describe lesions in psoriasis and distribution

Purple, silvery plaques Dry, flaky skin Itchy/painful Distribution: Extensors/scalp

Nail signs of psoriasis (3)

Onycholysis Pitting Subungual hyperkeratosis

Most common type of psoriasis

Plaque

What can triggers the onset of guttate psoriasis

Often 2 weeks post-Strep

What are the subtypes of psoriasis (5)

``` Plaque Pustular AKA palmo-plantar Guttate Flexural Erythrodermic ```

Describe guttate psoriasis

Raindrop plaques

Describe erythrodermic psoriasis

Systemic body redness and inflammation Often temperature dysregulation, electrolyte imbalances Requires hospitalisation

Ix for psoriasis (4)

Physical examination Basic observations Skin patch testing (contact dermatitis) Skin biopsy Usually clinical diagnosis

Usual causative pathogens of cellulitis and erysipelas

often strep pyogenes, or staph aureus

``` Cellultis: Site Borders Systemic symptoms? Sepsis? ```

Dermis, subcutaneous tissue More patchy Less common More common

``` Erysipelas: Site Borders Systemic symptoms? Sepsis? ```

Epidermis Well demarcated Fevers, rigors Less common

Complications of cellulitis

``` Abscess Sepsis (emergency) Necrotising fasciitis (emergency) Periorbital cellulitis (emergency) Orbital cellulitis (emergency) ```

Ix for cellulitis and erysipelas

``` Physical examination Basic observations (e.g. sepsis) ``` Bloods: FBC CRP Blood culture Pus/wound swab MCS CT/MRI (if orbital cellulitis – identify posterior spread of infection)

Mx of cellulitis and erysipelas (conservative 3, medical)

Draw around lesion (to see if it grows or shrinks) Monitor observations Oral fluids ``` Medical Oral ABx (e.g. flucloxacillin) IV ABx (if severe) ```

Admit cellulitis for which

``` Sepsis High HR High RR Low BP Confusion AVPU GCS ```

Infectious causes of erythema nodosum (3)

Strep pyogenes TB HIV

Systemic disease causes of erythema nodosum (3)

IBD Sarcoidosis Behçet’s disease

Drug causes of erythema nodosum

Sulphonamides

Non-infectious/systemic disease/drug causes of erythema nodosum

Pregnancy

Description of erythema nodosum (3) and distribution and 2 things it does not do

Bilateral nodules Tender Red/purple Distribution: Anterior shins Knees Does not ulcerate Does not scar

Define erythema multiform

inflammation of skin and mucous membranes – type IV hypersensitivity

Infectious causes fo erythema multiforme (3)

Herpes (HSV) Mycoplasma HIV

Drugs causes fo erythema multiforme

Sulphonamides

Symptoms of erythema multiforme

Prodrome | (fever, aches)

Describe the lesion in erythema multiforme (4)

Target lesions (Central vesicle/crust Ring of pallor Ring of erythema) Tender/itchy/pain

Distribution of erythema multiforme

Often start on hands | Then spreads

Define molluscum contagiosum

skin infection due to pox virus (molluscum contagiosum virus)

RF of molluscum contagiosum

Immunocompromise (e.g. HIV) | Atopic eczema

Describe the lesion in molluscum contagious (4)

Smooth papule Umbilicated Often painless Often itchy

Is molluscum contagiosum contagious

Yes. It's in the name lol

Do children need exclusion from school for molluscum contagiosum