Dermatology Flashcards
(176 cards)
1
Q
Risk factors/triggers/exacerbating factors for psoriasis
A
- Ethnicity - lower rates in Africans, Norwegians and some Asians
- Age - peaks in teenage/young adults and 50-60s
- Strep throat infection
- Other infections e.g. HIV
- Drugs e.g. lithium, beta-blockers, interferon-alpha, chloroquine
- Bone marrow transplant
- Obesity
- Smoking
- Alcohol
- Koebner phenomenon
- Psychogenic factors e.g. stress
2
Q
Two cardinal histological features of psoriasis
A
1) Epidermal hyper proliferation
2) Pronounced inflammatory infiltrate
3
Q
Clinical features of stable chronic plaque psoriasis
A
- Scaly, red well demarcated plaques
- Most commonly seen on extensor surfaces
- Remitting and relapsing course
- May be associated with psoriatic arthritis
- Increased risk of metabolic syndrome and CVD
4
Q
Clinical features of guttate psoriasis
A
- Several hundred small lesions
- Most common on the trunk
- Most common in children and young adults
- 2-3 weeks after strep throat
5
Q
Psoriatic nail signs
A
- Nail plate pitting
- Onycholysis
- Oily spots
6
Q
How would you diagnose psoriasis
A
- Clinical diagnosis
7
Q
Management of psoriasis
A
1) Avoidance of precipitants e.g. smoking cessation, reduce alcohol intake
2) Topical emollients
3) Topical corticosteroids (particularly in flexure and scalp psoriasis)
4) Topical vitamin D analogues
5) Phototherapy
5a) Narrow band UVB phototherapy (works best for small plaque psoriasis)
5b) PUVA therapy
6) Methotrexate
7) Ciclosporin
8) Retinoids (vitamin A analogues)
9) Biologics e.g. TNFa inhibitors or cytokine pathway inhibitor
8
Q
Side effects of topical corticosteroids
A
- Skin thinning
- Telangiectasia
- Striae
- Systemic steroid effects with prolonged use
- May loss efficacy over time
9
Q
Side effects of UBV phototherapy
A
- Small risk of sunburn
- Potential long-term increased risk of non-melanoma skin cancer
10
Q
Side effects of PUVA therapy
A
- Tan
- Increased risk of non-melanoma and melanoma skin cancers
11
Q
Side effects of methotrexate
A
- Hepatic fibrosis
- Bone marrow inhibition
- Immunosuppression
- Nausea
- Teratogenic - wait 3 months after stopping treatment two conceive
12
Q
Monitoring required for patients on methotrexate
A
- Regular FBC, LFTs and U&Es
13
Q
Side effects of ciclosporin
A
- Excessive hair growth
- Gingival hyperplasia
- Immunsuppression
- Nephrotoxicity
- Hypertension
- Increased risk of virally-associated cancers e.g. EBV-lymphoma, HPV-cervical cancer
14
Q
Side effects of retinoids
A
- Teratogenic - women should not conceive for 3 years after treatment with acitretin
- Triglyceride elevation
- Increased CVD risk
- Mucosal and cutaneous dryness
- MSK pain
15
Q
Side effects of biologics
A
- Immunosuppression
- Virus reactivation
- Worsening of inflammatory disease
16
Q
3 pathogenic features of acne vulgaris
A
1) Abnormal keratinisation of the follicular epithelium
2) Increased sebum excretion
3) Infection with gram-positive rod Propionibacterium Acnes
17
Q
Risk factors for acne
A
- Male sex
- PCOS
- Congenital adrenal hyperplasia
- Androgen secreting tumour
- Exogenous androgens e.g. steroids
- Family history
18
Q
Clinical features of acne
A
- Typically affects the face and upper torso/back
- Includes: comedones, inflammatory papules, pustules, scars
- May have features of hyper-androgenism e.g. hirsutism, androgenic alopecia
19
Q
Investigations to consider in a patient with acne
A
- Menstrual history
- Total and free testosterone
- DHEAS
- 17-hydroprogesterone
20
Q
Management options for acne
A
1) Topical retinoids (best for comedonal acne)
2) Topical benzoyl peroxide
3) Topical or systemic antibiotics (tetracyclines, erythromycin, clindamycin)
4) Hormonal methods in women e.g. COCP
5) Systemic retinoids (4 month course, dose depends on weight)
21
Q
Side effects of topical retinoids
A
- Mild inflammatory reaction e.g. erythema, dryness, scaling
- Teratogenic
22
Q
Side effects of topical/systemic antibiotics in acne treatment
A
- Need to be tried for 2 months before considered ineffective
- Tetracyclines CI in <12s - stain teeth and absorbed by bone
- Teratogenic
23
Q
What tests need to be done before starting a patient on isoretinoin?
A
- FBC
- Lipid profile
- TFTs
- Pregnancy test
24
Q
Monitoring required whilst on isoretinoin
A
- Pregnancy test every month
- Pregnancy test 5 weeks after stopping
25
Side effects of isoretinoin
- May precipitate acne fulminas/temporary worsening of acne
- Teratogenic - need to use 2 methods of contraception and not conceive for 5 weeks after stopping treatment
- Increased triglycerides and cholesterol
- Abnormal LFTs
- Chelitis
- Dry eyes
- Dry nose and nosebleeds
- Dry skin
26
Management options for acne scarring
- Dermabrasion
- Carbon dioxide laser resurfacing
- Excision of small scars or cystic lesions
- Punching out or grafting ice-pick scars
- Fillers
- Potent peels (alpha-hydroxy acids)
27
Management of urticaria
- Non-sedative anti-histamines e.g. fexofenadine, cetirizine
28
4 autoimmune conditions associated with chronic symptoms urticaria
- Thyroid disease
- Vitiligo
- Rheumatoid arthritis
- Pernicious anaemia
29
Name 5 types of physical urticaria
- Dermographism
- Solar urticaria
- Cold urticaria
- Cholinergic urticaria
- Aquagenic urticaria
30
Management of angioedema
- C1-esterase inhibitors
| - SC Icatibant (bradykinin B2 receptor antagonist)
31
Clinical features of anaphylaxis
- Vasodilation
- Hypotension
- Bronchoconstriction
- Circulatory collapse
32
Management of anaphylaxis
- IM adrenaline
- Oxygen
- IV fluids
33
Most common inflammatory skin condition
Eczema
34
Two pathological processes in eczema
1) Abnormal/inappropriate immune system behaviour
| 2) Compromised skin barrier function
35
Cardinal pathological features of eczema
- Intercellular epidermal oedema (spongiosis)
- Lymphoid infiltrates in the dermis and epidermis
- Acanthosis
- Hyperkeratosis
36
Exacerbating factors for atopic eczema
- Stress
- Dry skin
- Skin infection
- Certain foods
- Winter
- Skin irritation
- Hormones e.g. menstruation
37
Clinical features of atopic eczema
- Itchy, scaly rash on face at 6-12 months old
- Rash involves flexor surfaces
- Excoriations
- Skin weeps in flexures and feels rough and dry everywhere else
- Soap and detergents worsen symptoms
- Associated hay fever and asthma
- Lichenification
- Pityriasis alba
- Dennie-Morgan folds
- Increased peri-orbital pigmentation
- Chellitis
- Symptoms/signs of other atopic conditions e.g. sneezing, lacrimation, wheeze
38
Management of atopic eczema
1) Topical emollients
2) Topical antiseptics
3) Bandaging
4) Topical corticosteroids
5) Phototherapy - UVB or PUVA
6) Systemic immunosuppression
39
Biggest risk factor for contact irritant dermatitis
Atopic eczema
40
Differences between contact allergic dermatitis and contact irritant dermatitis
Contact irritant dermatitis has:
- no period of sensitisation
- dose dependent response
41
What type of hypersensitivity reaction is contact allergic dermatitis?
Type 4
42
Clinical features of contact allergic eczema
- Eczema symptoms develop 24-96 hours after exposure to antigen
- Erythema and induration
- Weeping vesicles and blister formation
- Itch
- Acanthosis and hyperkeratosis in prolonged reactions
43
Investigation of choice for contact allergic dermatitis
- Patch testing - suspected antigens applied to patient's back then removed 24 hours later. Patient's skin examined at 48-96 hours.
44
Clinical features of pemphigoid
- Usually >60s
- Itchy urticated lesions which precede blister formation by several months
- Large, tense, robust fluid-filled blisters
- Less mucosal involvement than pemphigus
45
Investigations and results in pemphigoid
- Blister biopsy: eosinophil rich inflammatory infiltrate and sub-epidermal blisters
- Immunofluorescence: IgG staining along basement membrane
46
Management of pemphigoid
1) Systemic corticosteroids +/- azathioprine
2) Other immunosuppressants
3) IV immunoglobulin, anti-CD20 antibodies or cyclophosphamide
47
Clinical features of pemphigus
- Superficial blisters (may have burst or crusted)
- Mucosal involvement - most patients have painful mouth erosions
- Positive Nikolsky sign (if you rub normal skin a blister will appear)
48
Investigations and results in pemphigus
- Biopsy: acantholysis
| - Immunofluorescence: IgG intercellular staining
49
Management of pemphigus
1) High dose systemic corticosteroids
2) Azathioprine or mycophenolate
3) IV immunoglobulin, anti-CD20 antibodies or cyclophosphamide
50
Clinical features of dermatitis herpetiformis
- Intense, burning itch
- Small clusters of vesicles present on wrist, extensor surfaces of elbows and knees, sacrum and buttocks
- NO mucosal involvement
51
Investigations and results in dermatitis herpetiformis
- Biopsy: small polymorph abscess in the upper dermis
- Immunofluorescence: granular deposition of IgA in the dermis papillary tips
- TTG antibodies (80% of patients)
52
Management of dermatitis herpetiformis
1) Gluten free diet
| 2) Dapsone
53
Important side effects of dapsone
- Haemolytic anaemia
| - Agranulocytosis
54
Clinical features of erythema multiforme
- <40s
- Males more commonly affected
- History of previous infection
- TARGET LESIONS (red/ducky cyanotic middles with bright erythematous outer ring) - initially macular but may become papular. May be haemorrhage or blistering at the centre.
- Rash most common on extremities e.g. hands, feet, face, elbows, knees
- Mucosal involvement may occur
- Fever and joint pain may occur
55
2 causes of erythema multiforme
- HSV
| - Mycoplasma
56
Management of erythema multiforme
1) Basic skin care with antiseptics
2) Topical steroids
- IV fluids in those with severe mucosal involvement
- Ophthalmology assessment in eye involvement
57
How long after starting a drug will TEN commence?
7-28 days
58
Main risk factor for TEN
- Immunosuppression
59
Clinical features of TEN
- Elderly patient
- Sudden onset of diffuse erythema with sheets of skin undergoing necrosis
- Excruciatingly painful
- Mucosal involvement likely e.g. mouth, eyes, genitals
- Wrinkling/blistering under sheets of skin
- Nikolsky sign positive
- Systemic features e.g. pyrexia, malaise, dysuria, sore eyes may precede rash
- Often worse on the trunk
60
Definition of Steven-Johnson Syndrome
<10% of body area involvement (+ mucosal involvement)
61
Differentials for positive Nikolsky sign
- Pemphigus
- TEN
- SSSS
62
Management of TEN
- Stop relevant drugs ASAP
- Monitor fluid balance
- Adequate analgesia
- Controlled pressure thermo-regulated bed and aluminium survival sheet
- Ophthalmology assessment
63
Potential drug causes of TEN
- Allopurinol
- Carbamazepine
- Sulphonamides
64
Clinical scoring system used to predict prognosis of TEN
- SCORTEN
65
A SCORTEN score >? predicts death in 90% of cases
5
66
Main causes of death in TEN
- Infection
| - Hyper-catabolic state
67
Clinical features of SSSS
- NO MUCOSAL INVOLVEMENT
- Usually children <5 (or immunosuppressed adults/adults with renal failure)
- Onset is a scarlet fever like rash around mouth and nappy area with peri-oral crusting and furrowing
- Erythema first appears on face then generalises
- Child is pyrexial but often systemically well
- Intense pain
- Over 48 hours, widespread blisters occur
- May be Nikolsky sign positive
68
Investigations to consider in suspected SSSS?
- Superficial skin biopsy
| - Culture swabs from throat and eyes
69
Management of SSSS
- IV Flucloxacillin and Vancomycin
- Supportive care
- Barrier nursing
70
Causes/associations of leucocytoclastic vasculitis
- Infection e.g. Hep A, B or C, streptococci or mycobacterium
- Drugs e.g. beta blockers, penicillin, thiazide diuretics
- Malignancy e.g. CLL, lymphoma, myeloma
- Small vessel vasculitis
- Systemic disease e.g. IBD, sarcoidosis, Behcet's
71
Clinical features of leucocytoclastic vasculitis
- Palpable purpura
- Most commonly on the legs
- Lesions can vary in size
- Lesions may be blistered or pustular
72
Management of leucocytoclastic vasculitis
- Bed rest and leg elevation
- Compression bandages
- Systemic corticosteroids or dapsone
73
Diseases associated with pyoderma gangrenosum
- IBD
- Rheumatoid arthritis
- Ankylosing spondylitis
- Myeloma
- IgA gammopathy
- Diabetes
- Chronic active hepatitis
- Primary biliary cirrhosis
74
Clinical features of pyoderma gangrenosum
- Lesion starts as a small red papule
- Then becomes pustular and ulcerated with red/purple/blue edges
- Lesion grows in size and becomes painful
- Systemically unwell patient
- Deep structures may be exposed
75
Management of pyoderma gangrenosum
- Systemic corticosteroids
76
Triggers/causes of erythema nodosum
- Drugs e.g. oral contraceptive, penicillin
- Bacteria e.g. streptococci, myocobacterium
- Sarcoidosis
- Brucellosis
- Malignancy e.g. lymphoma, leukaemia
- IBD
- Behcet's syndrome
77
Clinical features of erythema nodosum
- Painful red, raised or indurated lesions (look like bruises) - no ulceration and epidermis intact
- Most commonly seen in the lower legs
- Most common in young adults
- More common in females
- May have associated malaise, pyrexia and arthralgia
78
Management of erythema nodosum
- NSAIDs
- Bed rest and compression stockings
- Systemic corticosteroids
79
Clinical features of vitiligo
- Symmetrical, sharply demarcated macular areas of depigmentation
- Hair may lose pigment too
- Most commonly affects the genitals, eyes, mouth and hands
- Associated with autoimmune disease
80
Management of vitiligo
- Topical steroids
- Topical calcineurin inhibitors
- Phototherapy (PUVA or UVB)
- Epidermal transplants
81
Inheritance mode of albinism
Autosomal recessive
82
Clinical features of albinism
- Pale skin and hair
- Loss of pigmentation of the iris and retina
- Poor visual acuity
- Nystagmus
- Increased rates of skin cancer
83
Management of albinism
- Sun avoidance
- Early treatment of skin cancer
- Asssesment of visual acuity
84
Clinical features of melasma/chloasma
- Brown/grey patches on cheeks and forehead
| - Most common during pregnancy
85
Management of melasma/chloasma
- Sunscreen
- Azelaic acid
- Topical retinoids
86
Clinical features of rosacea
- Erythema, telangiectasia and flushing with possible sensory symptoms
- Oedema of the facial skin
- Papules and pustules on the face
- Ocular signs and symptoms e.g. blepharitis, keratitis, chalazia, scleritis, uveitis
- Rhinophyma (tissue overgrowth of nose)
- Most common on the nose and cheeks
- More common in middle-aged adults
- More common in those with pale skin and red hair
- Tends to be worse in men
87
Management options for rosacea
- General skin care - avoid irritants, soaps, UVR and many cosmetics
- Avoid precipitants e.g. alcohol, spicy food
- Topical brimonidine tartrate (improves erythema)
- Topical antibiotics e.g. metronidazole
- Topical azelaic acid
- Topical ivermectin
- Systemic antibiotics e.g. metronidazole, tetracyclines
- Systemic isoretinoin
- Surgical treatment of rhinophyma e.g. dermabrasion, surgical shaving
88
Medication ontra-indicated in rosacea
- Corticosteroids
89
Clinical features of premolar dermatitis
- Most common in young women
- Papules, pustules and erythema around the mouth
- Usually precipitated by topical corticosteroids or steroids inhalers
90
Management of premolar dermatitis
- Gradual reduction of topical corticosteroids
| - Systemic tetracyclines
91
Clinical features of seborrhoeic dermatitis
- Erythematous and scaly condition in sebum rich areas e.g. face, nasolabial folds, forehead, upper chest and back
- Most commonly seen in young and middle-aged adults
92
Management of seborrhoeic dermatitis
- Topical ketoconazole
| - Topical steroids (may be added to speed up resolution)
93
Two causes of scarring alopecia
- Lichen planus
| - SLE
94
Clinical features of lichen planus
- Intensely itchy rash
- Presence of violaceous polygonal flat-topped plaques
- Typically involves the wrists, forearms, lower legs or feet
- Frequent oral/mucosal involvement with a white mesh like pattern
- Can cause scarring alopecia
- Can affect the nails - causes thinning, longitudinal ridging and a widespread pattern (tracyonychia)
- More common in middle aged
95
Chronic lichen planus of the mucosa is associated with ???
Squamous cell carcinoma
96
Diagnostic investigation in lichen planus
- Wickham's striae (lace-like pattern) on dermatoscope
97
Management options for lichen planus
- Potent topical corticosteroids
- Sedative antihistamines
- Topical calcineurin inhibitors
- Short term systemic corticosteroids
98
Clinical features of lichen slerosus
- Atrophic wrinkled skin ('cigarette paper' skin)
- Typically affects skin, mucosa and genitals
- White patches of skin
- May lead to blisters, bleeding and scarring
99
Lichen sclerosus of the genitals is associated with an increased risk of ???
Squamous cell carcinoma
100
Management of lichen sclerosus
Topical steroids
101
Clinical features of pityriasis rosea
- Typically follows a viral infection
- Development of a Herald patch followed by smaller lesions 7-10 days later
- Typically affects the trunk in 'Christmas' tree distribution
102
Clinical features of ichthyosis vulgaris
- Diffuse polygonal scaling
- Sparing of the flexures
- Keratosis pilaris
- Hyperlinear palms
- May be associated with atopic dermatitis
103
Acquired ichthyosis may be a sign of ???
Underlying malignancy e.g. lymphoma
104
Clinical features of impetigo
- More common in children under 6
- Most commonly around the nose and mouth
- Begins with small vesicles which rupture followed by pus-filled blisters, with honey/golden crust
- May have associated leucocytosis and lymphadenopathy
105
Diagnostic investigation for impetigo
- Sampling of blister contents or skin swab
106
Management of impetigo
- Removal of crusts with wet dressings and cleaning of wounds
- Use personal towels and face cloths
- Topical mupirocin or fusidic acid +/- chlorhexidine
- Systemic antibiotics e.g. Flucloxacillin or cephalosporin
107
Common causes of folliculitis
- Staph
- Candida
- HSV
- Gram-negative folliculitis
108
Triggers/risk factors for folliculitis
- Excess sweating
- Obesity
- Diabetes
- Topical or systemic corticosteroids
- Oily skin care preparations
109
Management of folliculitis
Normally not required. Can use:
- Topical antiseptics
- Topical fusidic acid or mupirocin
- Systemic antibiotics (if systemically unwell)
110
Clinical features of cellulitis
- Elderly patients
- Unilateral area of erythema of the lower leg, with oedema, pain and local warmth
- Systemically unwell: pyrexia, malaise, leucocytosis
- May be associated painful ascending lymphangitis
111
Management of cellulitis
- IV/oral Flucloxacillin +/- Benzylpenicillin
112
Diagnostic test for dermatophyte infection
- Skin scraping
113
Management of dermatophyte infection
- Topical miconazole/ketoconazole or terbinafine
| - Oral terbinafine in scalp or nail dermatophyte infection)
114
Clinical features of pityriasis versicolor
- Most commonly seen in young people
- Most commonly noticed after a summer holiday
- Dull red/light brown scaly plaques on upper chest and back
- Slightly scaly
115
Diagnostic test for pityriasis versicolor
- Examination of scale with a drop of potassium hydroxide
116
Management of pityriasis versicolor
- Topical ketoconazole
117
Clinical features of molluscum contagious
- Most common in children
- Lesions/papules/nodules with a shiny white centre and central umbilication
- Often accompanied with eczema
118
What should you suspect in an adult with molluscum contagious
Immunosuppression
119
Clinical features of herpes simplex reactivation
- Tingling around lips
- Papule formation on lip
- Clustering or grouping of blistered lesions
120
Management of herpes simplex reactivation
- Topical acyclovir from earliest onset of symptoms
121
Diagnostic test for eczema herpeticum
- Rapid fluorescence or PCR of skin scrapings
122
Clinical features of eczema herpeticum
- Hundreds of punched out lesions
- Background of eczema
- Systemically unwell
123
Management of eczema herpeticum
- Systemic antivirals e.g. Acyclovir
124
Clinical features of chickenpox
- Spread by droplets, incubation period of 3 weeks
- Most commonly affects children
- Lesions begin as red merciless before forming small blisters then crust
- Lesions occur in crops
- Lesions are very itchy
125
When would you be concerned about a varicella zoster infection?
- Adults who are immunocompromised or not previously exposed to the virus - can produce a severe illness with pyrexia, malaria and pneumonia
- Pregnant women - can cause foetal abnormalities, spontaneous miscarriage or pre-term birth
126
Clinical features of singles
- Dermatomal pattern of vesicles on a red base which pustules, crust and may scar
- Vesicles preceded by dermatomal pain
127
What can exposure to a patient with shingles lead someone to develop?
Chickenpox (if they have not had it before)
128
Management of shingles
- Aciclovir to shorten symptoms duration (IV in immunocompromised patients)
- Vaccination in older adults
129
Clinical features of scabies
- Transmitted via close physical contact, causes reaction ~3 weeks after infestation
- Intense itch which is worse at night and widespread excoriation
- Burrows seen on palms, soles and in finger webs
- Nodules seen around nipples and genitalia
130
Diagnostic tests for scabies
- Full body examination
| - Fine needly pushed along burrow and examined under microscope
131
Clinical features of head lice
- Itchy eruption on scalp and nape of neck
| - Mites and nits seen on hair
132
Management of scabies
- Permethrin or malathion applied after a warm bath, left on overnight and repeated 7 days later (treat affected individual and all close contacts)
- Hot cycle wash of clothing and bedding
133
Management of head lice
- Topical malathion or permethrin repeated 7 days later
134
Management of body lice
Disinfect clothes with hot washes and ironing
135
Clinical features of polymorphic eruption of pregnancy
- Itchy red papules late in the 3rd trimester or just after delivery
- Lesions located preferentially within the striae
- Sparing of the umbilical region
- Rash spreads from abdomen to other parts of the trunk and limbs
- Most common in first pregnancy and rarely recurs
136
Management of PEP
- Topical corticosteroids and antihistamines
137
Clinical features of pemphigoid gestationis
- Appearance similar to pemphigoid
- Does not favour the striae
- No umbilical sparing
- Occurs earlier in final trimester or before
- Likely to recur and be more severe in future pregnancies (if father is the same)
138
Investigations used to diagnose pemphigoid gestationis
- Pathology (eosinophils and sub-epidermal blisters)
| - Immunofluorescence (positive C3 and IgG along basement membrane)
139
Management of pemphigoid gestationis
- Topical corticosteroids and sedative antihistamines
140
Inheritance mode of neurofibromatosis
Autosomal dominant
141
Clinical features of neurofibromatosis
- Cafe au lait spots
- Axillary freckling
- Neurofibromas
- Flexiform large sub-cutanrous neurofibromas
- Lisch nodules
- CNS tumours
142
Clinical features of tuberous sclerosis
- Ash-leaf macules
- Shagreen patches
- Angiofibromas
- Periungal fibromas
- Seizures and cognitive impairment
143
Inheritance mode of tuberous sclerosis
Autosomal dominant
144
Potential causes of acanthosis nigricans
- Underlying malignancy
- Obesity
- Type 2 diabetes
145
What would you be worried about in a patient with acanthosis nigricans?
- Underlying malignancy
146
Clinical features of acanthosis nigricans
- Brown hyper-keratotic velvety/warty areas in axilla, neck and groin
- Multiple superimposed skin tags
147
What would you be worried about in a patient with dermatomyositis?
Underlying malignancy
148
Clinical features of dermatomyositis
- More common in women
- Proximal muscle weakness
- Heliotrope rash around the eyes
- Erythematous rash in a photosensitive distribution
- Gottron's papules (Violaceous lichenoid rash along dorsal surface of hands and fingers)
- Painful cuticles and prominent nail fold capillaries
149
Investigations in dermatomyositis
- Skin biopsy
| - Raised serum creatinine kinase
150
Management of dermatomyositis
- High dose prednisolone
151
Inheritance mode of HHT
Autosomal dominant
152
Clinical features of HHT
- Small flat red spots on the lips, oral and nasal mucosa, skin (particularly the hands) and GI tract
- Frequently presents with nosebleeds or GI bleeds
- May lead to anaemia
153
Risk factors for BCC
- UV radiation exposure
- Sun sensitive skin
- Age
- Immunosuppression (especially those who have undergone organ transplant)
- Gorlin’s syndrome (rare inherited syndrome which presents with large numbers of BCCs at a young age)
154
Commonest skin cancer
BCC
155
Clinical features of a nodular BCC
- Translucent quality
- ‘Pearly’ translucent papules
- Papules surrounded by an ulcerated crater
- Telangiectasia
- Most common on the middle 1/3rd of the face (and other sun exposed sites e.g. scalp, back, legs, arms)
- Usually <1cm diameter
- Appear over months/years (slow-growing)
- Well defined tumour margins
156
Why do BCCs need treatment, despite not being able to metastasise?
They can invade locally and destroy nearby structures
157
Risk factors for SCC
- Age
- Male sex (2:1)
- UVR exposure (more so than other cancers), including PUVA
- Immunosuppression (especially patients who have had organ transplants)
158
Main cancer risk in immunosuppressed patients
Squamous cell carcinoma
159
Clinical features of an SCC
- Ulcerated keratinising nodule – may focus around a keratin plug to give a ‘volcano’ appearance
- Vary in size (0.5-4cm)
- Surrounding skin may show features of UV radiation damage e.g. dermal atrophy, increased variation of pigmentation and increased skin vasculature
- Only present on sites of cumulative UV exposure e.g. heads of bald men, tops of ears, face and back of hands
160
Management of SCC
- Surgical excision with 4-6mm normal tissue margin
| - Surgical excision + radiotherapy for high risk tumours
161
Risk factors for melanoma
- UV radiation exposure
- Sun sensitive skin
- Middle-age
- Female sex
- Family history (10% of cases) – Affected individuals have larger number of atypical naevi
- PUVA therapy – increases risk
- Immunosuppression (lower risk than SCC)
162
Clinical features of superficial spreading melanoma
- Flat/almost flat lesions in which cells appear to have spread laterally from one point
- Normally resemble normal melanotic naevi
163
Clinical features of lentigo maligna melanoma
- On continually sun-exposed skin e.g. face, back of hands
| - Present over many years with a slow increase in area and gradual darkening in colour
164
Clinical feature of aural melanoma
- Present on palms or soles
165
Most common sites for melanoma to present
- Trunk or legs
166
Most important prognostic indicator for a melanoma without metastatic spread at diagnosis
Breslow thickness
167
Management of malignant melanoma
- Surgical excision with 2mm margin followed by further excision based on Breslow thickness on histopathology
168
Clinical features of actinic keratoses
- Erythema
- Scale which feels rough on palpation
- Size varies from 1mm to >1cm in diameter
- Frequently multiple lesions
169
Management options for actinic keratoses
- Topical NSAIDs e.g. diclofenac
- Cryotherapy
- Curette and cautery
- Topical chemotherapy agents
170
Clinical features of keratocanthoma
- Morphologically similar to an SCC
- Lesion grows very quickly over 6-8 weeks then involute and disappear without any treatment
- Tend to scar on healing
171
Management of keratocanthoma
Surgical excision
172
Clinical features of seborrheic keratoses
- ‘Stuck on’ appearance
- Warty/irregular surface with an irregular edge
- Variable pigmentation
- Often appear greasy
- Most common on the trunk but can also occur on the face or limbs
- May itch or bleed
- Start to appear in 30-40s
- More common in Caucasians
- Some have ‘comedo like’ openings or white milia like (pseudocyst) structures
173
Clinical features of solar lentigines
- Almost flat brown marks
- Common on the back of hands, forearms and face
- Surrounding skin may show features of sun damage
- Very common after middle age in sun sensitive patients
174
Clinical features of Campbell de Morgan Spots
- Collapse and shrink in volume on pressure
175
Clinical features of Pyogenic granulomas
- Caused by trauma
- Common on the hands and around the mouth
- Bleed after minimal trauma
176
Management of pyogenic granulomas
- Surgical excision or curette
