Flashcards in general derm Deck (51):
what are some cutaneous manifestations of scurvy (due to vitamin C deficiency)?
perifollicular hyperkeratotic papules
what are you concerned about when you see a red plaque that is not responding to steroid treatment?
describe a BCC
Indolent, slow growing pearly nodular lesion with central ulceration. Telangiectasia across the lesion
Generally arise in areas that is exposed to sun.
rate in order of incidence, SCC, melanoma, BCC
BCC --> SCC --> melanoma
describe erythema nodosum
Raised erythematous tender lesions found commonly on the shins. Nodules are painful.
Associated with sarcoidosis, inflammatory bowel disease, fever, arthropathy.
Can be caused by sulfonamides and OCP
73 year old women presents with a lesion on her right cheek. On/e she has a 1cm diameter raised ulcerated lesion on her right cheek which has pearly edges. There is no reaction to the surrounding tissues; it is mobile; no lymphadenopathy. What is the appropriate management?
most likely SCC
Excisional biopsy required.
describe Bowen's disease
SCC in situ.
This occurs as a neoplastic formation (secondary malignancy) on top of underlying inflammation
Skin cancer can be caused by?
chronic inflammation (bowen's)
exposure to surface carcinogens
do we expect a BCC to metastasise?
who is at high risk of metastasis from SCC?
immunosuppressed patients e.g. with autoimmune disorders or organ transplant
what is a benign differential for SCC lesion?
what are some benign pigmented lesions
freckle- not raised
cafe au lait spots
vascular tumours (haemangioma)
what is the difference between freckle and mole?
Mole- melanocytes are proliferating more
Freckle- more melanin production
symptoms of melanoma
What are the 3 types of psoriasis
what is the medical management of psoriasis?
1. topical corticosteroid cream
3. biologic therapy
4. oral retinoic therapy
describe psoriasis lesions in general
located on extensor surfaces
salmon coloured plaques with silverly edge
not very itchy
associated with nail onycholysis and arthritis
what is the ABCDE of melanoma?
B- border irregularity
C- colour variability
D- Diameter > 5
what are the 4 subtypes of melanoma. which has the worst prognosis?
1. superficial spreading melanoma
2. lentigo maligna
3. acral lentiginous melanoma
4. nodular melanoma (worst prognosis)
how do we determine the excision margins for melanoma
using the breslow criteria
should we do a sentinel lymph node biopsy for melanoma?
yes.. we are moving towards doing SNB for melanomas with greater than 1mm depth
what mutation is associated with melanoma?
what types of melanoma do not fit the ABCDE criteria?
should we do prophylactic excision of dysplastic naevi?
NO. 2/3 of melanoma arise sporadically from normal skin
out of the four types of melanoma- which is the rapid growing tumour (the rest are slow growing)
what is the most common type of melanoma?
SSM- superficial spreading melanoma
you are concerned that a lesion a patient presents to you is melanoma. What ix would you do
- Sentinel lymph node biopsy
- CXR, PET scan
BRAF mutational analysis
main risk factor for SCC skin lesion?
smoking and sun exposure
describe SCC lesion
fast growing hyper plastic lesion, tender on palpation, may ulcerate or bleed
may present as a thickened scaly red patch
treatment for SCC?
surgical excision +/- radiotherapy
key histopathological features of psoriasis?
parakeratotic layer on top
abnormal epidermal hyperplasia
--> focal parakeratosis and epidermal acanthosis with dilated capillaries within dermal papillae
what nail changes can you get with psoriasis?
• Pitting in the nail
• Oil spots
Nail bed psoriasis
what predisposes guttate psoriasis?
recent streptococcal URTI
how do we treat scabies infection?
what inherited disorder do we have to watch out for that increases risk to skin cancer?
dysplastic familial syndrome
treatment for psoriasis?
• Topical steroids
• Anti TNF biological agents
what are some triggers for rosacea?
two types of rosacea?
vascular and inflammatory
characteristics of rosacea?
• Extra-reactive blood vessels in the face
• Inflammatory papules (not camedones)
• Easy flushing of the face is a risk factor
how would you treat Bowen's disease?
5 fluorouracil, aldara (imiquimod) or PDT
surgical excision if resistant to above therapy
what is the general management of eczema?
topical steroids and emollients
occasionally immunosuppression required
what are the variants of eczema?
discoid (mimics psoriasis)
asteatotic (winter rash)
Pompholyx vesicular rash on hands and feet
and diffuse (requires immunosuppression)
what are some complications of eczema
staph aureus superinfection due to scratching
eczema herpeticum secondary to HSV infection- may cause corneal damage
what are the two age peaks of psoriasis
20s and 50s
how do we treat guttate psoriasis?
what is the bacterium associated with acne?
what is a blackhead?
open commodone with oxidised sebum in it
options for acne control?
salicylic acid wash
OCP with anti-andronising effects
some things to let your patient know before commencing them on isotretinoin for their acne?
6-12 month course
associated with teratogenicity and lots of SE, including mucocutaneous dryness, photosensitivity and depression
will need ongoing monitoring
how do we dx scabies infection
look for burrows on the hands/affected area
scrape skin and look under the microscope for the mites