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Flashcards in general derm Deck (51):
1

what are some cutaneous manifestations of scurvy (due to vitamin C deficiency)?

perifollicular hyperkeratotic papules
perifollicular haemorrhages
purpura, and
ecchymoses.

2

what are you concerned about when you see a red plaque that is not responding to steroid treatment?

superficial BCC

3

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.

Rarely metastasises

4

rate in order of incidence, SCC, melanoma, BCC

BCC --> SCC --> melanoma

5

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

6

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.

7

describe Bowen's disease

SCC in situ.

This occurs as a neoplastic formation (secondary malignancy) on top of underlying inflammation

8

Skin cancer can be caused by?

irradiation/UV light
chronic inflammation (bowen's)
HPV
benign lesions
exposure to surface carcinogens
smoking

9

do we expect a BCC to metastasise?

no

10

who is at high risk of metastasis from SCC?

immunosuppressed patients e.g. with autoimmune disorders or organ transplant

11

what is a benign differential for SCC lesion?

keratoancanthoma

12

what are some benign pigmented lesions

mole-
freckle- not raised
cafe au lait spots
vascular tumours (haemangioma)
naevi
dermatofibroma

13

what is the difference between freckle and mole?

Mole- melanocytes are proliferating more
Freckle- more melanin production

14

symptoms of melanoma

itch
size
increasing size
shae
colour variation
inflammation
beeding

15

What are the 3 types of psoriasis

1. guttate
2. plaque
3. pustular

16

what is the medical management of psoriasis?

1. topical corticosteroid cream
2. methotrexate
3. biologic therapy
4. oral retinoic therapy
5. phototherapy
6. Cyclosporin

17

describe psoriasis lesions in general

located on extensor surfaces
salmon coloured plaques with silverly edge
not very itchy
symmetrical
associated with nail onycholysis and arthritis

18

what is the ABCDE of melanoma?

A- asymmetry
B- border irregularity
C- colour variability
D- Diameter > 5
E- evolving

19

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)

20

how do we determine the excision margins for melanoma

using the breslow criteria

21

should we do a sentinel lymph node biopsy for melanoma?

yes.. we are moving towards doing SNB for melanomas with greater than 1mm depth

22

what mutation is associated with melanoma?

b-raf

23

what types of melanoma do not fit the ABCDE criteria?

nodular melanoma

24

should we do prophylactic excision of dysplastic naevi?

NO. 2/3 of melanoma arise sporadically from normal skin

25

out of the four types of melanoma- which is the rapid growing tumour (the rest are slow growing)

nodular melanoma

26

what is the most common type of melanoma?

SSM- superficial spreading melanoma

27

you are concerned that a lesion a patient presents to you is melanoma. What ix would you do

- Dermatoscopy
- Biopsy
- Sentinel lymph node biopsy
- LDH
- CXR, PET scan
BRAF mutational analysis

28

main risk factor for SCC skin lesion?

smoking and sun exposure

29

describe SCC lesion

fast growing hyper plastic lesion, tender on palpation, may ulcerate or bleed

may present as a thickened scaly red patch

30

treatment for SCC?

surgical excision +/- radiotherapy

31

key histopathological features of psoriasis?

parakeratotic layer on top
abnormal epidermal hyperplasia

--> focal parakeratosis and epidermal acanthosis with dilated capillaries within dermal papillae

32

what nail changes can you get with psoriasis?

• Onycholysis
• Pitting in the nail
• Oil spots
Nail bed psoriasis

33

what predisposes guttate psoriasis?

recent streptococcal URTI

34

how do we treat scabies infection?

permethrin cream

35

what inherited disorder do we have to watch out for that increases risk to skin cancer?

dysplastic familial syndrome

36

treatment for psoriasis?

Mild disease
• Topical steroids

Moderate- chronic
• Methotrexate
• Anti TNF biological agents
Inflixamab/etanercep

37

what are some triggers for rosacea?

spicy foods
sunlight
heat
emotion
alcohol

38

two types of rosacea?

vascular and inflammatory

39

characteristics of rosacea?

• Extra-reactive blood vessels in the face
• Inflammatory papules (not camedones)
• Easy flushing of the face is a risk factor

40

how would you treat Bowen's disease?

5 fluorouracil, aldara (imiquimod) or PDT

surgical excision if resistant to above therapy

41

what is the general management of eczema?

topical steroids and emollients

occasionally immunosuppression required

42

what are the variants of eczema?

discoid (mimics psoriasis)
asteatotic (winter rash)
Pompholyx vesicular rash on hands and feet
and diffuse (requires immunosuppression)

43

what are some complications of eczema

staph aureus superinfection due to scratching

eczema herpeticum secondary to HSV infection- may cause corneal damage

44

what are the two age peaks of psoriasis

20s and 50s

45

how do we treat guttate psoriasis?

phototherapy

46

what is the bacterium associated with acne?

propionobactrium acnes

47

what is a blackhead?

open commodone with oxidised sebum in it

48

options for acne control?

salicylic acid wash
topical antibiotics
oral antibiotics
OCP with anti-andronising effects
roaccutane (isotretinoin)

49

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

systemic treatment

50

how do we dx scabies infection

look for burrows on the hands/affected area

scrape skin and look under the microscope for the mites

51

what do we worry about when we see dark pigmentation in nails?

melanoma

but can also be benign melanonychia