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Joints, bones and skin > Malignant melanoma/cutaneous warts/benign tumours/back pain > Flashcards

Malignant melanoma/cutaneous warts/benign tumours/back pain Flashcards

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1
Q

Breslow thickness that means large chanec of metastases

A

<1mm

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2
Q

Risk factors malignant melanoma

A

Sun exposure
Sunbed use under 25 esp
Fair skin - fitzgerald type I, freckles Red hair
Naevi - atypical mole syndrome
FH, prev cancer histtory
Immunosupressed

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3
Q

How to describe a mole

A

A-E
Asymmetrical/symmetrical
Borders
Colour - more than one
Diameter - over 5mm
Evolving - change over time

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4
Q

What features of melanoma get 2 points?

A

Change in shape
Irergular shape or colour

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5
Q

What features get 1 score? (minor) in melanoma

A

Largest diameter
Inflammation
Oozing
Change in sensation

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6
Q

Other concerning features of melanoma that are not on checklist

A
  • New mole after puberty
  • Change in longstanding mole
  • Moles 3 + colours
  • New pigmented line in nail
  • 8 weeks over
  • Lost shape or symmetry
  • Itch = not considered a feature alone or bleeding
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6
Q

Other concerning features of melanoma that are not on checklist

A
  • New mole after puberty
  • Change in longstanding mole
  • Moles 3 + colours
  • New pigmented line in nail
  • 8 weeks over
  • Lost shape or symmetry
  • Itch = not considered a feature alone or bleeding
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7
Q

What is an amelonoma melonoma?

A

No pigmentation

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8
Q

Breslow thickness related to survival with melanoma

A

Tumor over 3mm depth = 40% survival 5 years

1-3mm = 70%

Below = 90%

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9
Q

What is melonoma? + types

A

Malignanat tumour from melanocytes
Superifical spreading
Lentigo
Acral lentiginous

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10
Q

Facros for melanoma

A

A personal history of skin cancer, melanoma, or atypical naevi.
A family history of melanoma.
Pale skin (Fitzpatrick Skin Type I and II) that burns easily.
Red or light-coloured hair (for example, blonde).
High freckle density.
Light coloured eyes (for example, blue eyes).
History of sunburn, particularly blistering sunburn in childhood.
A large number of moles, or large congenital naevi.
Sun exposure — the risk is higher with intermittent sun exposure than cumulative chronic exposure.
Use of tanning beds or sun beds, particularly if 10 or more sessions.
Increasing age — the incidence of malignant melanoma increases with age during adolescence and is highest in the elderly.
Outdoor occupation.
Immunosuppression.
Genetic syndromes with skin cancer predisposition (for example, xeroderma pigmentosum)

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11
Q

What is the ugly ducklng sign?

A

Atypical melanocytic lesions different from surrounding moles

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12
Q

Investigations melanoma

A

Dermatoscope
Palpate lymph nodules on exam
Biopsy

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12
Q

7 point checklist for melanoma - what is a score

A

Over 3
Major:
Change in size
Irregular shape
Irregular colour
Minor:
Largest diameter 7mm or more
Inflammation
OOzing
Change in sensation incl ithc

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12
Q

7 point checklist for melanoma - what is a score

A

Over 3
Major:
Change in size
Irregular shape
Irregular colour
Minor:
Largest diameter 7mm or more
Inflammation
Oozing
Change in sensation incl ithc

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13
Q

Differentials melanoma

A

Angiomas and hemangiomas
Angiokeratomas
Dermatofobromas
Freckles
Kaposis sarcoma - malignant growth of blood vessels Lentigines -
Moles
Pigmented BCC
Pyogenic granulomas
Seborrheic keratoses

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13
Q

Differentials melanoma

A

Angiomas and hemangiomas
Angiokeratomas
Dermatofobromas
Freckles
Kaposis sarcoma - malignant growth of blood vessels Lentigines -
Moles
Pigmented BCC
Pyogenic granulomas
Seborrheic keratoses

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14
Q

When refer sus melanoma?

A

Score of 3 + on weighted 7 point checklist
Dermoscopy suggests
Nail changes or lesino under nail
Biopsy confirmed

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15
Q

Precursors for squamous cell carcinoma

A

Acitinic keratosis, Bowens disease

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16
Q

What impaired immune functions can cause SCC?

A

Solid organ transplants
Chronic lymphatic leukaemia
Rheumatoid arthritis - DMARD or biologic
Xeroderma pigmentosa

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17
Q

Chronic inflammatory skin conditions

A
  • Hypertrophic lichen planus
  • Chronic ulcers
  • Lichen sclerosis
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18
Q

Features of squamous cell carcinoma of skin?

A

Raised lesion on skin

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19
Q

Basal cell carcinoma

A

Ulcer with raised rolled edge
Prominent fine blood vessels around a lesion or nodule on skin
Pearly or waxy nodules

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20
Q

Diagnosis of BCC

A

Excision biopsy

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21
What do seborrheuc keratosis look like?
Proud, brown plaqurs - look stuck on
22
Why are seborrheic keratosis pigmented?
Keratinocytes proliferate receive more melanin from melanocytes (but originates in keratinocytes) Keratinocytes on top of each other appear darker Small cysts of keratin on surface Horn cysts
23
Which is most common skin tumour?
Benign basal tumour
24
What does SCC look like?
Lump with horn on tip Well differentiated Base of horn
25
What can a poorly differentiated SCC look like?
BCC
26
What is rate of growth of SCC?
Rapid growing in 3 months
27
Which skin tumours are painful
SCC and BCC
28
Which age group are more likely BCC?
Younger people
29
Distribution of BCC
and present most frequently on the trunk and shins
30
Morphology of BCC
Expand slowly as a red / pink patch Develop a very fine raised 'whipcord' edge As they enlarge the surface becomes more fragile developing focal erosions and crust
31
Who is likely to get SCCs
Patients with xeroderma pigmentosum, albinism or epidermolysis bullosa can develop lesions at a very young age Phototherapy Men Excessive exposure to sunlight Immunosupressive therapy Chronic inflammation Older people
32
Distribution of SCC?
Sun exposed sites Backs of hands and forearms, upper part of face, lower lip and pinna
32
Distribution of SCC?
Sun exposed sites Backs of hands and forearms, upper part of face, lower lip and pinna
33
Morphology SCC?
Firm to palpate Nodular PLaque like Verocous
34
Well differentiated vs poorly differentiated
Well = slower growing, keratotic surface in early stages, ulcerate, shed later, eventually csues elser indurated, eroded margin, purulent exuding surface that bleeds rather easily Poorly diff - organisation diminsihes - keratin is sparse or absent.
35
Treatment for skin cancers
Surgical excision Chemo/radiotherapy for metastases
36
Treatment for acitniic keratosis
fluorouracil. imiquimod ingenol mebutate or diclofenac Freezing therapy Scraping Laser therapy Photodync#amic therapy
37
What virus causes verrucas
HPV
38
What HPVs increase risk of cervical cancer?
16+18
39
Treatment for verrucas?
Salicyclic acid Cryotherapy Managed in primary care
40
When to refer verrucas?
- Persistent - Large - Quick growing, changes - Facial - Complications of immunosupression - Uncertain if wart or different lesion
41
Exogenous eczema
- Contact dermatitis - Photosensitive - Lichen simplex - eczema due to scratching - Asteatotic - crazy paving
42
Endogenous eczema
- Atopic eczema - Discoid - Eczema due to venous insufficiency - varicose/venous
43
What is the conus medularis?
Where spinal tracts end After this is cauda equina
44
What is anterior lithiasis?
Anterior displacement of vertberal body relative to one below
45
What is spondylosis?
Arthritis of the spine
46
What is major cause of spinal stenosis?
Thickening of the ligamentum flavum
47
What is radiculopathy?
imparment of nerve root → radiating pain. Pain, muscle weakness, numbness, itngling
48
Red flags cauda equina
saddle anaesthesia, numbness, tingling, reduced tone anal sphinvtre, ass with lower leg weakness
49
Cauda equina vs sciatica sides
Cauda equina is bilateral, sciatica is unilateral
50
Visceral causes of back pain
- Waves of pain - Aortic aneurysm - Chronic PID - Prostatitism - Endometriosis - Nehrolithiasis ‘Pulonephrosism’ - Perenephric avscess
51
5 top places metastases to spine originate from
lung, prostate, breast, kidney. thyroid Multiple myeloma in older patients
52
SCAM for lesions
Site Size and shape Colour Ass symtpoms painful, necrotic Margin and morphology
53
What does BCC develop from?
Basal cell layer of epidermis
54
3 types of BCC
Nodulaar - pearly shiny nodules, rolled borders Superficial - pink, well defined, scaly Morpheaform - infiltrating. Ill defined pale scar (pigmented - melanin present0
55
What is a superficial spreading melanoma
Flat pigemneted lesion w asymetrical or irregular borders Most comon type Epidermis for long periods
56
WHat is a nodular melanoma
Atypical nodule - ulcerate an dbleed easily Pigemented or non pigemented
57
What is a lentigo maligna melanoma
Develops from preinvasive phase phase lentigo maligna Irregular shaped brown macule grows slowkly and darkend/becomes irregular Initially horizontal growth but can -> nodules and vertical growth >60s esp head and neck
58
Acral lentiginous melanoma what is it
Most common on soles of feet, plams, nail beds Falt pigemented area, slow increasing size smooth then thicker and irregular, dry or warty More common in darker skin types and >40s
59
What is lentifos maligna
Hutchinsons melanotic freckle Precurose to lentigo maligna melanoma Slow growing or hcanging patch of discoloured skin in situ face or neck - 5-20 years growth
60
Rare melanomas
Desmoplastic. Malignant blue naevus. Mucosal. Neurotropic. Ocular melanoma. Spitzoid.
61
When refer 2ww pathway fro melanoma
They have a suspicious pigmented lesion with a weighted 7-point checklist score of 3 or more. Dermoscopy suggests melanoma. There are nail changes, such as a new pigmented line in the nail (especially if there is associated damage to the nail), or a lesion growing under the nail. They have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear. There is any doubt about the lesion, or there is a history of recent change. Consider if: A pigmented or non-pigmented skin lesion that suggests nodular melanoma. Any major feature in the 7-point checklist, or any features of the ABCDE system.
62

Joints, bones and skin (31 decks)

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