Week 3

Question 1

Define counter transferance

Answer 1

The effect the patients feelings have on you, and the reaction of yours to this

Question 2

Define fundamental attribution error

Answer 2

Judgemental clinicians blaming the patient rather than seeing something that is wrong e.g obese patient due to overeating rather than hypothyroidism

Question 3

Man presents with a painless lump that has slowly grown over a while, it is pearly translucent and has visible blood vessels. It also has a central dip. Diagnosis? Treatment?

Answer 3

Basal cell carcinoma of the cystic type

Surgical removal

Question 4

Elderly Man presents with a crusty thick lesion that is scaling on his scalp. It has progressed from just a flat red area, to scaley then just got worse. He mentions he worked in the navy and didnt use sunscreen. Diagnosis? Treatment?

Answer 4

Squamous cell cancer
(Common on sun exposed areas like scalp, ears, lip, common for high risk metastasis)
Excision

Question 5

What is the relevance of breslows thickness?

Answer 5

Measure of melanoma from the granular layer to the deepest point of the tumour. It is a sign of prognosis

Question 6

What are some of the features you look for in determining a benign or malignant lesion

Answer 6

ABCDE
Asymmetry, border, colour (multiple colours), diameter (6-7mm), evolution (changed over weeks/ months)
Ugly duckling sign

Question 7

What are some of the genetic predisposition for developing skin cancer?

Answer 7

Type I skin
DNA repair syndrome- xeroderma pigmentosum, gorlins syndrome, albinism
Epidermolysis bullosa

Question 8

give some examples of driver mutations for cancer

Answer 8

RAS
B-RAF
EGF
Rb 
TP53

Question 9

UVA is worse to be exposed to than UVB. T/F why?

Answer 9

F
UVB has a shorter wavelength so has greater penetration into the DNA to directly effect it by creating pyrimidine dimers
UVA has a long wavelength and so causes indirect DNA damage by oxidative mechanisms

Question 10

What is the effects of chronic UV exposure on the immune system

Answer 10

Becomes immunosuppressive due to the keratinocytes secreting IL-10 to downregulate it. As well as making the langerhan cells less effective to present antigens to dendritic cells

Question 11

Mutations of the CDK2A or CDK4 proteins carry a high risk of what cancer

Answer 11

Familial melanoma mutations

Question 12

Mutations of the RAS, BRAF, MAPK pathway can lead to what skin cancer?

Answer 12

Melanoma

Question 13

In basal cell carcinoma what tumour suppresor gene isn mutated?

Answer 13

PTCH1

Question 14

Embryologically what is the development of melanocytes?

Answer 14

Melanoblasts Migrate from the neural crest to the skin, uveal tract, leptomeninges to then become melanocytes

Question 15

What are the 5 types of melanocytic naevi

Answer 15

Congenital
Usual type
Dysplstic
Spitz
Blue

Question 16

Describe the development of naevus

Answer 16

Multiple naevus (melanocytes) collect in a ‘nest’ originating from the epidermal junction that then progressively descend into the dermis. So junctional naevus, compound naevus, then intradermal naevus

Question 17

What are melanocytic naevi?

Answer 17

Naevus clusters that grow uncontrollably and can be precursors to melanoma

Question 18

What are the different types of melanocytic naevi

Answer 18

Congenital
Usual type
Dysplastic
Spitz (commoner in kids)
Blue

Question 19

Describe the pathology of melanoma

Answer 19

Beginning from the melanocytes in the basal layer they begin to proliferate uncontrollably then invade into the dermal layer.

Question 20

55 year old female presents with a dark raised macuole that is irregular, with a diameter of around 10mm on her cheek, it is different shades. She mentions that it was previously a birth mark but has changed over the last two months. It has some dark patches surrounding the central macuole. She is a type I skin and used to be a lifeguard. Diagnosis?

Answer 20

Melanoma

Specifically, (odds would be) lentigo maligna as its a sun exposed site

Question 21

What are the two growth phases of melanoma?

Answer 21

RGP (radial growth phase) where progress into a macuole e.g superficial stage
VGP (vertical growth phase) where progress into skin depth

Question 22

What is the term for a melanoma originating in the mouth or sole of the foot?

Answer 22

Acral/ mucosal lentiginous

Question 23

Nodular melanoma originates as a flat patch that then gains height T/F?

Answer 23

FALSE; extremely fatal as growth is so rapid it goes from normal to nodule.

Question 24

What is a sentinel node biopsy?

Answer 24

Where you identify sentinel nodes around the melanoma by injecting dye then excise them to send for biopsy to see if cancerous

Question 25

Man of 70 years presents with a lesion on his abdomen, it is pigmented, raised, quite rough on the surface and has an almost greasy appearance. Regular border. Diagnosis?

Answer 25

Benign seborrhoeic

Question 26

Elderly women presents with a scaley, crusted erythmatous patch on her leg. It was a small patch but has gradually gotten bigger over the year. Shes used emollients but it hasnt gotten any better. Diagnoiss?

Answer 26

Bowens disease as it is scaley, not BCC as it doesnt involve the dermis so wouldnt be scaley.

Question 27

Women with pre-existing bowens disease on her hand now presents with a raised nodule with a central ulcer in the same spot. It arose quite suddenly. Likely diagnosis?

Answer 27

Squamous cell carcinoma | Bowens is a known precursor and on the hand which is a sunexposed area makes diagnosis of scc likely

Question 28

What are some known precursor lesions to squamous cell cancer?

Answer 28

Bowens disease Actinic keratosis Viral lesions

Question 29

Elderly man presents with multiple scaley lesions on his scalp. Theyve been there for a long time. Histology shows partial thickness dysplagia of epidermal keratinocytes. Diagnosis? Treatment?

Answer 29

Actinic keratosis Aldara an immunomodulator Efudix - cytotoxic medication

Question 30

Elderly man presents with a pigmented raised lesion with a regular border on his back. It has a dimpled surface and looks stuck on. Diagnosis

Answer 30

Seborrhoeic keratoses

Question 31

70 year old man presents with a multi-coloured lesion on his forearm. It wasnt present 2 months ago and is quite itchy. It has an irregular border and isnt symmetrical. Diagnosis?

Answer 31

Melanoma

Question 32

What would the transition of a junctional naevus, compound naevus and intradermal naevus appear as on the skin?

Answer 32

Junctional; flat pigmented and fat Compound; raised and brown Intradermal; raised but skin coloured

Question 33

Can melanoma be non-metastasising?

Answer 33

Yes during the radial growth phase where it is just spreading across the epidermis it is classed as in-situ When get to the vertical growth phase then it is metastising ability

Question 34

Define a chronic leg ulcer

Answer 34

An open lesion between the knee and ankle joint lasting more than 4 weeks

Question 35

What are some of the possible causes of chronic leg ulcers?

Answer 35

Varicose veins, vasculitis, malignancy, inflammatory, arterial insufficiency

Question 36

Haemocidrin presence is a sign of what?

Answer 36

Venous stasis It is the discolouration of the skin due to rbc leaking out of venules/ capillaries and appearing brown due to the presence of iron

Question 37

Man with known stenting presents with a punched out red ulcer medially on his proximal calf. He has some hair loss and limbs are cold. What may the cause be of his ulcer?

Answer 37

Arterial insufficiency

Question 38

Man presents with chronic venous ulcer. Why must an ABPI be performed? What is a normal range?

Answer 38

To see if the arterial supply is good enough for compression stockings. 0.8-1.2

Question 39

What is the time frame for an ulcer to heel ?

Answer 39

12 weeks. If not in this time reconsider diagnosis

Question 40

If an ulcer is covered in ‘slough’ then what methods are there to remove it. As it inhibits healing

Answer 40

``` Hydrogels to soak it up Scrape it off Maggot therapy Honey Can put zinc paste around it to prevent leakage into other areas of skin ```

Question 41

What is the long term treatment for ulcers after they heal?

Answer 41

Compression stockings for life and use emollients

Question 42

What is the most common cancer in 15-24 year olds?

Answer 42

Melanoma