My Skin Lesions

  1. How does UV light relate to skin cancer?
    • Directly causes neoplastic p53 damage to keratinocytes
    • Host immune system suppression
  2. Where are basal cell carcinoma's most commonly found, and why? What is the prognosis?
    • 80% found on head and neckSites exposed to UV radiation
    • Very good prognosis, as it rarely metastasises
  3. Describe this lesion and give a diagnosis:
    Image Upload 1
    • Nodular basal carcinoma
    • Shiny, or 'pearly'
    • Broken blood vessels around border
    • Raised
    • Central ulceration
  4. Describe this lesion and give a diagnosis:
    Image Upload 2
    • Superficial basal cell carcinoma
    • Well demarcated plaque
    • Scaly/crusty
    • Pearly
    • Raised edge
    • Ulceration
  5. Describe this lesion and give a diagnosis:
    Image Upload 3
    • Pigmented basal cell carcinoma
    • Raised edge
    • Pearly ages
    • Melanocyte build up, causing pigmentation
    • Similar to nodular, with dark areas
  6. Describe this lesion and give a diagnosis:
    Image Upload 4
    • Pleiotic basal cell carcinoma
    • Very slight blood vessels
    • Shinier appearance than normal skin
    • Depressed, scarred centre
  7. Describe the treatment options of basal carcinomas
    • Surgical excision: 3-4mm margin
    • Curettage and cautery: Scraped with scalpel
    • Cryotherapy: Liquid nitrogen freezes and neutralises cells
    • Photodynamic: Cells oxidised using light
    • Topical cream: 5-fluorouracil/imiquimod = immune destruction
    • Moh's surgery: Surgery with histology to examine margines
  8. Describe this lesion, and give a diagnosis
    Image Upload 5
    • Squamous cell carcinoma
    • No shiny/pearliness
    • No raised edge
    • No blood vessels
    • Keratinous, crusty lesion on surface
  9. What is actinic keratosis?
    • Thick, scaly, crusty skin patches
    • Premalignant condition
  10. How are squamous cell carcinomas treated?
    • Gold standard = surgical excision at 4-5mm
    • 95% of cure rate
    • Curettage and cautery; 70% cure rate
  11. Outline the pathophysiology of malignant melanoma
    • DNA damages caused by UV
    • Radial then vertical growth; vertical more risky disease as closer to lymphatics
  12. Outline the scoring systems for malignant melanoma
    • Breslow depth: Biopsy measured for depth of invasion in mm, up to 4mm
    • Clark level: Epidermis - papillary dermis - dermal junction - reticular dermis - subcutaneous fat
  13. Describe this lesion, and give a diagnosisImage Upload 6
    • Malignant melanoma
    • Asymmetrical shape
    • Colour difference
    • Thickness varies throughout
    • Form depends on type
  14. Define these types of malignant melanoma:
    - Nodular
    - Acral
    - Subungual
    - Amelanotic
    - Lentigo maligna
    • Nodular: Well circumscribed, small, smooth edges dark spot. Usually deep
    • Acral: Found in distal sites, usually late presentation
    • Subungual: Found underneath the nails, stripe like
    • Amelanotic: Fast turnover = no melanin
    • Lentigo maligna: Melanoma in situ, found on face
  15. Outline the treatment of malignant melanoma
    • Surgical ecision if Breslow <1mm; 1cm margin
    • If metastatic, chemotherapy on limb
    • VEGF antibodies
  16. Describe some tumour syndromes with cutaneous presentations
    • Gorlin's : Inherited- multiple BCCs, jaw cysts, risk of breast cancer
    • Gardner's: Soft tissue tumours, polyps, bowel ca risk
    • Cowden's: Multiple hamartomas, thyroid/breast ca risk
  17. What thyroid diseases can affect the skin?
    • Hypothyroidism: Dry skin
    • Grave's: Skin thickening or fingertip swelling
  18. What manifestations of diabetes affect the skin?
    • Necrobiosis lipoidica: Purple/yellow + thin patches on shins. Can ulcerate/scar
    • Diabetic dermopathy: Scarred, itchy, ulcerating hyperpigmented shin lesions
    • Scleredema: Palpable thickness, stiffness and red (oedema)
    • Infection: Ischaemia/neuropathy + glucose = ulcers
    • Granuloma annulare: Acute onset, discrete + raised edge
  19. What cutaneous presentations can occur in steroid use?
    • Acne
    • Gynocomastia
    • Erythema
    • Striae
    • Hyperpigmentation (insufficiency)
  20. Define necrolytic migratory erythema (glucagonoma)
    • Erythematous, annular, scaly plaques
    • Found acral, intertrigonous and periorificial
    • Relataed to pancreatic islet tumour
  21. Define erythema gyratum repens
    • "Crawling, circling redness"
    • Reddened concentric bands, severe prutitis
    • Strongly suggests lung cancer (or breast, cervical)
  22. What is acanthosis nigricans?
    • "Thick blackness"
    • Hyperkeratotic plaques; smooth, velvety
    • Found in intertriginous areas
    • Malignancy, inherited or in DM/obesity
  23. What cutaneous features are seen in certain vitamin deficiencies?
    • B6: Dermatitis
    • B12: Angular chelitis
    • B3: Pellagra = dermatitis, dementia and diarrhoea
    • C: Purpura/bruising, spiral hairs, dry skin/hair and gingivitis
  24. Describe erythema nodosum and its causative diseases
    • Bilateral red nodules; very sensitive
    • Most commonly caused by strep throat
    • Hormonal changes, sarcoidosis also
  25. Describe pyoderma gangrenosum and its casuative diseases
    • Ulceration with characteristic purple, raised edge
    • Inflammatory bowel diseases most common known cause
    • Usually ideopathic
    • R.A., myeloma also
  26. What are some causes of nail clubbing?
    • Lung malignancy
    • Cystic fibrosis
    • Renal disease
    • Congenital
  27. Outline some causes of hair thining and loss
    • Thinning: B12/iron deficiency, SLE, hypothyroidism
    • Alopecia: Discrete patches of hair loss. AI
    • Male balding: Androgen excess
Card Set
My Skin Lesions
Basal, squamous, melanoma