Dermatology

• What are the main types of lesions?

  Epidermal (tend to be non-pigmented)

  Melanocytic (tend to be pigmented)
• Seborrheic keratosis

  Benign basal epidermal lesion

  Appear stuck on skin

  'Warty' surface

  Often found on torso, but can be present on temples

  Common in older pts

  
• Basal cell carcinoma

  Malignant basal epidermal lesion

  Relatively avascular

  Opalescent

  Telangiectasia (branching blood vessels on surface)

  Often on centre of face

  Most common cancer in human

  Almost never metastasise (locally invasive, often slow-growing)

  Treatment = standard referral to derm (unless any red flags, surgical excision w/ 4mm margin)

  
• What is shown in this image?

  Ulcerated basal cell carcinoma

  
• What is shown in the image?

  Seborrheic keratosis

  
• What is shown in the image?

  Basal cell carcinoma

  
• What is shown in the image?

  Solar/Actinic keratosis

  
• Solar/Actinic keratosis

  Benign squamous epidermal lesion

  Intraepidermal dysplasia -> produce abnormal keratin -> hard, spiky scale

  Most common in areas of maximum sun exposure

  Can become keratin horn formation (marker of malignant change)

  
• Bowen's disease

  Benign squamous epidermal lesion

  Full thickness epidermal dysplasia

  Not much scale

  Greater risk of progression to squamous cell carcinoma
• Squamous cell carcinoma

  Malignant squamous epidermal lesion

  Nail-like horn

  Can metastasise

  Often in H zone in face, fingers & genitals

  Can be well or poorly differentiated

  Poorly differentiated

  • often ulcerate
  • more likely to metastasise

  Treatment = urgent 2 week wait referral + surgical excision w/ 4mm margin

  
• What is shown in the image?

  Poorly differentiated squamous cell carcinoma

  
• What is shown in the image?

  Squamous cell carcinoma

  
• What is shown in the image?

  Actinic keratosis with horn

  
• What is shown in the image?

  Malignant melanoma

  
• Malignant melanoma

  Malignant melanocytic lesion

  Most serious skin tumour (poor prognosis, high mortality, quicker progression)

  One of biggest killers in young people

  When to refer...

  • pt with lots of moles who say they look 'funny'
  • new moles (esp after 50 yrs)

  Treatment = 2 week wait referral + surgical excision (sent to lab, Breslow thickness) + ? wider excision & lymphadenectomy

  
• What are the prognostic indicators of malignant melanoma?

  Based on Breslow thickness

  • Up to 0.75mm = 98% 5 year survival
  • 1mm = over 90% 5 year survival
  • 1-3mm = 70% 5 year survival
  • Over 3mm = 40% 5 year survival
• What are the key features of malignant melanoma?

  ABCD

  Asymmetry

  Border = variable edge

  Colour = most are dark (black) colour

  Diameter
• Fill in the blanks

  A) macule

  B) papule

  C) patch

  D) nodule

  E) plaque

  
• Fill in the blanks

  A) vesicle

  B) bulla

  
• What is shown in the image?

  Crust

  
• What is shown in the image?

  Lichenification

  
• Fill in the blanks

  A) erosion

  B) ulcer

  C) excorations

  
• What is shown in the image?

  Haemosiderin

  
• Types of eczema

  External

  -> due to irritant

  Internal

  -> due to skin carrier, cutaneous immune system disorder
• What are the red flags of eczema?

  Infected eczema

  • wet looking
  • common organisms = staph aureus, strep B
  • treatment = flucloxacillin, clarithromycin

  Eczema herpeticum

  • look for HSV (viral swab)
  • if near eye, need same day referral to ophthalmology

  Erythroderma

  • same day referral
  • high risk for kidney failure
• Eczema treatment

  Emollients (creams, lotions, ointments)

  Steroids (apply lots for 5-7 days, then wean down to 2x week)