Dermatology Presentations

Question 1

What is SCC?

Answer 1

• Common variant skin cancer
• Arises from squamous cells -flat, thin cells found in epidermis (top layer)
• RF inc sun exposure, tanning beds, immunosupression, genetic conditions eg Xeroderma pigmentosum
• Typically present on sun exposed areas
• Rapidly expand, ulcerated nodules
• Cauliflower appearance sometimes
• Some bleed

Question 2

Management of SCC

Answer 2

• Surgical excision with 4mm margin (6mm in high risk lesions)
• Mohs micrographic surgery - tissue removed and examined under microscope in real time to ensure all cancerous cells are removed
• Radiotherapy
• Curretage and cautery
• Topical 5-fluorouracil or imiquimod
• Cryo if lesion small risk (flat and sueprficial)
• Plastic surgery involve if difficult to remove

Question 3

GP management for SCC

Answer 3

• 2WW to pigmented lesion clinic
• Ensure this appointment is received
• Psychosocial support

Question 4

Safety netting for SCC

Answer 4

• If increasing in size rapidly and invading surrounding structures
• Lumps in neck

Question 5

What is BCC?

Answer 5

• Most common type of non-melanoma skin cancer worldwide
• Arise from epidermis - lowest layer
• Commonly caused by exposure to UV light
• More risk if fairer and easily burn
• Can vary greatly in appearance
• Curable in most cases
• Rarely spread

Question 6

Management for BCC

Answer 6

• Wide local excision
• Cryotherapy
• Iquimoid cream - topical chemo
• Curretage - scraping and scooping tissue
• Mohs micrographic surgery
• Radiotherapy

Question 7

Safety netting for BCC

Answer 7

• 50% of people will develop 2nd BCC within 3yrs of first
• Prevent further lesions by preventing sunburn
• At increased risk of other cancers eg melanomas
• Do regular self skin checks and annual skin checks
• Look for change in shape, colour, size 7mm or more, irregular

Question 8

How does measles present?

Answer 8

• Intial cough and fever - URTI symptoms
• Then rash
• Rash starts behind ears and on face
• Then spreads (like chicken pox progression)
• VERY infectious - contacts?
• Check for Koplik spots in buccal mucosa
• Only affects unvaccinated usually

Question 9

Rash for measles

Answer 9

Erythematous maculopapular rash, non pruiritic

Question 10

Dermatology terminology - common of PCDS

Answer 10

Question 11

Where to refer for suspected melanoma?

Answer 11

2WW pigmented lesion clinic

Question 12

Appearance of ringwoem

Answer 12

• Round
• Leading edge of infection
• Central clearing
• Crusted
• Rolled edge (raised)

Question 13

Ringworm vs pityriasis rosea

Answer 13

Question 13

Treatment ringworm (tinea corporis)

Answer 13

• Topical clotrimazole or miconazole if isolated (available OTC for specific age groups)
• Topical hydrocrotisone 1% if lots of inflam
• Oral terbinafine if extensive

Question 14

How long do fungal infections take to resolve?

Answer 14

• skin 3-4 weeks
• Nails can take 6 weeks-6 months of treatment

Question 15

Possible actual cause for “recurrent thrush” presentation

Answer 15

• Lichen sclerosis

Question 16

Tests involved in pruiritis screen

Answer 16

• FBC
• U&E
• LFT
• TFT - can cause dry skin
• CRP

Question 17

Causes of itchyness - most to least itchy

Answer 17

1. Scabies
2. Uraemia
3. Lichen planus
4. Lichen sclersosis
5. Nodular prurigo
6. Eczema
7. Bites

Question 18

Scabies 1st line

Answer 18

Permethrin 5% cream

Question 19

Cream that can reduce itchiness, used in chicken pox

Answer 19

Calamine lotion

Question 20

Chicken pox presentation

Answer 20

• 2-3 weeks incubation (from contact)
• Blistering lesions - not all blistering tho
• Always have cough/URTI symptoms

Question 21

Management chicken pox

Answer 21

• Symptomatic treatment - paracetamol if pain, calamine lotion, chlorphenamine if over 1
• Self resolving unless immunocompromised etc then Aciclovir is offered

Question 22

Shingles presentation

Answer 22

• Single dermatomal distribution - dormant in dorsal root ganglia
• Resurface when immunocompromised

Question 23

Long term complication shingles

Answer 23

• Post herpetic neuralgia - prescribe aciclovir if present within 72hrs of rash if they are 50 years or older esp

Question 24

What is Pompholyx?

Answer 24

Eczema and blisters

Question 25

Causes of round lesions

Answer 25

* Psoriasis * Fungal * Eczema * Pityriasis rosea - herald patch with inverted christmas tree pattern on back * Target lesions - eg lymes

Question 26

Pityriasis rosea vs versicolour

Answer 26

* Versicolour is fungal infection - looks like change to skin pigmentation COLOUR rather than red rash * Need antifungals * Rosea is just self limiting

Question 27

Lymes disease - presentation and treatment

Answer 27

* Target lesion * After walking in long grass that deer are found - tick bite * 3 weeks of Doxycycline

Question 28

Causes of scaly lesions

Answer 28

* Ichthyosis * Psoriasis * Eczema * Tinea * Pityriasis rosea

Question 29

Nappy rash vs candida

Answer 29

* Nappy rash commonly caused by ammonia in urine irritating skin * Spared skin sections which do not touch ruine * Fluffier edges compared to candida

Question 30

What is psoriasis which is just back droplets and not plaques?

Answer 30

* Guttate psoriasis - 1/3 have no FH and do not go on to develop plaques

Question 31

RF associated with psoriasis

Answer 31

* Mortality and CVS risk - calculate QRISK

Question 32

Management psoriasis

Answer 32

* Topical emolients * Topical corticosteroid * Topical Vitamin D preparations - eg Calcipotriol (Dovonex or Enstillar foam) * Topical calcineurin inhibitors (eg Tacrolimus) * Narrow band UVB phototherapy * Systemic drugs eg methotrexate, ciclosporin * Biologics eg anti-TNFa

Question 33

Scoring for psoriasis

Answer 33

PEST score

Question 34

What does psoriasis often come along with?

Answer 34

* Dactilytis - sausage finger * Achille tendonitis * Plantar fascitis

Question 35

Order of strengths of topical steroids - lowest to strongest

Answer 35

1. Hydrocortisone 2. Eumovate or Betnovate RD- clobetasone butyrate or reduced dose betamethasone valerate 0.025% 3. Betnovate -betamethasone valerate 0.1% 4. Dermovate - clobetasol propionate 0.05%