Skin 2

Question 2

What should you describe when examining a skin lesion?

Answer 2

Location, size, shape, mobility, consistency, overlying skin/mucosa, compressibility, fluctuation, pulsatility, thrill, bruit, and associated features (e.g. nerve weakness, numbness, lymphadenopathy, sinus tracts).

Question 3

How do you test if a lump moves with swallowing?

Answer 3

If fixed to larynx → moves on swallowing.

Question 4

How do you test if a lump moves with tongue movement?

Answer 4

If fixed to tongue → moves when patient sticks tongue out.

Question 5

Why is mobility important in describing lumps?

Answer 5

Mobility indicates whether the lesion is superficial, fixed to skin, deep tissues, or attached to underlying structures.

Question 6

What is fluctuation?

Answer 6

Suggests fluid-filled lesion.

Question 7

What does compressibility of a lesion suggest?

Answer 7

Vascular lesion (empties and refills).

Question 8

What does pulsatility or a bruit suggest?

Answer 8

Lesion has significant blood supply.

Question 9

What are common causes of skin cysts?

Answer 9

Blocked sebaceous glands → retention of oily secretions → cyst formation (often on face).

Question 10

How does a discharging dental sinus mimic a cyst?

Answer 10

Appears as a skin lesion at mandibular border. A sinus tract connects lesion → tooth apex. GP point + radiograph can confirm source.

Question 11

What are the causes of pigmented lesions?

Answer 11

Melanin, vascular lesions, foreign material (e.g. tattoos).

Question 12

What is a traumatic tattoo?

Answer 12

Pigment from trauma (e.g. road gravel into skin).

Question 13

What is an amalgam tattoo?

Answer 13

Amalgam particles embedded in mucosa (during dental work/extraction) → grey/black stable lesion.

Question 14

What determines the colour of vascular lesions?

Answer 14

Depth and blood flow (arterial blood = bright red, venous = darker).

Question 15

What is telangiectasia?

Answer 15

Dilated small vessels. Hereditary haemorrhagic telangiectasia = genetic condition → skin lesions, recurrent epistaxis.

Question 16

What is a spider naevus?

Answer 16

Central red papule with radiating vessels. Associated with liver disease (cirrhosis, hepatitis).

Question 17

What is Sturge-Weber syndrome?

Answer 17

Congenital condition → port wine stain (vascular malformation) in trigeminal distribution + leptomeningeal vascular malformations → epilepsy risk.

Question 18

What is an infantile haemangioma?

Answer 18

Benign vascular tumour. Absent at birth, appears after, grows rapidly in infancy, regresses over time.

Question 19

How to examine vascular lesions?

Answer 19

Test extent, compressibility, refill speed.

Question 20

How are vascular lesions managed?

Answer 20

Medical: propranolol. Sclerotherapy (irritant injection → fibrosis). Embolisation (reduce blood flow). Surgical resection. Laser therapy (superficial lesions).

Question 21

What is malignant melanoma?

Answer 21

Aggressive cancer of melanocytes.

Question 22

Risk factors for melanoma?

Answer 22

UV radiation, sunbeds, fair skin, young patients.

Question 23

Common melanoma sites?

Answer 23

Trunk, limbs > face/neck (but can occur anywhere).

Question 24

What is the 7-point checklist for melanoma?

Answer 24

Change in size, Irregular pigmentation, Irregular border, Itch/altered sensation, Larger than other lesions, Inflammation, Oozing/crusting.

Question 25

Why is melanoma aggressive?

Answer 25

Early metastasis via lymph and blood.

Question 26

How is melanoma treated?

Answer 26

Early wide local excision (20 mm margins). Lymph node management: neck dissection/radiotherapy if involved. Metastatic: chemo, immunotherapy, targeted therapy (e.g. BRAF inhibitors).

Question 27

What is basal cell carcinoma (BCC)?

Answer 27

Slow-growing, locally invasive, rarely metastasises. Caused by UV radiation, common in elderly, outdoor workers.

Question 28

Clinical features of BCC?

Answer 28

Pearly raised nodule, rolled edge, central ulcer, face/neck (80%), bleeding/oozing late.

Question 29

Treatment of BCC?

Answer 29

Wide local excision (4 mm margin).

Question 30

What is squamous cell carcinoma (SCC)?

Answer 30

More aggressive than BCC, higher metastatic potential.

Question 31

Risk factors for SCC?

Answer 31

UV exposure, elderly, outdoor occupation.

Question 32

Clinical features of SCC?

Answer 32

Crusted, ulcerated lesion, indurated edges. May resemble BCC.

Question 33

Treatment of SCC?

Answer 33

Wide local excision, may need neck dissection/radiotherapy.

Question 34

Why is early diagnosis important in skin cancers?

Answer 34

Improves prognosis by preventing deeper invasion and metastasis.

Question 35

How are skin cancers diagnosed and staged?

Answer 35

Biopsy + imaging (CT/MRI). Staging considers size, depth, lymph node involvement, metastasis.

Question 36

What is the treatment principle for skin cancers?

Answer 36

T (primary tumour): wide excision (melanoma: 20 mm, BCC: 4 mm). N (nodes): regional neck dissection ± radiotherapy. M (metastasis): systemic chemo, immunotherapy, targeted therapy.

Question 37