year 4 CMS > SKin > Flashcards

SKin Flashcards

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1
Q

What is the major external barrier between the outside world and the body?

A

Skin

The skin has important protective functions and is constantly renewing itself.

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2
Q

List the four functions of skin as represented by the acronym STaMP.

A
  • Sensation
  • Thermoregulation
  • Metabolic functions
  • Protection

These functions highlight the skin’s role in sensing, regulating temperature, metabolism, and providing protection.

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3
Q

What is the function of skin receptors?

A

Sense touch, pressure, pain, and temperature

These receptors are essential for the sensation function of the skin.

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4
Q

What features of the skin are involved in thermoregulation?

A
  • Sweat glands
  • Hair
  • Adipose tissue

These features help regulate the body’s temperature.

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5
Q

What does subcutaneous adipose tissue produce?

A
  • Vitamin D
  • Triglycerides

This highlights the metabolic functions of the skin.

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6
Q

What does skin protect against?

A
  • UV light
  • Mechanical stresses
  • Thermal stresses
  • Chemical stresses
  • Dehydration
  • Invasion by micro-organisms

These protective functions are vital for maintaining skin integrity.

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7
Q

What is the first layer of skin called?

A

Epidermis

The epidermis is a thin outer portion that is keratinized and stratified.

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8
Q

What type of epithelium is the epidermis composed of?

A

Keratinized stratified squamous epithelium

This structure is important for the protective function of skin.

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9
Q

Does the epidermis have its own blood supply?

A

No

The epidermis relies on blood from the dermis.

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10
Q

What are dermal papillae?

A

Folds of the basal layers of the epidermis

These structures enhance the connection between the epidermis and dermis.

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11
Q

How many layers does thin skin contain?

A

Four layers

Thick skin, in contrast, has five layers.

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12
Q

What is the stratum basale?

A

Single layer of cells closest to the dermis

It is the deepest layer of the epidermis.

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13
Q

What is the role of the stratum spinosum?

A

Contains desmosomes and keratin that anchor the cells

This layer provides structural integrity to the epidermis.

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14
Q

What occurs in the stratum granulosum?

A

Cells turn into keratinized squames

The granules in this layer contain a lipid-rich secretion that acts as a water sealant.

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15
Q

What is the stratum lucidum?

A

Thin transparent layer found only in thick skin

This layer is difficult to see and provides additional protection.

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16
Q

What is the stratum corneum composed of?

A

Layers of dead cells reduced to flattened scales filled with keratin

This outermost layer provides a barrier to environmental damage.

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17
Q

What is the thicker inner portion of the skin called?

A

Dermis

The dermis is known as the connective tissue layer of skin.

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18
Q

List the components contained in the dermis.

A
  • Collagen and elastin fibres
  • Fibroblasts
  • Macrophages
  • Adipocytes
  • Nerves
  • Glands
  • Blood supply
  • Hair follicles

Sweat glands open out onto the surface of the dermis.

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19
Q

What are the two main functions of dermal papillae?

A
  • Helps with adhesion between the dermal and epidermal layers
  • Provides a large surface area to nourish the epidermal layer

Dermal papillae are particularly prominent in thick skin.

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20
Q

The superficial region of the dermis is also known as what?

A

Papillary dermis

This region makes up around 20% of the dermis.

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21
Q

What type of tissue is found in the deeper region of the dermis?

A

Dense irregular connective tissue

This layer gives skin its strength and extensibility.

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22
Q

What is the main function of adipose tissue in the hypodermis?

A
  • Production of vitamin D
  • Storage of triglycerides

Adipose tissue mainly contains fat cells.

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23
Q

Where is the deep cutaneous plexus located?

A

At the dermal/hypodermal junction

It supplies the fatty tissue of the hypodermis and deeper parts of the dermis.

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24
Q

What does the superficial subpapillary plexus supply?

A

Capillaries in the dermal papillae

The pink color of skin is mainly due to the blood seen in venules of this plexus.

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25
True or false: The **hypodermis** contains sweat glands.
TRUE ## Footnote Sweat glands are found deep in the hypodermis.
26
What are **Meissner's corpuscles**?
Touch receptors ## Footnote They are located in the papillary dermis.
27
What are the **similarities** between measles and rubella?
* Both have a red rash * Both are respiratory infections * Symptoms can be similar ## Footnote Rubella is caused by a different virus and is less infectious and severe than measles.
28
What is the significance of **measles** as a public health issue?
* Important in the UK and globally * Successful vaccination programs reduce incidence * Huge relevance to unborn children ## Footnote Anecdote about Alastair’s son Finn contracting measles in New Zealand due to poor vaccination uptake.
29
What are common **symptoms** of measles?
* Dry cough * Runny nose * Body pains * Headache * Sore throat * Watering/swelling of the eyes * Discomfort * Fatigue * Loss of appetite * Diarrhoea * Light sensitivity * Inflamed lymph nodes * Koplik’s spots ## Footnote Koplik’s spots are blue/red spots in the mouth.
30
What is the typical duration of a **measles** infection?
7-10 days ## Footnote A small number of people may develop meningitis and/or pneumonia as secondary infections.
31
What is the risk of **rubella** for pregnant women?
* High chance (90%) of baby developing measles in womb * Can lead to foetal abnormalities such as deafness and developmental problems ## Footnote This highlights the importance of vaccinations for MMR.
32
What are common **symptoms** of rubella?
* Mild respiratory illness * Rash * Malaise * Arthralgia ## Footnote Arthralgia refers to stiffness of the joint.
33
True or false: **Rubella** is caused by the same virus as measles.
FALSE ## Footnote Rubella is caused by a different virus than measles.
34
What virus causes **chicken pox**?
Varicella Zoster virus ## Footnote Chicken pox is very common in children and is not vaccinated for in the UK.
35
True or false: **Chicken pox** is more severe in adults than in children.
TRUE ## Footnote Children usually recover more easily, while adults may experience more severe symptoms.
36
What are the **initial symptoms** of chicken pox?
* Raised red bumps or papules * Itchy fluid-filled blisters ## Footnote The rash starts with raised spots that eventually rupture and scab over.
37
List the **stages** of chicken pox rash.
* Stage 1: Small, raised spots appear (itchy) * Stage 2: Spots fill with fluid and form blisters (itchy) * Stage 3: Blisters become scabs (some flaky/white, others leak fluid) ## Footnote Each stage represents the progression of the rash.
38
How can **chicken pox** in childhood develop into **shingles**?
Varicella Zoster retreats to the central nervous system and lays dormant in the dorsal root horn of sensory nerves ## Footnote It can reactivate due to factors like surgery, illness, or immunocompromised states.
39
Where does **Varicella Zoster** lay dormant in the body?
Dorsal root horn of sensory nerves ## Footnote It can remain dormant for years without causing symptoms.
40
What does shingles present as across **dermatomes**?
A band corresponding to the affected nerve ## Footnote This can also affect the head or neck, particularly the trigeminal nerve.
41
Which division of the **trigeminal nerve** is more commonly associated with shingles?
Frontal division ## Footnote This is exemplified by cases like Mary, who had shingles affecting this area.
42
Fill in the blank: The NHS has no official statement on **_______ parties** for chicken pox.
pox ## Footnote It is generally recommended to avoid such gatherings.
43
What is the most recognizable symptom of **mumps**?
Painful swellings in the side of the face under the ears (parotid glands) ## Footnote This gives a person with mumps a distinctive 'hamster face' appearance.
44
List other symptoms of **mumps**.
* Headaches * Joint pain * High temperature ## Footnote These symptoms may develop a few days before the swelling of the parotid glands.
45
What serious condition can **mumps** lead to?
Viral meningitis ## Footnote This occurs if the virus moves into the outer layer of the brain.
46
Why is **mumps** very rare now?
Due to the introduction of the MMR vaccine ## Footnote The MMR vaccine protects against measles, mumps, and rubella.
47
What is HSV-1 commonly known as?
Herpes labialis ## Footnote It is relatively common in patients, particularly as children.
48
How is **HSV-1** spread?
By oral to oral contact ## Footnote This is different from HSV-2, which is linked to genital contact.
49
What is the primary presentation of **HSV-1**?
Primary herpetic gingivostomatitis ## Footnote Appears like marginal gingivitis with some vesicles in the labial mucosa or on the tongue.
50
What can reactivate **Herpes Simplex** to cause recurrent herpes labialis?
* Stress * Steroids * Ultraviolet radiation ## Footnote This can cause the virus to lie dormant in the trigeminal nerve.
51
What are the initial symptoms of **recurrent herpes labialis**?
* Tingling * Soreness in the lip ## Footnote Symptoms gradually become more uncomfortable and develop into a blister.
52
How long does it take for a **cold sore** to recover?
7-10 days ## Footnote The blister eventually ruptures and is most infectious at this stage.
53
What is the treatment available for **herpes labialis**?
Aciclovir ## Footnote It inhibits viral DNA replication and is also effective for shingles/chicken pox.
54
What should be done if a patient has a **cold sore** during a clinic examination?
Ask them to come back another day ## Footnote An open cold sore is very infectious.
55
What is **ocular herpes**?
Virus particles from fingers spread to the eyes ## Footnote It results in red, painful, swollen tissues that can lead to cataracts, glaucoma, or loss of vision.
56
What is **herpetic whitlow**?
Painful, red, swollen finger due to inoculation of the virus ## Footnote Vesicles can form just like on the lip, and the fluid is very infectious.
57
True or false: **HSV-2** is linked to genital contact.
TRUE ## Footnote This is separate from HSV-1, which is primarily associated with oral contact.
58
What does **HSV-1** present as regardless of ethnicity?
Cold sores ## Footnote HSV-1 presents in a similar way across different ethnicities.
59
What is the full name of **HPV**?
Human Papilloma Virus ## Footnote HPV is associated with a variety of diseases due to its numerous subtypes.
60
List some diseases associated with **HPV**.
* Genital warts * Cervical intraepithelial neoplasia * Cervical cancer * Head and neck cancer ## Footnote HPV is responsible for different human diseases due to its vast number of subtypes.
61
Cervical cancer rates are similar to the rates of **________** cancer.
Oral ## Footnote This highlights the connection between HPV and various cancer types.
62
What is the growing interest in HPV related to?
Oropharyngeal and tonsil cancer ## Footnote People with HPV may develop head and neck cancer despite lacking other risk factors.
63
What are **warts** and **verrucae** characterized by?
* Can be self-limiting * Treated with topical salicylic acid, freezing, or curetting ## Footnote They typically resolve on their own and are not a burden on patients.
64
What is the link between **HPV infection** and cervical cancer?
Strong link ## Footnote HPV is transmitted via sexual contact, particularly with genital warts.
65
How often are **cervical screenings** offered to women?
Every 4-5 years ## Footnote Smears take cells from the cervix to assess risk of cervical intraepithelial neoplasia.
66
What determines the risk of developing **cervical intraepithelial neoplasia**?
Shape/characteristics of cells ## Footnote This form of neoplasia is similar to dysplasia in the oral epithelium.
67
When did the successful **vaccination programme** for HPV start?
2008 ## Footnote Initially targeted females, now also offered to males who can transmit the disease.
68
What are longitudinal studies awaiting to determine regarding HPV?
Impact on the incidence of head and neck cancers ## Footnote The vaccination programme has improved outcomes for cervical cancer.
69
What is **folliculitis**?
An infection of the hair follicle leading to a red spot around one hair ## Footnote Plucking the hair away can remove the infection.
70
What leads to the formation of a **skin boil**?
Extension of redness from folliculitis leading to liquefaction of tissue (formation of pus) ## Footnote A boil is a localized infection that can be painful.
71
Differentiate between **furuncles** and **carbuncles**.
* Furuncles: One boil on the skin * Carbuncle: Multiple boils that come together, undermining the skin ## Footnote Carbuncles are more extensive and involve several furuncles.
72
What are the characteristics of **furuncles** and **carbuncles**?
* Generally red and inflamed * Contain pus * Can lead to scarring after pus discharge ## Footnote Occasionally, they can lead to sepsis, but this is unusual.
73
What is **erysipelas**?
A serious bacterial infection caused by streptococci, leading to rapidly spreading infection ## Footnote It is characterized by red, swollen, tender skin with a clear margin between infected and unaffected areas.
74
What distinguishes **streptococci** from **staphylococci** in terms of infection?
* Streptococci: Generate toxins that break down tissue * Staphylococci: Tend to form pus and are less aggressive ## Footnote This difference affects the severity and spread of infections.
75
What symptoms might a patient with **erysipelas** present?
* Red, swollen, tender skin * Systemically unwell * Sore tissue with a clear margin ## Footnote Drawing a line around the infection can help monitor its spread.
76
How should **erysipelas** be treated?
With antibiotics and aggressive treatment ## Footnote It is important to take erysipelas seriously due to its potential to spread rapidly.
77
What is **impetigo** characterized by?
* Tender area on the face * Forms a vesicle with localized redness * Yellow crust after vesicle ruptures ## Footnote Impetigo is a common skin infection that poses a risk of cross-infection.
78
What causes **impetigo**?
* Mixture of streptococcal infections * Mixture of staphylococcal infections ## Footnote It usually requires antibiotics prescribed by a GP.
79
True or false: **Impetigo** is very contagious.
TRUE ## Footnote If someone presents with the rash, they need to be sent home as they are very infectious.
80
What can **sebaceous cysts** resemble in dental management?
* Dental infections ## Footnote They can be mistaken for dental infections, as seen in a case where a patient was referred for a 'cyst' but had a dental infection.
81
What should you check if you see a **sebaceous cyst** on the face?
* Look in the mouth * Check for a non-vital tooth ## Footnote A dental infection may cause a chronic discharging sinus tracked to the external skin.
82
What is **eczema** related to?
* Type 1 Hypersensitivity * Immunoglobulin E [IgE] mediated inflammation ## Footnote Eczema is a very common childhood condition associated with allergic reactions.
83
Where does **eczema** typically appear?
* Flexor surfaces * Moist skin areas ## Footnote It tends to occur in damp areas, including torso creases.
84
What cycle can occur due to **eczema**?
* Broken skin → increased permeability → antigen entry * Antigen entry → inflammation → broken skin ## Footnote This cycle leads to worsening of the condition.
85
What is the primary method of **treatment** for eczema?
* Moisturise skin with emollients containing fats * Avoid strong soaps * Use topical antihistamines or topical steroids ## Footnote Antibiotics are not a first-line treatment for eczema.
86
True or false: People with eczema are advised to wash their hair frequently.
FALSE ## Footnote They are told not to wash their hair at all or to use conditioner only.
87
What is **contact dermatitis** more common in?
Adults ## Footnote It is relevant to dentistry, often related to wearing gloves.
88
What can cause **contact dermatitis** in adults?
* Material of gloves * Wedding rings * Material from a golf handle ## Footnote It is not necessarily due to a latex allergy.
89
What are the management strategies for **contact dermatitis**?
* Avoid the antigen creating the exposure * Keep the skin moist with oils * Keep skin supple to reduce permeability * Use topical antihistamines and steroids in severe cases ## Footnote These strategies help manage symptoms and prevent further irritation.
90
What is **psoriasis** characterized by?
* Thickening of the skin * Scaly, itchy skin with shiny patches ## Footnote It is an inflammatory condition with an unknown cause.
91
How quickly do skin cells mature in **psoriasis** compared to normal?
Several hours ## Footnote In normal conditions, skin cells take three to seven days to mature.
92
Where does **psoriasis** typically present on the body?
* Outside of the elbow * Outside of the knee ## Footnote It generally does not present in flexor surfaces.
93
What is a potential complication of **psoriasis**?
Psoriatic arthropathy (psoriatic arthritis) ## Footnote Some patients with psoriasis can develop arthritis.
94
What is the aim of **treatment** for psoriasis?
Slow down keratinocyte proliferation ## Footnote Treatment options include topical Vitamin D, phototherapy, or systemic steroids.
95
What is **Systemic Lupus Erythematosus** (SLE)?
An uncommon autoimmune disease that can present in various ways ## Footnote Patients may be unaware they have SLE.
96
What is a common **presentation** of SLE?
* Anti-phospholipid syndrome * Butterfly-shaped rash across the nose and cheeks * Systemic issues affecting skin, joints, kidneys, liver, GIT, vascular, and blood ## Footnote These presentations can vary in severity.
97
What does the **butterfly-shaped rash** indicate in SLE?
A rash across the nose and upper cheeks/forehead ## Footnote It may occasionally affect the back and shoulders.
98
What is **Discoid Lupus Erythematosus** (DLE)?
A skin-related condition present in 20% of SLE patients ## Footnote DLE is characterized by discoid lesions and many patients won't develop SLE.
99
What are the **characteristics** of discoid lesions in DLE?
Shaped like a disc, can break down and form vesicles ## Footnote DLE primarily relates to skin presentation.
100
How is **SLE and DLE** managed?
* Depends on severity and systems involved * Anti-inflammatories * Steroids * Methotrexate * Biological response modifiers (e.g., monoclonal antibodies) ## Footnote These treatments aim to block parts of the immune response.
101
What is **scleroderma**?
An immunologically mediated disease that affects various systems ## Footnote It can lead to lower esophageal, gastric, and gut problems.
102
What is a typical manifestation of **scleroderma**?
Thickening and tightening of skin ## Footnote Raynaud’s phenomenon is also typical in patients.
103
What is **Raynaud’s phenomenon**?
Tightening of the skin leading to blocked blood supply and necrosis ## Footnote Results in white extremities due to poor perfusion.
104
True or false: Most patients with **DLE** will develop **SLE**.
FALSE ## Footnote A lot of patients with DLE won’t develop SLE.
105
What is **lichen planus**?
Very common, immunologically mediated condition with an unknown cause or trigger ## Footnote It can appear on the skin or mouth, and patients with implants may have more generalized disease.
106
What distinctive appearance is observed in a biopsy of **lichen planus**?
Band of T-cell infiltrate ## Footnote This finding is characteristic of the condition.
107
What are **Wickham striae**?
Lace-like strands of white across the affected area ## Footnote They are visible in the papules of lichen planus and other dermatoses, typically in the oral mucosa.
108
What does the **Koebner phenomenon** describe?
Appearance of new skin lesions of a pre-existing dermatosis on areas of cutaneous injury ## Footnote It is also known as the Köbner phenomenon and isomorphic response.
109
Where can **lichen planus** be found in the mouth?
* Buccal mucosa * Gingiva * Lip ## Footnote It is typically bilateral in the mouth.
110
What is a **lichenoid reaction**?
An immune response to a medication or filling material, usually amalgam ## Footnote It can present similarly to lichen planus.
111
How does **desquamative gingivitis** present in lichen planus?
More severe than marginal gingivitis, affecting the whole attached gingiva ## Footnote It can show thickening of the gum and/or mucosa, potentially with atrophy or erosion.
112
What is the management approach for **lichen planus**?
* Symptom management * Difflam mouthwash * Occasionally prescribe steroids * Recommend SLS-free toothpaste * Use of topical or systemic steroids ## Footnote There is no cure for lichen planus; management focuses on alleviating symptoms.
113
Pemphigus and pemphigoid are grouped into the **vesiculobullous diseases** because they create _______.
vesicles and bullae (blisters) ## Footnote Both conditions are autoimmune reactions that produce vesicles or bullae.
114
True or false: Pemphigus and pemphigoid are more common than **lichen planus**.
FALSE ## Footnote Both conditions are much less common than lichen planus.
115
If we see **vesicles or blisters** in the mouth, it is something we consider as a _______.
differential diagnosis ## Footnote This indicates the need to evaluate for conditions like pemphigus and pemphigoid.
116
Pemphigus and pemphigoid are both **autoimmune reactions** to molecules that hold skin cells together, producing _______.
vesicles or bullae ## Footnote This categorizes them as vesiculobullous diseases.
117
What happens if **vesicles/bullae** rupture in pemphigus and pemphigoid?
* Leads to blistering * Causes shallow ulceration ## Footnote Most often, patients present when they have burst.
118
The **oral mucosa** is held together by _______ and hemidesmosomes.
desmosomes ## Footnote Desmosomes hold skin cells against each other.
119
In pemphigus vulgaris, antibodies form against the _______.
desmosomes ## Footnote This leads to intraepithelial vesicles and easily broken bullae.
120
Pemphigus vulgaris is characterized by _______ areas of blistering.
huge ## Footnote It can affect the mouth, trunk, limbs, face, head, and neck.
121
Healing from pemphigus vulgaris takes a long time and can lead to a _______.
superficial secondary infection ## Footnote This complicates the recovery process.
122
Pemphigoid is more common than pemphigus and primarily affects which demographic?
elderly ## Footnote It is a rare condition but not as severe as pemphigus.
123
In pemphigoid, the reaction occurs with _______ instead of desmosomes.
hemidesmosomes ## Footnote This leads to subepithelial lesions.
124
Pemphigoid forms vesicles that affect the _______.
* mouth * eye * skin ## Footnote It is uncomfortable but less destructive than pemphigus lesions.
125
True or false: Pemphigoid is a more serious condition compared to pemphigus.
FALSE ## Footnote Pemphigoid is less serious and can lead to benign mucous membrane pemphigoid.
126
What is **Dermatitis herpetiformis** related to?
Coeliac disease ## Footnote It is an immune response to gluten molecules in wheat, causing disruption in the villi of the small intestine.
127
What are the symptoms of **Dermatitis herpetiformis**?
* Diarrhoea * Abdominal pain ## Footnote These symptoms arise due to the loss of surface area for nutrient absorption.
128
Younger patients with **Dermatitis herpetiformis** generally respond to what type of diet?
Gluten-free diet ## Footnote This is related to their condition being associated with a wheat allergy.
129
What type of deposits are found sub-epithelially in **Dermatitis herpetiformis**?
Granular IgA deposits ## Footnote These deposits are associated with the immune response affecting the epidermis.
130
What causes the formation of subepithelial vesicles in **Linear IgA disease**?
Linear deposit of IgA ## Footnote This condition leads to the development of vesicles on the skin.
131
True or false: Drug reactions can be associated with **Linear IgA disease** in younger patients.
TRUE ## Footnote If a younger patient develops vesicles and bullae, consider a drug reaction leading to IgA disease.
132
What skin condition can lead to string lesions in younger patients?
IgA disease ## Footnote This can occur due to drug reactions that cause vesicles and bullae.
133
What is the importance of a **systematic approach** when describing skin lesions?
Helps prevent errors ## Footnote A systematic approach aids in accurately recording skin lesions and any lumps or bumps.
134
What should be recorded about the **location** of a skin lesion?
* Where it is on the body * What structures are close to it ## Footnote Understanding the location helps in assessing the lesion's significance.
135
How is the **size** of a skin lesion measured?
Measured in cm ## Footnote Size is a critical factor in evaluating the lesion.
136
What are the possible **shapes** of a skin lesion?
* Round * Oval * Linear * Irregular ## Footnote The shape can provide clues about the nature of the lesion.
137
What does it indicate if a lesion is **fixed**?
* Suggests it is from that tissue or has become attached * More inflammation can make tissues stick together * Cancer spreads through tissues, causing fixation ## Footnote Fixed lesions may be attached to deep tissues, muscles, or bones.
138
What movement should be assessed for a lesion in the **neck**?
* Does it move? * Is it fixed to the larynx and moves on swallowing? * Is it fixed to the tongue? ## Footnote Movement can indicate whether the lesion is within the thyroid or other structures.
139
What is a **thyroglossal cyst** and how does it behave?
Forms in the thyroglossal duct and can move when you stick your tongue out ## Footnote Thyroglossal cysts are typically located in the midline of the upper neck.
140
What should be recorded about the **consistency** of a lesion?
* Soft * Firm * Hard * Bony hard * Rubbery * Fluctuant ## Footnote Fluctuant means it feels like a water balloon pressed down on one end.
141
What features of the **overlying skin/mucosa** should be noted?
* Red * Inflamed * Normal * Ulcerated ## Footnote The condition of the overlying skin can provide additional diagnostic information.
142
What does it mean if a lesion is **compressible**?
Does it empty and then refill? Is it vascular? ## Footnote Compressibility can indicate the presence of fluid or vascular structures.
143
What does **fluctuant** indicate about a lesion?
Is it fluid filled? ## Footnote Fluctuant lesions often contain fluid, which can be assessed during examination.
144
What does **pulsatile** suggest about a lesion?
Indicates blood supply ## Footnote Pulsatile lesions may be associated with vascular structures.
145
What is a **fluid 'thrill'**?
Turbulent blood flow ## Footnote A thrill can be felt during examination and indicates vascular activity.
146
What does a **bruit** indicate?
Turbulent blood flow ## Footnote Bruits are often associated with vascular lesions or abnormalities.
147
What does the presence of a **sinus** indicate?
Indicative of periapical issues requiring further investigation ## Footnote Sinuses can signal underlying dental or infectious problems.
148
What does **facial nerve weakness** suggest?
Suggestive of nerve issues ## Footnote The facial nerve runs through the parotid gland, and weakness may indicate pathology.
149
What should be assessed regarding **lymphadenopathies**?
Any palpable lymph nodes? ## Footnote Lymphadenopathy can indicate systemic disease or localized infection.
150
What should be noted about **other skin or neck lumps**?
* Are they isolated? * Are they in groups? ## Footnote The distribution of lumps can provide diagnostic clues.
151
What are **Skin cysts** commonly caused by?
* Blocked sebaceous glands ## Footnote The glands secrete sebum, a thick, oily secretion on the face, which can easily get blocked.
152
What is a **punctum** in relation to kin cysts?
The blocked pore of the gland ## Footnote If squeezed, discharge is expected from the punctum.
153
What should be done with caution when dealing with **skin cysts**?
* Squeezing them * Assessing for infection ## Footnote Squeezing can disrupt the cyst and lead to infection.
154
What is a common differential diagnosis for skin cysts?
Discharge from a chronic dental sinus ## Footnote Excising the lesion will not resolve the underlying dental issue.
155
What procedures may be necessary if a dental sinus is present?
* Root canal * Tooth extraction ## Footnote Dentists should remember their role and not think like maxillofacial surgeons.
156
What should you assess if you see a skin lesion along the lower border of the mandible?
Look inside the patient's mouth for a sinus tract ## Footnote An open sinus can indicate which tooth is causing the problem.
157
What happens to pigment in **tattoos**?
Deposited in the dermis and taken up by macrophages ## Footnote The epidermis is thin enough to see the pigment.
158
How can **tattoos** occur traumatically?
* Bike accidents * Grazing skin with gravel/tarmac ## Footnote Proper cleaning is essential to prevent permanent tattoos from foreign materials.
159
What are **amalgam tattoos**?
Pigmented lesions in the oral cavity from amalgam ## Footnote They can occur at sites of trauma or laceration of the mucosa.
160
What can happen when removing an amalgam from a socket?
It can drop into the socket and stay there ## Footnote This may present as a grey/black lesion that doesn’t change.
161
What are **vascular lesions** commonly caused by?
* Vascular tumours * Vascular malformations ## Footnote Vascular lesions can appear similar across different ethnicities.
162
How do vascular lesions typically present on the skin?
* Bright red * Blue-purple appearance ## Footnote The appearance depends on the depth of the lesion and the type of blood flowing through it.
163
What is **telangiectasia**?
* Common vascular lesion * Small, red, isolated spots ## Footnote Hereditary haemorrhagic telangiectasia is associated with frequent nose bleeds.
164
What are **naevi**?
* Relatively common * Little dilated blood vessels * Spider naevi: thick body with long, thin legs ## Footnote More common in individuals with liver diseases such as hepatitis or liver cirrhosis.
165
What does the color of a vascular lesion depend on?
* Oxygenation of blood * Depth below the surface epithelium ## Footnote More oxygenated blood results in a red color, while deeper venous blood gives a bluish/purple appearance.
166
What is a **port wine stain**?
* Type of facial vascular malformation * Associated with Sturge-Weber syndrome ## Footnote Typically found in the distribution of the trigeminal nerve.
167
What are **infantile haemangiomas**?
* Not present at birth * Grow in the first few months * May regress and disappear altogether ## Footnote They are a common vascular malformation.
168
What are the characteristics of **haemangiomas**?
* Common vascular malformation * May be developmental or traumatic * Various shapes/sizes ## Footnote If the blood supply is good, they may bleed a lot.
169
What is **Sturge-Weber syndrome**?
* Rare vascular disorder * Problem with blood vessel growth in skin, eyes, and brain ## Footnote Associated with port-wine stains and may lead to epilepsy.
170
What should be considered when examining **vascular lesions**?
* Extent (intraoral/extraoral) * Does it empty? * Does it refill? (arterial fast, venous slow) ## Footnote If asked about a vascular lesion, refer to a GP for specialist care.
171
What advice should dental practitioners follow regarding **haemangiomas**?
* Be cautious when extracting teeth near haemangiomas * Refer only if there is a large haemangioma next to the affected tooth ## Footnote Sturge-Weber syndrome and port-wine stains do not require referral unless complications arise.
172
What are the management options for **haemangiomas**?
* May not need treatment if no functional problems * Medical treatment: Propranolol * Sclerotherapy * Embolisation * Surgical resection (for large lesions) * Laser treatment ## Footnote Propranolol is a beta blocker used to reduce the impact of childhood lesions.
173
Where do **melanocytes** live in the skin?
In the basal layer ## Footnote Everyone has the same number of melanocytes regardless of skin colour.
174
What do **melanocytes** produce?
Melanin pigment ## Footnote This pigment is shared with other cells in the epidermis.
175
What are normal **pigmented lesions** that reduce with age?
Freckles ## Footnote Moles are slightly larger lesions found on the side of the cheek.
176
What is **melanoma**?
An invasive pigmented lesion ## Footnote More common than oral cancer with better survival rates.
177
What is the incidence of **oral cancer**?
6-10 per 100,000 people ## Footnote Compared to melanoma, which has an incidence of 25 per 100,000 people.
178
What is the key to avoid **melanoma**?
Avoid excessive UV radiation ## Footnote Australia initiative: Slip, slop, slap, seek, slide.
179
What is particularly bad for increasing the risk of **melanoma**?
Sunbeds ## Footnote They can increase the risk of melanoma, skin cancer, and other types of melanoma skin cancer.
180
What is the **seven point checklist** for identifying melanoma lesions?
* Change in size * Irregular pigmentation * Irregular border * Itch or altered sensation * Larger than other lesions * Inflammation * Oozing/crusting ## Footnote These points help in the early detection of melanoma.
181
Where is melanoma more commonly found?
* Limb * Trunk * Face/neck ## Footnote Melanoma can occur anywhere but is more common in these areas.
182
True or false: Melanoma usually causes many symptoms.
FALSE ## Footnote It does not usually cause many symptoms unless it gets very large.
183
What can melanoma do early in its progression?
Metastasize ## Footnote This means it can spread to other parts of the body.
184
What is **non-melanoma skin cancer** categorized into?
* Basal cell carcinomas * Squamous cell carcinomas ## Footnote Non-melanoma skin cancer is an aggressive disease but less aggressive than melanoma.
185
What is the typical presentation of **basal cell carcinoma**?
* Very slow growing lesion on the face or neck (80%) * Often has a pearly edge without ulceration * Can ulcerate as it grows * Can come and go, then reappear * Associated with ultraviolet radiation * Common in older patients who spend time outdoors ## Footnote Examples include gardeners, golfers, and farmers.
186
True or false: **Basal cell carcinoma** is likely to metastasize.
FALSE ## Footnote It is unusual for basal cell carcinoma to metastasize, but it will not go away on its own.
187
What is the typical presentation of **squamous cell carcinoma**?
* More aggressive than basal cell carcinoma * Tends to grow quicker with larger, ulcerated lesions * Common in elderly patients exposed to UV radiation ## Footnote Examples include gardeners, farmers, and golfers.
188
What is the **TNM scale** used for?
Staging/grading all types of cancer ## Footnote It assesses 'Tumour', 'Node', and 'Metastasis' status.
189
What is the typical **clearance** for a basal cell carcinoma during surgery?
4mm ## Footnote Melanoma would require about 20mm clearance to be on the safe side.
190
What is the survival rate for **melanoma**?
80% ## Footnote For non-melanoma skin cancer, the survival rate is about 90%.
191
Fill in the blank: **80% of head and neck skin cancer** is due to _______.
UV radiation ## Footnote This highlights the significant role of UV exposure in skin cancer development.
192
What is the peak age for **melanoma** and **non-melanoma skin cancer**?
70-80 ## Footnote Both types of skin cancer show a peak incidence in this age range.
193
What type of therapy can be provided for melanoma related to the **BRAF mutation**?
Targeted therapy ## Footnote Patients with the BRAF mutation are more likely to respond to targeted chemotherapy.
year 4 CMS
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