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29 Cards in this Set
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- Back
- 3rd side (hint)
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A 71 year old man presents to the GP with a pigmented lesion on his cheek. He believes the "brown spot" has been there most of his life but has recently noticed that it has become larger with a nodule developing in the centre.
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Lentigo maligna melanoma
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An African man presents to the GP as he is concerned about a dark brown lesion on the palm of his hand. He believes he first noticed the lesion one month ago.
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Acral lentiginous melanoma
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Acral lentiginous melanomas usually occur on the palms and soles, no matter which race. It has been suggested that this variant of melanoma is not related to UV exposure.
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A 25 year old female, who loves surfing at the beach and grew up in Queenscliff, presents to the GP after noticing a "funny spot" on her left thigh. The lesion is varied in colour and is palpable. She believes it has been present for around 3 months and has "gotten wider" during this time.
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Superficial spreading melanoma
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Superficial spreading melanoma is the most common kind in Caucasians. It usually shows much colour variation and is often palpable. Females are more likely to get melanoma on their lower legs, compared to males who get melanoma on their backs.
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You are reviewing the results of an excision biopsy for one of your patients. The report states the a melanoma measuring 1mm by 1mm was excised, with a 1 cm margin. The Breslow's thickness was <1mm. There was no nodal involvement or micro/macrometastasis. What is the expected 5 year survival rate for your patient?
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A Breslow's thickness <1mm has a 95-100% five year survival rate.
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Breslow's thickness measures from the granuloma layer of the skin to the deepest point of penetration of the melanoma. It gives an indication of prognosis.
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A 78-year-old man presents to the GP with an ulcer nearby his left eye. The ulcer has a rolled, pearly edge. He believes the lesion has been present for at least two years and has grown slowly over that time.
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Basal cell carcinoma
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Basal cell carcinomas are common on the faces of the elderly. They begin as small, glistening skin coloured papules, and may progress over time to necrose in the centre, leaving an ulcer with an raised, pearly edge and telangectasia. BCCs rarely invade or metastasise but can be dangerous if they are nearby vital organs, such as the eye.
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A 65-year-old grandmother presents to the GP with a warty nodule on the middle finger of her right hand. She was burnt many times during her younger years. She believes the nodule first appeared around two months ago and that it has increased in size within that time.
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Squamous cell carcinomas.
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SCC is a proliferative tumour that grows over a few months. They may present as keratotic nodules, exophytic erythematous nodules, infiltrating firm tumours and ulcers with an indurated edge. Excision generally equal cure.
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A 40-year-old man notices that he has a few small red lesions on his torso. The lesions are bright read and less than 1mm in diameter.
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Campbell de Morgan's spots.
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These are a benign vascular tumour (hemangioma) or harmatoma.
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A 50-year-old lady presents to the GP with an unsightly growth on her left cheek. She believes it has appeared over the past month and has grown rapidly. Upon closer inspection you notice that the lesion is 2cm in diameter, is volcano-shaped and has a keratin plug. What is the appropriate treatment?
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Nothing.
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This is a keratocanthoma, which is a benign keratinocyte tumour. They normally resolve spontaneously over a few months.
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A 50-year-old man presents to the GP with multiple, elevated brown lesions on his back. Some are only slightly elevated while others look "stuck on". Under a lens, the surface appears greasy and pinpoint keratin plugs can be seen.
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Seborrhoeic keratoses.
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These are benign epidermal tumours, but can often mimic melanoma.
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A mother brings her teenage daughter to see you because she is concerned about the large number (around 30) of dark brown spots present upon her body, including the face, arms, legs and buttocks. The lesions are all less than 1 cm in diameter, and vary slightly in colour from one lesion to the next. The daughter is unconcerned and believes she has had most of the spots since she was a little kid.
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Melanocytic naevi (moles).
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Mrs S is a 75-year-old lady who has been in hospital for three weeks with a fractured right neck of femur. The nurse calls you over to inspect some skin lesions she noticed while bathing Mrs S. There is a deep penetrating ulcer on the lower back (overlying the sacrum) and a localised area of erythema on the R foot (overlying the calcaneal tuberosity).
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Pressure sores.
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Up to 30% of elderly patients with a fractured neck of femur will develop a pressure ulcer.
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A 45-year-old obese woman has a painful left ankle, present for 2 weeks. She believes that she has been wearing ill-fitting shoes.When removing her shoe you notice the medial malleolus has an ulcer 4cm in diameter that is smelly and exudative.
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Venous ulcer, colonised by bacteria.
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This is a venous ulcer which has developed due to venous hypertension as a result of the woman's obesity and physical inactivity. The ulcer has been colonised by bacteria. The ulcer requires dressing, removal of exudate and oral antibiotic therapy should be started.
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A 35-year-old Aboriginal man comes to the Emergency Department complaining of "sore feet". He looks unwell and complains he feels "hot and sweaty". You remove his shoes to find the heels on both feet have large ulcers which are exudative. What should your next investigation be?
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Fasting BSL or urinalysis to test for diabetes or glycosuria respectively. This man has a neuropathic ulcer likely due to diabetes.
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The most common cause of a neuropathic lcer is diabetes. The ulcers occur over weight-bearing areas.
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A 70-year-old man in a nursing home is complaining of a cold left foot. When examining the foot you note that it is cyanotic and cold, and that the skin is atrophic and hairless. You cannot feel the pedal pulses. You notice a deep ulcer above the lateral malleolus.
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Arterial ulcer
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Risk factors for arterial ulcers include: DM, HTN, HL, Smoking
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A 25-year-old woman has painful blisters in her mouth and face which are very painful and cause bleeding when touched. Nikolsky's sign is positive. Indirect immunofluorescence discovers a high level of IgG auto-antibodies present in the serum.
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Pemphigus vulgaris
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Rare auto-immune skin condition in which autoantibodies attack desmoglein1-3, causing intra-epidermal blistering.
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A 65-year-old male has widespread itchy skin lesions and tense blisters. A skin biopsy is taken and under immunofluorescence there is shown to be the presence of IgG and C3 at the basement membrane.
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Bullous pemphigoid.
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chronic autoimmune bullous disorder in which autoantibodies are directed against hemidesomsomal antigens, causing an inflammatory reaction which damages the hemidesmosomes, leading to blistering.
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A 20-year-old man has an itchy, red rash on his face and torso. He has suffered from asthma since childhood. He recalls having a similar rash as a child, but it was on the backs of his knees and the front of his elbows. The rash makes his skin look red, swollen and cracked, with some papules and vesicles evident.
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Atopic eczema.
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A 25-year-old lady develops a rash over her back. The rash is red and itchy, her skin appears swollen and cracked, and there are some papules and vesicles evident. She believes the rash started when she began wearing her new bra.
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Allergic contact eczema.
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A 20-year-old female develops an itchy rash over both her elbows, both her knees and lower back. The rash has multiple red lesions with a silvery-white scale. The scale is easily removed by scratching, which causes the lesion to bleed.
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Plaque psoriasis.
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A 15-year-old boy develops a rash after a streptococcal throat infection. The rash appeared rapidly, with multiple salmon-pink, droplet-shaped lesions, less than 1cm in diameter. The rash is mainly over his knees and elbows.
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Guttate psoriasis.
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A 30-year-old lady with two pet dogs at home develops a rash on her left arm. The rash is red and scaly, and the lesions are erythematous, annular and have a well-defined edge, with central clearing.
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Tinea corporis.
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It is summer time and a 30-year-old female presents to the GP after noticing a widespread, red rash over her body. Two weeks earlier she noticed an oval lesion on her arm, which had a central pinkish centre and dark purple periphery.
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Pityriasis rosea.
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A 20-year-old man being treated for pneumonia returns to your clinic after noticing that he has a widespread, red, scaly rash. The rash appeared after he began treatment for his pneumonia.
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Drug reaction to penicillin.
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It is summer time, and a 27-year-old man notices a change in his skin colour when he takes off his shirt to go swimming. The skin on his upper torso looks lighter than the tanned skin on the rest of his body.
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Pityriasis versicolour.
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A 30-year-old man presents with an intensely itchy rash over his left wrist. The individual lesions are flat-topped, pink-purplish papules with a fine white network on the surface. New lesions develop where he scratches.
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Lichen planus.
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A 23-year-old homosexual man develops a red rash on the palms of his hand and the soles of his feet. On closer inspection, the rash consists of macules, papules and pustules. He feels unwell, with joint and muscle pain, and has a fever and lymphadenopathy.
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Secondary syphilis.
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A mother notices that her four-year-old child has a lump in the middle of his fore-head. The lump is smooth and 2cm in diameter. You suspect if removed it will contain keratin and hairs.
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Dermoid cyst.
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A 30-year-old man presents with a sore lump on his left arm. The lump developed over an area where he had accidentally cut himself some months ago. The lump is tender, firm and rubbery and appears fixed to the soft-tissue.
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Fibroma.
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Fibromas often occur following minor soft-tissue trauma.
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A 45 year-old lady notices a painless, slowly enlarging mass on the her left wrist. On excision, it is filled with mature white adipose tissue.
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Lipoma.
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