Which of the following skin conditions associated with malignancy are not correctly paired?
Correct Answer C: Erythema gyratum repens is generally associated with solid organ malignancies such as lung and breast cancer.
Skin disorders associated with malignancy:
Paraneoplastic syndromes associated with internal malignancies:
A 54-year-old man presents with a two month history of a rapidly growing lesion on his right forearm. The lesion initially appeared as a red papule but in the last two weeks has become a crater filled centrally with yellow/brown material. On examination the man has skin type II, the lesion is 4 mm in diameter and is morphologically as described above.
What is the most likely diagnosis?
Correct Answer B: Keratoacanthoma is a benign epithelial tumour. They are more frequent in middle age and do not become more common in old age (unlike basal cell and squamous cell carcinoma).
Features - said to look like a volcano or crater:
Spontaneous regression of keratoacanthoma within 3 months is common, often resulting in a scar. Such lesions should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma. Removal also may prevent scarring.
Subungual distal keratoacanthoma. Note the keratotic plug on the distal bed.
X-rays showing massive osteolysis of the distal bony phalanx associated with subungual keratoacanthoma.
Keratoacanthoma. Keratin-filled crateriform nodule on the lid margin.
A central keratin plug is typical, with a history of rapid evolution followed by involution.
Keratoacanthoma, which is often larger and more hyperkeratotic than actinic keratosis.
You review a 50-year-old man who has psoriasis. Which one of the following medications is most likely exacerbate his condition?
Correct Answer D: Psoriasis: exacerbating factors:
The following factors may exacerbate psoriasis:
A 23-year-old man presents as he is concerned over recent hair loss. Examination reveals a discrete area of hair loss on the left temporal region with no obvious abnormality of the underlying scalp.
Correct Answer B: Alopecia areata is a presumed autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken 'exclamation mark' hairs.
Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients.
Alopecia areata: Other treatment options include:
Alopecia areata.
A 25-year-old male presents with extensive patches of altered pigmentation on his front, back, face and thighs. There is mild pruritus. A diagnosis of extensive pityriasis versicolor is made.
What is the most appropriate management?
Correct Answer C: Given the extensive nature of the lesions systemic therapy is indicated in this case.
Pityriasis versicolor: Pityriasis versicolor, also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale).
Features:
Predisposing factors:
Management:
Pityriasis versicolor. Skin scales mounted in potassium hydroxide (KOH) and Calcofluor white UV illumination. The hyphae diagnostic of the condition have taken up the stain immediately. Malassezia yeasts are also present.
Pityriasis versicolor: chest, neck, and shoulders A 22 year old man with pigmented patches on chest and neck for several years. Multiple pink to tan, well demarcated scaling macules becoming confluent on the neck, chest, flank, and arm.
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