🧑‍⚕️ FREE MSRA PODCAST – Molluscum Contagiosum: Recognise, Reassure, Refer
🎯 Your rapid revision session for one of dermatology’s most common viral infections. We cover diagnosis, management, red flag scenarios and the must-know referral pathways for the MSRA.

Key Learning Points

🔍 Definition
• Molluscum contagiosum is a common, self-limiting viral skin infection caused by the molluscum contagiosum virus (MCV, poxvirus family).

🦠 Transmission & Risk Groups
• Spread by direct skin contact or sharing contaminated objects (towels, clothing, toys).
• Most common in young children, but also seen in immunocompromised patients and sexually active adults (anogenital lesions).
• Key risk groups: children with eczema, people with HIV or immunosuppression.

💡 Pathophysiology & Clinical Features
• Classic appearance: small, firm, dome-shaped, flesh-coloured or pearly papules with a central umbilication (dimple).
• Painless, often multiple, sometimes itchy or inflamed.
• Distribution: flexures, trunk, face in children; genital area, pubis, thighs in adults (if sexually transmitted).
• Incubation period: 2–8 weeks. Infectious while visible lesions remain.

📈 Epidemiology
• Very common (esp. children 1–10 years).
• Peaks: young children and sexually active young adults.
• Immunosuppressed patients can have extensive/atypical lesions.

🧠 Mnemonic for Referral Red Flags:
H-E-A-R

• HIV or known immunosuppression (extensive, persistent lesions → urgent referral)

• Eye involvement (eyelid lesions with red eye → urgent ophthalmology)

• Adult anogenital lesions (GUM referral for STI screening)

• Recalcitrant or rapidly spreading cases (consider immune status, refer if severe)

🩺 Diagnosis
• Nearly always clinical—look for the classic umbilicated papules.
• Dermatoscopy can help confirm, but histology/PCR rarely needed.
• Always consider HIV or immune workup for persistent, widespread or atypical cases.

💊 Management
• First line: Reassurance—self-limiting (resolves within 6–18 months).
• Advise: avoid scratching, don’t share towels, moisturise, don’t exclude from school/swimming.
• Treatment (if distressing, inflamed, or for transmission): options include curettage, cryotherapy, topical agents (imiquimod, cantharidin—limited evidence, risk of irritation/scarring).
• Treat associated eczema with mild topical steroids.
• Antibiotics only for secondary bacterial infection.

⚠️ Complications
• Secondary infection (impetigo, cellulitis), scarring (from scratching or treatment), persistent/multiple lesions in immunocompromised, eye involvement (conjunctivitis), psychosocial distress.

📎 More MSRA Revision for Molluscum Contagiosum:
📝 Revision Notes: https://www.passthemsra.com/topic/molluscum-contagiosum-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/molluscum-contagiosum-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/molluscum-contagiosum-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/molluscum-contagiosum-rapid-quiz/
🧪 Full Quiz: https://www.passthemsra.com/quizzes/molluscum-contagiosum/
🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/

🌐 For more free & premium revision resources:
https://www.passthemsra.com

#MSRA #MolluscumContagiosum #DermatologyMSRA #MSRARevision #MSRAFlashcards #PassTheMSRA #FreeMSRA #ViralSkinInfection #Poxvirus #RedFlagReferral

⚕️ FREE MSRA PODCAST – Milia
🎧 A clear, high-yield breakdown of this keratin-filled cystic skin condition – perfect for exam prep and real-life clinical scenarios.

🧠 Key Learning Points

📌 Definition
• Tiny, benign keratin-filled cysts under the skin
• Appear as white or yellowish dome-shaped bumps
• Most common on the face (eyelids, cheeks, nose)

📌 Causes & Risk Factors
• Trapped keratin beneath the epidermis
• Skin trauma – burns, blistering, surgery
• Prolonged use of thick creams or steroids
• Blistering skin conditions (e.g. EB)
• Prolonged sun exposure
• Extremely common in newborns – affects ~50%
• Occlusive skincare and poor exfoliation

📌 Pathophysiology
• Disruption of normal exfoliation
• Keratin gets trapped → forms firm cyst under stratum corneum
• In secondary milia: linked to damage or underlying dermatoses

📌 Symptoms
• Usually asymptomatic
• Appear as small (1–2 mm), smooth, white or yellow papules
• Can rarely be itchy or inflamed if manipulated
• Common sites: eyelids, cheeks, nose, chin; less often genitalia

📌 Differential Diagnosis
• Acne vulgaris (comedones, inflammation)
• Syringomas, xanthelasma, trichoepithelioma
• Basal Cell Carcinoma – esp. in older patients
• Vitiligo, molluscum contagiosum, Favre-Racouchot

📌 Diagnosis
• Clinical – based on history and appearance
• No tests needed in typical cases
• Biopsy if:
 – Elderly with sun-damaged skin (to rule out elastosis or BCC)
 – Suspected milia en plaque

📌 Management
• Often self-resolving, esp. in infants
• Watchful waiting is first-line
• If removal requested:
 – Sterile extraction by a professional
 – Topical retinoids, chemical peels, microdermabrasion
• Avoid over-the-counter salicylic acid – not effective
• Educate patients: no squeezing or DIY removal

📌 Complications
• Rare if left alone
• Improper removal may cause:
 – Infection, inflammation
 – Scarring, pigmentation changes

📌 Prognosis
• Excellent – benign with no systemic impact
• Spontaneous resolution common, especially in neonates
• May recur or new lesions may form over time

📎 More MSRA Resources for Milia

📝 Revision Notes:
https://www.passthemsra.com/topic/milia-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/milia-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/milia-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/milia-rapid-quiz/

🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/milia/

🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #Milia #Dermatology

⚕️ FREE MSRA PODCAST – Melanocytic Naevus
🎧 A clear, high-yield breakdown of this extremely common pigmented skin lesion – perfect for MSRA prep and clinical confidence.

🧠 Key Learning Points

📌 Definition
• A melanocytic naevus (mole) is a benign proliferation of melanocytes, the pigment-producing cells of the skin.
• Think of it as a small cluster of pigment cells, forming a flat or raised lesion.

📌 Causes & Risk Factors
• Genetic predisposition – family history of moles or melanoma
• UV exposure, especially early sunburns
• Hormonal shifts – e.g. puberty, pregnancy
🧠 Mnemonic: "SUN GLOWS" – Sunburn, UV, Naevus, Genes, Life stages, Oestrogen, Worrying Signs

📌 Pathophysiology
• Melanocytes multiply → cluster in different skin layers
• Depth of the cluster defines the type of naevus
• UV damage and genetic factors may trigger growth

📌 Symptoms
• Usually asymptomatic
• Flat or raised, round or oval, brown/black/flesh-coloured
• Can be macules, papules, or nodules
• Changes in size, shape, or colour → potential red flag

📌 Differential Diagnosis
• Dysplastic naevus (atypical mole)
• Melanoma – must be ruled out
• Spitz naevus – can mimic melanoma
• Seborrhoeic keratosis – stuck-on, waxy lesion
• Dermatofibroma, pigmented BCC

📌 Diagnosis
• Clinical exam – first step
• Dermoscopy – enhances assessment of suspicious lesions
• ABCDE mnemonic for red flags:

• Asymmetry

• Border irregularity

• Colour variation

• Diameter >6mm or increasing

• Evolving (new symptoms/changes)
  • Excisional biopsy if suspicious or indeterminate

📌 Management
• Most require no treatment
• Educate on self-monitoring and ABCDE changes
• Excision biopsy for lesions:

• In hard-to-monitor sites (scalp, genitalia)

• That are changing or symptomatic

• That have concerning dermoscopy features
  • Shave excision may be used for benign cosmetic removal (only if 100% confident it’s benign)

📌 Complications
• Rare transformation into malignant melanoma
• Cosmetic distress, psychological burden
• Trauma-related irritation, especially if located in friction areas

📌 Prognosis
• Excellent – most remain benign lifelong
• Having many or atypical naevi increases melanoma risk
• Long-term prognosis depends on early detection of change

📎 More MSRA Resources for Melanocytic Naevus

📝 Revision Notes:
https://www.passthemsra.com/topic/melanocytic-naevus-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/melanocytic-naevus-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/melanocytic-naevus-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/melanocytic-naevus-rapid-quiz/

🎯 Topic Quiz:
https://www.passthemsra.com/quizzes/melanocytic-naevus/

🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

📣 Course Mentions
This episode is part of the Dermatology for the MSRA course on PassTheMSRA.com.
Explore full revision guides, flashcards, quizzes and more at:
👉 https://www.passthemsra.com

#MSRA #MelanocyticNaevus #MSRARevision #MSRADermatology #MSRAFlashcards #MSRAQuiz #ABCDEMelanoma #DermatologyForTheMSRA #PassTheMSRA #MSRAPodcast #MoleCheck #SkinLesions #FreeMSRARevision #MultiSpecialtyRecruitmentAssessment

⚕️ FREE MSRA PODCAST – Marjolin’s Ulcer
🎧 A deep dive into this aggressive malignancy arising from chronic wounds – vital for exams and spotting danger in clinical practice.

🧠 Key Learning Points

📌 Definition
Marjolin’s Ulcer is a rare but aggressive skin cancer, most often squamous cell carcinoma, arising from chronic non-healing wounds, burn scars, or longstanding ulcers. It has a long latency period (often decades) and carries a poor prognosis if missed.

📌 Causes & Risk Factors
• Chronic non-healing wounds (especially burn scars)
• Longstanding pressure ulcers
• Chronic osteomyelitis sinuses
• Repeated trauma or infection to scars
• Immunosuppression (reduced immune surveillance)
• Environmental carcinogen exposure

🧠 Memory Tip: "Burns and Beyond" – Think burns, bedsores, and chronic inflammation

📌 Pathophysiology
• Chronic inflammation → ongoing repair → genetic mutations accumulate
• Repeated cell turnover in damaged tissue triggers malignant transformation
• Most commonly leads to SCC, but can also evolve into BCC or melanoma

📌 Symptoms
• Non-healing ulcer at site of old scar or wound
• New or worsening pain, bleeding, foul-smelling discharge
• Induration (firmness), ulceration, or nodularity in scar
• Irregular, raised, rolled borders
• Changes after decades of stability

📌 Differential Diagnosis
• Venous/arterial/diabetic ulcers
• Pyoderma gangrenosum
• Chronic traumatic ulcers
• Primary cutaneous SCC
• Infected scars

📌 Diagnosis
• Biopsy is essential – confirms SCC or other malignancy
• Examine regional lymph nodes
• Ultrasound or CT imaging to check for local invasion or metastasis
• Full staging needed for prognosis and management decisions

📌 Management
• Multidisciplinary team (MDT) approach
• Wide local excision with clear margins is first-line
• Mohs surgery in sensitive locations
• Reconstruction with skin grafts or flaps
• Consider amputation if extensive local disease
• Adjuvant radiotherapy or chemotherapy for incomplete resection or spread
• Targeted therapy in select cases

📌 Complications
• Local recurrence
• Regional or distant metastases (e.g. lymph nodes, lungs, liver)
• Functional loss from surgery/amputation
• Poor wound healing
• Psychological impact

📌 Prognosis
• Depends on depth of invasion, tumour size, and presence of metastasis
• Early diagnosis and full excision improve outcomes
• Delay in recognition leads to high morbidity and mortality

🧠 Key Takeaway: Any sudden change in a longstanding wound or scar should raise alarm bells. Biopsy it.

📎 More MSRA Resources for Marjolin’s Ulcer

📝 Revision Notes:
https://www.passthemsra.com/topic/marjolins-ulcer-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/marjolins-ulcer-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/marjolins-ulcer-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/marjolins-ulcer-rapid-quiz/

🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/marjolin-s-ulcer/

🎓 Full Dermatology Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

📣 All resources are part of the Dermatology for the MSRA course at:
👉 https://www.passthemsra.com

Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQandANotes #MSRAAccordions #MultiSpecialtyRecruitmentAssessment #MarjolinsUlcer #Dermatology #ChronicWoundCancer #PassTheMSRA

⚕️ FREE MSRA PODCAST – Lichen Sclerosus
🎧 A clear, high-yield breakdown of this chronic inflammatory skin condition affecting the genital area – perfect for exam prep and real-life clinical scenarios.

🧠 Key Learning Points

📌 Definition
• Chronic inflammatory skin disorder
• Most commonly affects the anogenital area
• Causes white, shiny, atrophic plaques with itching and fragility

📌 Causes & Risk Factors
• Likely autoimmune with genetic predisposition
• Postmenopausal status, low oestrogen
• Associated with thyroid disease, vitiligo, diabetes, smoking, and BMI
• Possible local triggers: trauma, infection, moisture

📌 Pathophysiology
• Autoimmune attack on elastic fibres
• Replacement with dense collagen = thin, fragile skin
• Scarring and loss of elasticity over time

📌 Symptoms
• Severe itching (especially at night)
• Pain, tearing, fissuring
• White atrophic patches – parchment-like
• In women: labial fusion, clitoral hood changes, introitus narrowing
• In men: phimosis, painful erections
• Extragenital: less common white itchy patches elsewhere

📌 Differential Diagnosis
• Vitiligo, lichen planus, psoriasis
• Candidiasis, morphea, lichen simplex chronicus
• VIN, Bowen’s, leukoplakia, SCC
• Be vigilant for premalignant/malignant mimics

📌 Diagnosis
• Primarily clinical
• Biopsy if atypical features, treatment failure, or malignancy concern
• Swabs only if secondary infection suspected
• No routine blood tests unless autoimmune suspicion

📌 Management
• First-line: Clobetasol propionate 0.05% (ultra-potent topical steroid)
• Maintenance: Potent steroid 1–2x/week
• Topical calcineurin inhibitors for steroid-sensitive patients
• Severe cases: intralesional steroids, systemic agents
• Patient education on skincare, irritant avoidance, and red flag awareness

📌 Complications
• Scarring, fusion, sexual and urinary dysfunction
• Constipation from anal pain
• Neuropathic pain, pseudocysts, psychosexual impact

📌 Prognosis
• Chronic but manageable
• 98% symptom remission with correct steroid use
• Some spontaneous remission in children
• Lifetime SCC risk ~4–5% → needs lifelong monitoring

📎 More MSRA Resources for Lichen Sclerosus

📝 Revision Notes:
https://www.passthemsra.com/topic/lichen-sclerosus-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/lichen-sclerosus-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/lichen-sclerosus-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/lichen-sclerosus-rapid-quiz/

🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/lichen-sclerosus/

🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #LichenSclerosus #Dermatology

⚕️ FREE MSRA PODCAST – Leukoplakia
🎧 A focused deep dive into this potentially pre-malignant white oral lesion – essential for MSRA revision and real-world clinical practice.

🧠 Key Learning Points

📌 Definition
Leukoplakia is a white, thickened patch in the mouth that cannot be scraped off. It is a diagnosis of exclusion and considered potentially pre-cancerous, most often found on the buccal mucosa, tongue, or floor of mouth.

📌 Causes & Risk Factors
• Tobacco use (smoking/chewing) – most significant factor
• Chronic mechanical irritation (e.g. sharp teeth, dentures, cheek biting)
• Alcohol use (especially with tobacco – synergistic effect)
• HPV infection
• Poor oral hygiene
• Older age, male gender
🧠 Mnemonic: TAP-IT
T – Tobacco / Trauma
A – Alcohol
P – Poor hygiene / Prolonged irritation / HPV
I – In males
T – Typically in older adults

📌 Pathophysiology
• Chronic irritation triggers epithelial cell changes
• Leads to abnormal keratinisation and thickening
• Can result in dysplasia – precancerous cell changes
• Dysplasia increases risk of transformation to oral squamous cell carcinoma

📌 Symptoms
• White or greyish plaque-like lesion
• Can be smooth, rough, speckled, or warty (verrucous)
• Typically painless and non-scrapable
• May cause irritation, soreness or burning
• Common sites: cheeks (buccal mucosa), tongue (sides/undersurface), floor of mouth

📌 Red Flag Features for Malignant Risk
• Speckled or verrucous appearance
• Ulceration or erosion within lesion
• Induration (firmness/hardening)
• Presence of a nodule
• High-risk sites: floor of mouth, underside of tongue
🧠 These features warrant urgent biopsy and specialist referral

📌 Differential Diagnosis
• Oral candidiasis (scrapes off)
• Oral lichen planus (lace-like pattern)
• Chemical burns
• White sponge nevus
• Lupus, psoriasis, syphilis

📌 Diagnosis
• Clinical history + examination
• Biopsy is essential – to confirm diagnosis and assess for dysplasia
• Histology reveals: mild, moderate, severe dysplasia, carcinoma in situ, or cancer

📌 Management
• Eliminate risk factors – smoking cessation, alcohol reduction
• Treat contributing factors – sharp teeth, ill-fitting dentures
• Surveillance – regular follow-up for lesion changes
• Repeat biopsies if lesion evolves
• Treatment (if required):
– Surgical excision
– Laser therapy
– Cryotherapy
– Topical agents like retinoids (limited role)
• Specialist referral to oral medicine/maxillofacial teams essential
❗ Note: No universal treatment consensus. Even excised lesions can recur or progress.

📌 Prognosis & Complications
• Most lesions remain stable or regress
• 1–9% may develop into oral squamous cell carcinoma
• Higher risk with:
– Non-homogenous lesions
– Presence of dysplasia
– Lesions on floor of mouth or tongue
– Continued smoking
• Other complications: local irritation, discomfort, psychological stress

📎 More MSRA Resources for Leukoplakia

📝 Revision Notes:
https://www.passthemsra.com/topic/leukoplakia-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/leukoplakia-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/leukoplakia-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/leukoplakia-rapid-quiz/

🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/leukoplakia/

🎓 Full Dermatology Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

📣 All resources part of the Dermatology for the MSRA course at
👉 https://www.passthemsra.com

Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQandANotes #MSRAAccordions #MultiSpecialtyRecruitmentAssessment #MSRAOnlineRevision #Leukoplakia #OralPathology #Dermatology #PassTheMSRA

🧑‍⚕️ FREE MSRA PODCAST – Lentigo Maligna: Melanoma In Situ Unpacked
🎯 Everything you need to revise lentigo maligna for the MSRA. From clinical clues to management and prevention—get all the essentials, fast.

Key Learning Points

🔍 Definition
• Lentigo maligna is a melanoma in situ—malignant melanocytes limited to the epidermis.
• Grows slowly on sun-damaged skin, usually the face or neck of older adults.

💡 Causes & Risk Factors
• Cumulative UV exposure (decades in the sun)
• Fair skin, age >60, history of skin cancer, immunosuppression
• Think “chronic sun damage” not acute sunburn

🧬 Pathophysiology
• UV light causes DNA mutations in melanocytes
• Slow, radial (horizontal) spread within the epidermis
• Can progress to invasive melanoma by breaching the basement membrane

🩺 Clinical Features
• Flat, slow-growing, irregularly pigmented patch (brown/black)
• Asymmetrical, ill-defined borders, colour variegation
• Usually on face/neck, >6mm diameter
• Usually asymptomatic
• Doesn’t darken after recent sun, unlike freckles

💡 Mnemonic: ABCDE for Pigmented Lesions
A – Asymmetry
B – Border irregularity
C – Colour variation
D – Diameter >6mm
E – Evolution (change over time)
Lentigo maligna often ticks several of these!

📝 Differential Diagnosis (Mnemonic: F-S-A-L-M)
F: Freckle
S: Seborrhoeic keratosis
A: Actinic keratosis
L: Lentigo maligna
M: Melanoma (other types)
Also: solar lentigo, superficial spreading melanoma, ephelides

🔬 Investigations
• Clinical exam (ABCDE checklist)
• Dermoscopy
• Definitive diagnosis = Skin biopsy (punch or excision)

💊 Management
• Surgical excision with clear margins is gold standard
• Mohs micrographic surgery for facial lesions (tissue-sparing, high cure)
• If unfit for surgery: Imiquimod cream, radiotherapy, cryotherapy (less reliable)
• Any suspicious lesion → Refer to dermatology

📈 Prognosis
• Excellent if caught in situ and treated
• ~5% progress to invasive melanoma (much higher risk if untreated)
• Post-treatment: regular skin surveillance

⚠️ Complications
• Progression to invasive melanoma (major risk)
• Recurrence if incomplete removal
• Cosmetic concerns, side effects of treatment
• Increased risk of further skin cancers

📎 More MSRA Revision for Lentigo Maligna:
📝 Revision Notes: https://www.passthemsra.com/topic/lentigo-maligna-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/lentigo-maligna-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/lentigo-maligna-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/lentigo-maligna-rapid-quiz/
🧪 Full Quiz: https://www.passthemsra.com/quizzes/lentigo-maligna/
🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/

🌐 For more free & premium revision resources:
https://www.passthemsra.com

#MSRA #LentigoMaligna #MelanomaInSitu #DermatologyMSRA #MSRARevision #PassTheMSRA #FreeMSRA #ABCDE #SkinCancer #MSRAFlashcards

🧑‍⚕️ FREE MSRA PODCAST – Keratoacanthoma: The Volcano Tumour You Can’t Ignore
🎯 Rapid, high-yield revision of keratoacanthoma for your MSRA, with all the crucial links between KA and squamous cell carcinoma (SCC).

Key Learning Points

🔍 Definition
• Keratoacanthoma (KA) is a rapidly growing, dome-shaped skin lesion with a central keratin-filled crater—think “volcano tumour”.
• Often resembles squamous cell carcinoma (SCC), but can regress spontaneously.

💡 Causes & Risk Factors
• Major: Chronic UV (sun) exposure, fair skin, older age, male sex
• Others: Trauma, HPV infection, immunosuppression, genetic predisposition, prior skin cancers, occupational exposures (tar, pitch)
• Remember: Risk factors mirror those for SCC!

🧬 Pathophysiology
• Abnormal proliferation of follicular keratinocytes (hair follicle origin)
• Driven by UV damage, genetic mutations, and immune dysfunction
• Classic course = rapid growth (weeks), plateau, then possible spontaneous regression

🩺 Clinical Features
• Firm, dome-shaped nodule with central keratin plug—volcano appearance
• Rapid enlargement (over weeks)
• Usually painless, sun-exposed sites: face, neck, hands, forearms
• May regress, leaving a scar

🧑‍⚕️ Differential Diagnosis
• Squamous cell carcinoma (top)
• Basal cell carcinoma
• Actinic keratosis
• Seborrhoeic keratosis
• Molluscum contagiosum

📝 Investigations
• Biopsy is essential—excisional or deep incisional (not superficial shave)
• Pathology confirms diagnosis and excludes invasive SCC

🧑‍⚕️ Management

1. Surgical excision (preferred): Ensures diagnosis, rules out SCC, and removes lesion

2. Medical alternatives (if surgery unsuitable):
    – Systemic retinoids (e.g., isotretinoin)
    – Intralesional: methotrexate, 5-fluorouracil, steroids
    – Topicals: imiquimod, 5-fluorouracil cream
    – Cryotherapy (sometimes)

3. Prevention: Sun protection, skin surveillance

4. Referral: Dermatology/plastic surgery for diagnosis and management

⚠️ Complications
• Cosmetic scarring
• Misdiagnosis as SCC (over or under-treatment)
• Rarely, progression or transformation to SCC—regular follow-up needed
• Persistent or recurrent lesions = red flag

📈 Prognosis
• Generally excellent—most regress after excision or even spontaneously
• But: Always rule out SCC, as the risk is significant

📎 More MSRA Revision for Keratoacanthoma:
📝 Revision Notes: https://www.passthemsra.com/topic/keratoacanthoma-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/keratoacanthoma-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/keratoacanthoma-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/keratoacanthoma-rapid-quiz/
🧪 Full Quiz: https://www.passthemsra.com/quizzes/keratoacanthoma/
🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/

🌐 Explore more free & premium revision resources at:
https://www.passthemsra.com

#MSRA #Keratoacanthoma #DermatologyMSRA #VolcanoTumour #SquamousCellCarcinoma #SkinCancer #MSRARevision #PassTheMSRA #FreeMSRA

⚕️ FREE MSRA PODCAST – Keloid Scars
🎧 Dive into this high-yield episode where we break down everything you need to know about keloid scars – a niche but frequently tested dermatology topic for the MSRA.

🧠 Key Learning Points

📌 Definition
• Keloid scars are raised, thickened areas of fibrous tissue that extend beyond the original wound margins.
• They are benign but may cause significant cosmetic and symptomatic concerns.

📌 Causes & Pathophysiology
• Result from overproduction of collagen during wound healing.
• Linked to genetic predisposition and dysregulation in pathways like TGF-β signalling.
• Excessive fibroblast activity and lack of ‘stop signals’ lead to ongoing scar tissue formation.
• Often triggered by skin trauma, surgery, burns, piercings, acne, or inflammation.

📌 Risk Factors
• Family history of keloids
• Darker skin tones (more common in African, Hispanic, and Asian descent)
• Ages 10–30, with peak incidence in young adults
• Common anatomical sites: earlobes, shoulders, sternum, upper back, cheeks

📌 Symptoms
• Firm, raised, rubbery scar tissue
• Often itchy, sometimes tender or painful
• May be red, pink, or hyperpigmented compared to surrounding skin
• Frequently extends beyond the initial injury
• Can restrict movement if over joints

📌 Differential Diagnosis
• Hypertrophic scar (raised but stays within the wound boundary)
• Dermatofibroma
• Dermatofibrosarcoma protuberans (rare)
• Keloidal acne or granulomas

📌 Diagnosis
• Primarily clinical – based on history and characteristic appearance
• Biopsy only if diagnosis is uncertain or malignancy suspected

📌 Management
🎯 Goal: Improve appearance and relieve symptoms
• Silicone gel sheeting – reduces scar height and improves texture
• Intralesional corticosteroids (e.g. triamcinolone) – first-line for active or symptomatic keloids
• Cryotherapy – especially helpful for small keloids, often combined with steroids
• Laser therapy – can reduce pigmentation and flatten lesions
• Pressure garments – useful after excision or in earlobe keloids
• Surgical excision – only in combination with preventative therapy, as recurrence is high
• Post-op radiotherapy or 5-FU injections – for resistant or recurrent cases

📌 Prevention
• Avoid unnecessary trauma (e.g. piercings or tattoos in high-risk individuals)
• Early treatment of acne and inflammatory skin issues
• Preventative strategies post-surgery:
 - Careful closure along skin tension lines
 - Immediate steroid injections
 - Pressure therapy or silicone use

📌 Prognosis
• Chronic condition with high recurrence rate
• Symptoms can impact quality of life
• No systemic complications, but significant cosmetic and psychological effects
• Specialist referral often needed

📎 More MSRA Resources for Keloid Scars

📝 Revision Notes:
https://www.passthemsra.com/topic/keloid-scar-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/keloid-scar-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/keloid-scar-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/keloid-scar-rapid-quiz/

🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/keloid-scar/

🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

📣 All resources are part of the Dermatology for the MSRA course at PassTheMSRA.com.
Find full revision packs, MCQs, flashcards and more at:
👉 https://www.passthemsra.com

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⚕️ FREE MSRA PODCAST – Kaposi’s Sarcoma
🎧 A clear, high-yield breakdown of this immunosuppression-linked skin cancer – perfect for exam prep and real-life clinical scenarios.

🧠 Key Learning Points

📌 Definition
• A rare vascular tumour caused by HHV-8 infection, commonly affecting the skin, mucosa, lymph nodes, and internal organs, particularly in immunocompromised individuals.

📌 Causes & Risk Factors
• HHV-8 infection is essential
• Immunodeficiency (HIV/AIDS, post-transplant) is the main trigger
• Other risk factors: male sex, older age, Mediterranean or African ancestry, diabetes, long-term steroid use
🧠 Mnemonic: IMAGE – Immunodeficiency, Male, Age, Geography, Ethnicity

📌 Pathophysiology
• HHV-8 infects endothelial cells → abnormal proliferation
• Angiogenesis → formation of leaky, highly vascular tumours
• Lesions contain spindle cells, abnormal blood vessels, and inflammatory cells

📌 Symptoms
• Purple-red skin lesions – may evolve from patches → plaques → nodules
• Common sites: legs, face, genitalia, oral mucosa
• Systemic involvement → GI tract (bleeding, pain), lungs (dyspnoea, haemoptysis)
• Often painless but may cause swelling or ulceration

📌 Differential Diagnosis
• Melanoma, cutaneous lymphoma, basal cell carcinoma
• Opportunistic infections (especially in HIV): fungal, viral, bacterial
• Other causes of purple skin lesions

📌 Diagnosis
• 🧪 Biopsy – confirms diagnosis with spindle cells and vascular features
• 🩺 HIV test, CD4 count, viral load
• 🖼️ Imaging – CXR or CT if systemic symptoms present
• Endoscopy for suspected GI involvement

📌 Management
• 🎯 First-line for HIV-associated KS: start or optimise ART
• Local lesions → surgery, cryotherapy, radiotherapy, topical agents
• Disseminated disease → liposomal anthracyclines, paclitaxel, interferon-alpha
• Watch for IRIS (immune reconstitution inflammatory syndrome) after ART start – may temporarily worsen symptoms

📌 Complications
• Internal organ spread → life-threatening
• Opportunistic infections
• Disfigurement, bleeding, secondary cancers

📌 Prognosis
• Varies by type and immune status
• Good prognosis with early ART and limited disease
• Worse if systemic, untreated, or CD4 <200

📎 More MSRA Resources for Kaposi’s Sarcoma

📝 Revision Notes:
https://www.passthemsra.com/topic/kaposis-sarcoma-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/kaposis-sarcoma-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/kaposis-sarcoma-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/kaposis-sarcoma-rapid-quiz/

🎯 Topic Quiz:
https://www.passthemsra.com/quizzes/kaposi-s-sarcoma/

🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

🎓 Course Mention
All resources are part of the Dermatology for the MSRA course on PassTheMSRA.com – your go-to platform for structured, exam-aligned revision.
Explore full guides, quizzes, flashcards, and more at:
👉 https://www.passthemsra.com

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