Dermatology Skin cancer Psoriasis Dr Rochelle Velho Academic

Dermatology: Skin cancer & Psoriasis Dr Rochelle Velho Academic Foundation Year 1 S. L. I. M. E. Workshop

S. L. I. M. E. Workshop Dermatology OSCE Psoriaris Skin Cancer Quiz

Derm. History OSCE

Derm. O/E OSCE INSPECT DESCRIBE PALPATE SYSTEMATIC CHECK • Site, distribution • S. C. A. M • Size, Shape, Colour, Assym. , Morphology, Margin • Surface, consistence, mobility, Tenderness, temp. • r/v • Hair, nails, scalp, joints

Psoriasis

Psoriasis • Definition: Hyperproliferation keratinocytes and inflammatory cell infiltration • Course: Relapsing, remitting, Noninfectious • Epidemiology: 2% population • Cause: complex • Mx Aim: control not cure

Types Plaque (most common) Guttate Seborrhoeic Flexural Pustular Erythrodermic

Hx • • • Scaly plaques ‘Itchy & burning’ Extensor > Flexor common Scratch bleed (Auspitz sign) 50% - nail changes 5 -8% psoriatic arthropathy

O/E INSPECT • Site, distribution • LOCAL, EXTENSOR, L ARM DESCRIBE • EXTENSOR, ELBOW, PLAQUE, PINK/WHITE, ASSYM, ERYTHEMA, ILL DEFINED MARGIN PALPATE • PALPABLE, SCALY, IMMOBILE, +/TENDERNESS, +/- WARM • AUSPITZ +ve SYSTEMATIC CHECK • Hair, nails, scalp, joints

Management Oral Topical General measures -avoid precipitating factors - Vitamin D analogues -Corticosteroid -Tar Photochemo therapy -Psoralen and UVA – Methotrexate, Ciclosporin

Skin Cancer 1) Non melanoma - Basal Cell Carcinoma (BCC) - Squamous Cell Carcinoma (SCC) 2) Melanoma

Epidiemiology Melanoma Non-melanoma • • >100, 000 cases/year UK M: F - 2: 1 Elderly On the epidermis – visible, detected early • UK 2007 – 491 deaths • Disfiguring • Risk - Sun exposure • • 8000 new cases/year UK M: F - 1: 1. 5 Increases with age Early local invasion and metastasis • 75% of all skin cancer related deaths, 2500 deaths per year • 6 th most common cancer

Non-melanoma vs Melanoma BCC SCC

Basal Cell Carcinoma INSPECT DESCRIBE PALPATE SYSTEMATIC CHECK • 90% face • Pearly, Telangectasia, Raised, Rolled (not everted) Edges, ulcers, scabs • Ulcer/rolled edges • Rodents – destroy face • RARELY METS

Squamous Cell Carcinoma INSPECT DESCRIBE PALPATE SYSTEMATIC CHECK • Various sites • Slow growth • Irregular ulcer/ slowly growing nodule • Raised, everted edges • Central scab, Keratin formation • Irregular • Raised edge – everted • Low risk mets, unless lip/ear

Melanoma – Hx • • • Recent change in size/shape/colour Bleeding/itching Excess sun exposure + fair skin History of sunburn FH Amelanotic melanomas – pink/red fleshy colour, tend to be more aggressive

Melanoma - Distribution • Men - trunk (especially the back) • Women legs http: //info. cancerresearchuk. org/cancerstats/types/skin/incidence/}

O/E - Appearance • • • Asymmetry Border – irregular Colour – non uniform Diameter > 7 mm Elevation

Melanoma - Prognosis • Breslow Depth - primary tumour Depth (mm) 5 -year survival <0. 75 >95% 0. 75 – 1. 5 90% 1. 5 – 4. 0 70% >4. 0 <50%

Skin Cancer – General points Mx • GPs do not to excise, referred to GPSI or dermatologist • Early detection is important -Education programs: – Sun avoidance during peak hours – Proper use of sunscreen and protective clothing – Avoid sun tanning

Quiz

Psoriasis - plaque • Erythematous plaques with silvery scale over both knees • Plaques areas of palpable skin change over. 5 cm in diameter

Pitting • Nail dystrophy (a good general term to describe any nail abnormality) • Nail pitting and onycholysis (the nail plate has come away from the nail bed distally

Psoriatic arthritis • It affects around 30% of patients with moderate to severe psoriasis • In many cases it is a mono-or oligo- arthritis • a symmetrical polyarthritis involving the distal interphalangeal joints can also be seen

Kobner • Psoriasis develops at sites of skin trauma (surgery in this example) • Koebner’s phenomenon is seen in psoriasis (not pathognomic though)

Melanoma This is a pigmented lesion. The way to describe pigmented lesions is: ‘This is a pigmented lesion…’ and then follow the ABCD algorithm where: A asymmetry B boarder (regular or irregular) C colour (how many, uniform or irregular) D diameter of the lesion This is a superficial spreading malignant melanoma (the most common form of melanoma)

Summary Dermatology OSCE Psoriaris Skin Cancer Quiz

Revision - BAD handbook

Skin cancer references 1. 2. 3. 4. • • http: //info. cancerresearchuk. org/cancerstats/types/skin/incidence Lecture Notes: General Surgery. Harold Ellis Medicine at a Glance. Patrick Davey http: //info. cancerresearchuk. org/cancerstats/incidence/commoncancer s/#Non-melanoma http: //www. aafp. org/afp/20000715/357. html Oxford Handbook of Clinical Medicine

Thank you for listening. Any questions?