Skin Cancer A few questions A few photos

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Skin Cancer A few questions A few photos A few suggestions Dr Peter Allen

Skin Cancer A few questions A few photos A few suggestions Dr Peter Allen

Lignocaine is: 1. A vasodilator 2. A vasoconstrictor 3. Both vasodilator and vasoconstrictor 4.

Lignocaine is: 1. A vasodilator 2. A vasoconstrictor 3. Both vasodilator and vasoconstrictor 4. Neither vasodilator nor vasoconstrictor

Adrenaline is: 1. 2. 3. 4. A vasoconstrictor A vasodilator Both vasoconstrictor and vasodilator

Adrenaline is: 1. 2. 3. 4. A vasoconstrictor A vasodilator Both vasoconstrictor and vasodilator Neither vasoconstrictor nor vasodilator

A patient had a heart attack in the last 3 months and is on

A patient had a heart attack in the last 3 months and is on amiodarone. The maximum safe dose of lignocaine 1% with adrenaline is: 1. 2. 3. 4. 2 mls 4 mls 10 mls 20 mls

What is this forearm lesion? 1. I don’t know 2. Ulcerating BCC 3. Ulcerating

What is this forearm lesion? 1. I don’t know 2. Ulcerating BCC 3. Ulcerating SCC 4. Amelanotic melanoma 5. Chronic ulcer 6. Pyogenic granuloma What do I do when I see this?

What is this on an 80 yr old’s medial calf? 1. I don’t know

What is this on an 80 yr old’s medial calf? 1. I don’t know 2. SCC 3. BCC 4. Amelanotic melanoma 5. sarcoma 6. What do I do when I see this? If it is pink and you do not know what it is biopsy/refer/remove urgently. Pink/red tumours are some of the worst.

What is this? Elderly lady rapidly growing tumour left cheek. 1. I don’t know

What is this? Elderly lady rapidly growing tumour left cheek. 1. I don’t know what it is. 2. BCC 3. SCC 4. Melanoma 5. Sarcoma 6. Granulation tissue What do I do when I see this?

What is this? Elderly man, ulcerating lesion growing on finger. 1. SCC 2. BCC

What is this? Elderly man, ulcerating lesion growing on finger. 1. SCC 2. BCC 3. Melanoma 4. Sarcoma 5. Granulation tissue 6. I don’t know

What is this? Maori lady, ulcerating lesion on nose growing for two years? 1.

What is this? Maori lady, ulcerating lesion on nose growing for two years? 1. I don’t know 2. BCC 3. SCC 4. Melanoma 5. Granulation tissue 6. Sarcoma Message: It’s is not safe to assume Maori do not get skin cancer.

What is this? On back of middle aged male. 1. I don’t know 2.

What is this? On back of middle aged male. 1. I don’t know 2. BCC 3. SCC 4. Melanoma 5. Benign naevus What did the GP punch biopsy show? Message is : remove or refer, do not punch biopsy pigmented lesions.

What is this? Elderly man, lesion on temple. 1. BCC 2. SCC 3. Keratoacanthoma

What is this? Elderly man, lesion on temple. 1. BCC 2. SCC 3. Keratoacanthoma 4. Melanoma 5. Sarcoma 6. I don’t know

Aggressive Sarcoma

Aggressive Sarcoma

You have to do an excision or punch biopsy in a danger area (nerve

You have to do an excision or punch biopsy in a danger area (nerve or tendon): • How do you reduce the risk of damage to the nerve or tendon?

Hydrodissection (5 mls saline or Local Anaesthetic)

Hydrodissection (5 mls saline or Local Anaesthetic)

Visible clinical margins for excision BCC or SCC with well defined borders: • 2

Visible clinical margins for excision BCC or SCC with well defined borders: • 2 mm margin gives 70% clearance and 30% recurrence • 3 mm margin gives 85% clearance and 15% recurrence • 4 mm margin gives 98% clearance and 2% recurrence • 5 mm margin gives 1. 76% recurrence

How to achieve complete excision Draw around lesion and then draw a 4 mm

How to achieve complete excision Draw around lesion and then draw a 4 mm margin around this Then draw and plan the excision

Rhomboid skin flap

Rhomboid skin flap

A-T flap

A-T flap

What are these? • What is this lesion on the side of the nose?

What are these? • What is this lesion on the side of the nose? 1. BCC 2. SCC 3. Melanoma 4. Solar keratosis 5. Impetigo 6. I don’t know

Please refer early

Please refer early