Transcript Psoriasis & Skin Cancer

Psoriasis & Skin Cancer
Revision
Dermatology History
PC
What’s the problem? Where is it? How long has it been there?
Hx Of PC
What did it look like to begin with? Has it changed? If so, how?
Itchy? Painful? Bleeding?
Aggravating/ relieving factors
Previous & current treatments (effective or not)
Recent contact with diseases? Stressful events? Illness? Travel?
History of sunburn, use of tanning machines
Skin type? (1-4)
Past medical history
History of atopy i.e. asthma, allergic rhinitis, eczema
History of skin cancer & any suspicious skin lesions
Medication & allergies
Family history
Social history
Occupation- alcohol gel, over washing of hands, gloves
Improvement of lesions when on annual leave
Smoke/Drink?
ICE
Examination
• INSPECT
• DESCRIBE
• PALPATE
• SYSTEMATIC CHECK
INSPECT
– Where are the lesions & how many are
there?
– Is there a pattern i.e extensors affected only
DESCRIBE SCAM
– Size (at the widest diameter) & Shape
– Colour
– Associated secondary change
– Margin (border)
If lesion is pigmented ABCDE
–Asymmetry
–Irregular Border
–Two or more Colours within the
lesion
–Diameter > 6mm
–Evolution- change in size, shape
over time? Started to bleed?
• PALPATE & comment on:
– Consistency
– Mobility
– Tenderness
– Temperature
• SYSTEMATIC CHECK
Examine:
– Nails
– Scalp
– Hair
– mucous membranes
– Regional lymph nodes
• General examination
Psoriasis
2
1
1 Describe the lesion 33
2 What is this?
3 What is this?
2
Psoriasis
Chronic inflammatory skin disease
“Hyperproliferation of keratinocytes & inflammatory
cell infiltration”
Chronic plaque psoriasis most common type
Other types include:
• Guttate (raindrop lesions),
• Seborrhoeic (naso-labial and retro-auricular),
• Flexural (body folds),
• Pustular (palmar-plantar)
• Erythrodermic (total body redness)
Which type?
Seborrhoeic
Flexural
Pustular
Guttate
Erythrodermic
2% of population in UK
Complex interaction of genetic,
immunological & environmental factors
Precipitating factors inc:
-Trauma
-Infection (e.g. Strep throat)
-Drugs
-Stress
-Alcohol
Well-demarcated, erythematous, scaly PLAQUES
Extensor surfaces of the body & over scalp
Auspitz sign (Gentle removal of scales = capillary bleeding)
50% have nail changes (e.g. pitting, onycholysis)
5-8% assc. psoriatic arthropathy:
• Symmetrical polyarthritis
• Asymmetrical oligomonoarthritis
• Lone distal interphalangeal disease
• Psoriatic spondylosis
• Arthritis mutilans
Lesions itchy, burning, painful
Management
Avoid precipitating factors, emollients to reduce
scales
• Topical therapies (localised & mild psoriasis):
-Vitamin D analogues i.e calcitrol
-Topical corticosteroids
-Coal tar preparations inc. scalp treatments
-Dithranol
-Topical retinoids i.e Tarazotene
-Keratolytics (Urea based creams)
• Phototherapy (extensive disease)
- Mainly UVA
-UVB can be used when UVA fails- can cause
sunburn
•Oral therapies (extensive, severe psoriasis &
psoriasis with systemic involvement)
-Methotrexate
-Retinoids
-Ciclosporin
-Mycophenolate mofetil
-Biological agents (e.g. infliximab, etanercept,
efalizumab)
Skin Cancer
Cancer
Skin
SCC
BCC
Solar
Keratosis
Malignant
Melanoma
Skin cancer can be divided into:
• Non-melanoma (basal cell carcinoma &
squamous cell carcinoma)
• Melanoma (malignant melanoma).
Basal Cell Carcinoma
Slow-growing, locally invasive tumour epidermal
keratinocytes- affect basal layers of skin
Malignant but rarely metastasises
Most common malignant skin tumour
Risk factors include:
-UV exposure
-History of frequent/ severe sunburn in childhood
-Skin type 1
-Increasing age
-Being male
-Immunosuppression
-Previous history of skin cancer
-Genetic predisposition
Nodular most common
Small, skin-coloured papule or nodule
Surface telangiectasia,
Pearly rolled edge
May have necrotic/ ulcerated centre rodent ulcer
Head & neck involvement
Management
• Surgical excision
• Radiotherapy - when surgery is not appropriate
• Cryotherapy
• Topical photodynamic therapy
• Topical treatment (imiquimod cream) -small, lowrisk lesions
Squamous Cell Carcinoma
Locally invasive malignant tumour of epidermal
keratinocytes - affect squamous layer of skin.
Potential to metastasise
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Causes
Risk factors include:
Excessive UV exposure
Actinic/ Solar keratoses
chronic inflammation (leg ulcers, wound scars)
Immunosuppression
Genetic predisposition
Keratotic (scaly, crusty), ill-defined nodule
May ulcerate
Management
• Surgical excision - treatment of choice
• Radiotherapy - for large, non-resectable
tumours
Malignant Melanoma
Invasive malignant tumour of epidermal melanocytes
Potential to metastasise
Causes
Risk factors include:
• Excessive UV exposure
• Skin type 1
• History of multiple moles/ atypical moles
• Family history or previous history of melanoma
The ‘ABCDE Symptoms’ rule → What are they?
Legs in women & trunk in men
Superficial
Spreading Melanoma
Nodular melanoma
Name the
types of
melanoma
Acral Lentiginous
Melanoma
Lentigo Maligna
Melanoma
Types:
•Superficial spreading melanoma – lower limbs,
young & middle-aged, intermittent high intensity UV
exposure
•Nodular melanoma - trunk, in young & middle-aged
adults, intermittent high-intensity UV exposure
• Lentigo maligna melanoma - face, elderly pop, longterm cumulative UV exposure
•Acral lentiginous melanoma - palms, soles & nail
beds, elderly pop, no clear relation with UV exposure
Management
•Surgical excision
•Radiotherapy
• Chemotherapy for mets
Prognosis
Recurrence based on Breslow thickness
<0.76mm thick – low risk
0.76mm-1.5mm thick – medium risk
>1.5mm thick – high risk
5-year survival rates based on TNM
classification
Stage 1 (T <2mm thick, N0, M0) – 90%
Stage 2 (T>2mm thick, N0, M0) – 80%
Stage 3 (N≥1, M0) – 40- 50%
Stage 4 (M ≥ 1) – 20-30%
Thank You For Listening
&
Good Luck