Transcript Skin Cancer
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 • Site, distribution INSPECT DESCRIBE PALPATE SYSTEMATIC CHECK • 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 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 Melanoma • • • • 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 • 6th most common cancer Non-melanoma vs Melanoma Melanoma BCC SCC Basal Cell Carcinoma • 90% face INSPECT DESCRIBE PALPATE SYSTEMATIC CHECK • 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 > 7mm 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 are 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?