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?