Sajid Nazir 2009

How would you manage it?

almost never metastasizes but it may kill by local invasion commonest skin cancer incidence is related to sunlight exposure 75% occur in the head and neck Initial small pearly white lesion, telengectasia, central ulceration and rolled edges, bleed-ulcerate-heal again Treatment is excision by specialist, send for histology

How would you manage and what treatment would you avoid?

Flushing, papules and pustules - forehead, bridge of the nose and cheeks Unknown aetiology Precipitated by topical steroids, sunlight, alcohol, hot drinks topical metronidazole topical azelaic acid oral tetracycline

How would you manage it?

Small white yellow papules that occur on face and neck Common in newborns and are transient Believed to originate from maldeveloped sweat glands Often rupture and skin and no treatment is required

What features support diagnosis? What would you do with this patient?

Asymmetrical, irregular border and colour, increasing size Urgent referral Prognosis related to thickness (Breslow)

How would you manage?

Usually appear in first 2 decades No treatment required May be excised if malignant change suspected or for cosmetic reasons

Characteristically: rapidly expanding painless, ulcerated nodule, rolled indurated margin. Commonly ulcerate and bleed Potential to metastasize Must refer for biopsy/excision

Slowly expanding pink, scaly plaque that has a sharply defined border Risk of invasive SCC (3-5%) Histology required Management options include watchful waiting, topical fluorouracil, cryotherapy, curettage, excision, laser

What are the erythematous areas called? Name 2 causes

Target Lesions Causes: barbiturates, aspirin, sulphonamides, herpes simplex, TB, mycoplasma, typhoid, pregnancy, vit c deficiency, collagen vascular disease, IBD Treat causes Symptomatic Rx e.g. Antihistamines Heals in 3 weeks

How would you treat them?

hyperpigmented or scaly lesions, usually brown with a scaly base marked thickening of the keratin layer Can progress to SCC Topical diclofenac 3%, 5-fluorouracil, topical retinoids physical treatment e.g. cryotherapy, curettage, local excision

Varicella zoster virus Unilateral aciclovir administration of 800 mg five times per day for 7 days Can result in post-herpetic neuralgia

How would you treat it?

Spares face, hands and feet topical antifungal therapy or with steroid Oral terbenfaine/itraconazole

What is this called and what causes it?

Reddened skin due to longterm infrared radiation exposure Common in elderly who sit in front of heater Or use of a hot water bottle as in this case Laptops may cause it!! Mild cases resolves spontaneously if you remove source, others are permanent

What is this and what diseases may it be associated with?

Erythema nodosum is a reactive process of unknown pathogenesis Causes: streptococcal infection, sarcoidosis. Pregnancy, the oral contraceptive pill, inflammatory bowel disease, tuberculosis In 50% of cases the cause is not identified. Must to bloods and CXR to investigate

Screen for other autoimmune disorders eg thyroid No treatment required

yeast infection Usually noted after a holiday when normal skin tans Mild or localised pityriasis versicolor may clear with repeated applications of a topical imidazole cream oral imidazole (ketoconazole, fluconazole or itraconazole) for extensive infections