Download presentation
Presentation is loading. Please wait.
1
Psoriasis and Skin Cancer
Edward Pritchard
2
Long Cases You could get these!
Last year’s finals! - Patient with recurrent SCC, with no symptoms. History focussing on skin exposure and social. Was asked about risk factors, macroscopic and microscopic appearance of different types of skin cancer and different treatments
3
Skin Examination Scalp Auricles Face Extremities (upper)
Chest (front and back) Abdomen (front and back) Genitalia Extremities If lesions – consider local lymph nodes etc.
4
Psoriasis
5
Definition Relapsing and remitting chronic skin condition characterised by scaly plaques Or inflammation of the dermis, with epidermal hyperproliferation
6
Epidemiology ~2% of the population Peak incidence in early 20s and 50s
Precipitated by infection, drugs (antimalarials, B-blockers, lithium), sunlight, stress, scars, burns
7
Pathophysiology Immune mediated leads to increased speed of skin turnover (28 days to 4), causes thickening of the epidermis.
8
Symptoms and Signs Typically well demarcated red, scaly, symmetrical, non itchy plaques 5 main presentations
9
Plaque – typically on extensor surfaces and scalp
10
Guttate – small eruptions over trunk – typically 2 weeks post B streptococcal throat infection
11
Pustular – widespread sterile pustules
12
Flexural – affects flexural aspects
Flexual Psoriasis – occurs typically in later life, forms in the groins, natal cleft and submammary area
13
Erythrodermic – extreme form affecting 90%+ of body – can be fatal
Erythrodermic Psoriasis erythrodermic psoriasis may develop as the result of slow or rapid progression of existing disease, or less commonly, de novo plaques cover over 90% of the body surface protective function of the skin is lost and problems with thermoregulation, septicaemia, dehydration, high output cardiac failure and metabolic changes due to increased cutaneous blood flow may occur (1) erythrodermic psoriasis may be life threatening
14
Management Conservative – diet, weight loss, smoking cessation, exercise advice Medical Topical Emolients Vitamin D analogues Topical steroids (mild to moderate) Coal tar Salicylic acid Phototherapy UVB PUVA ( Psoralen + UVA) Systemic Immunosuppresent – Methotrexate, ciclosporin Biologics – Infliximab, Adalimumab Surgical – no real role
15
Skin Cancer
16
Aetiology/Risk Factors
Squamous cell – UV light exposure (sunbathing), fair skin, radiation exposure, carcinogens, metastasise quickly Basal Cell – UV light exposure, radiation exposure, arsenic exposure, “never” metastasise – local tissue destruction Malignant melanoma – UV light exposure, metastasise rapidly
17
Symptoms and signs Squamous cell – rapidly enlarging lesion, ill defined (variable), pink colouration, may have ulceration, scaling, bleeding or weep Basal cell – slow growing lesion, well demarcated papule, raised rolled pearly edges with central depression Malignant melanoma – a new or changing mole.
18
Squamous Cell Carcinoma
~20% of cutaneous malignancies ~70% on head or neck Premalignant conditions (Bowen’s disease, actinic Keratosis) 95% cure rate with excision if localised disease. But metastasises rapidly to lymph with poor outcome
19
Basal Cell Carcinoma 75% of diagnoses
Moh’s Surgery – removal of obvious tumour and thin layer of tissue. Frozen and stained, then examined under microscope. If there are tumour cells present a further, deeper layer is removed and the process repeated until tumour free. Gives best cosmetic outcome –smaller lesions.
20
Malignant Melanoma Asymmetrical Border irregularity Colour variation
Diameter >6mm Evolution
22
Investigations Biopsy/Excisional biopsy (Breslow depth, Clark level – for melanoma) Stage – CT/PET
23
Tx + Prognosis Prognosis Management
Conservative – reduce risk factors, smoking cessation Medical – if for chemotherapy Surgical – excision biopsy +/- lymph node resections Prognosis Basal cell – very good, fatality rare Squamous cell – poor Malignant melanoma – poorer (often metastasised at presentation)
24
Questions Thanks
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.