1. Skin Cancer A few questions A few photos A few suggestions Dr Peter Allen

2. Lignocaine is: 1. A vasodilator 2. A vasoconstrictor 3. Both vasodilator and vasoconstrictor 4. Neither vasodilator nor vasoconstrictor

3. Adrenaline is: 1.A vasoconstrictor 2.A vasodilator 3.Both vasoconstrictor and vasodilator 4.Neither vasoconstrictor nor vasodilator

4. A patient had a heart attack in the last 3 months and is on amiodarone. The maximum safe dose of lignocaine 1% with adrenaline is: 1.2 mls 2.4 mls 3.10 mls 4.20 mls

5. What is this forearm lesion? 1.I don’t know 2.Ulcerating BCC 3.Ulcerating SCC 4.Amelanotic melanoma 5.Chronic ulcer 6.Pyogenic granuloma What do I do when I see this?

6. What is this on an 80 yr old’s medial calf? 1.I don’t know 2.SCC 3.BCC 4.Amelanotic melanoma 5.sarcoma 6.What do I do when I see this? If it is pink and you do not know what it is biopsy/refer/remove urgently. Pink/red tumours are some of the worst.

7. What is this? Elderly lady rapidly growing tumour left cheek. 1. I don’t know what it is. 2.BCC 3.SCC 4.Melanoma 5.Sarcoma 6. Granulation tissue What do I do when I see this?

8. What is this? Elderly man, ulcerating lesion growing on finger. 1.SCC 2.BCC 3.Melanoma 4.Sarcoma 5.Granulation tissue 6.I don’t know

9. What is this? Maori lady, ulcerating lesion on nose growing for two years? 1. I don’t know 2. BCC 3.SCC 4.Melanoma 5.Granulation tissue 6.Sarcoma Message: It’s is not safe to assume Maori do not get skin cancer.

10. What is this? On back of middle aged male. 1.I don’t know 2.BCC 3.SCC 4.Melanoma 5.Benign naevus What did the GP punch biopsy show? Message is : remove or refer, do not punch biopsy pigmented lesions.

11. What is this? Elderly man, lesion on temple. 1.BCC 2.SCC 3.Keratoacanthoma 4.Melanoma 5.Sarcoma 6.I don’t know

12. Aggressive Sarcoma

13. You have to do an excision or punch biopsy in a danger area (nerve or tendon): How do you reduce the risk of damage to the nerve or tendon?

14. Hydrodissection (5 mls saline or Local Anaesthetic)

15. Visible clinical margins for excision BCC or SCC with well defined borders: 2mm margin gives 70% clearance and 30% recurrence 3mm margin gives 85% clearance and 15% recurrence 4mm margin gives 98% clearance and 2% recurrence 5mm margin gives 1.76% recurrence

16. How to achieve complete excision Draw around lesion and then draw a 4 mm margin around thisThen draw and plan the excision

17. Rhomboid skin flap

18. A-T flap

19. What are these? What is this lesion on the side of the nose? 1.BCC 2.SCC 3.Melanoma 4.Solar keratosis 5.Impetigo 6.I don’t know

20. Please refer early