1. Dermatology: Skin cancer & Psoriasis S.L.I.M.E. Workshop Dr Rochelle Velho Academic Foundation Year 1

2. S.L.I.M.E. Workshop Quiz Skin Cancer Psoriaris Dermatology OSCE

3. Derm. OSCE History

4. Derm. OSCE O/E Site, distribution INSPECT S.C.A.M Size, Shape, Colour, Assym., Morphology, Margin DESCRIBE Surface, consistence, mobility, Tenderness, temp. PALPATE r/v Hair, nails, scalp, joints SYSTEMATIC CHECK

5. Psoriasis

6. Definition: Hyperproliferation keratinocytes and inflammatory cell infiltration Course: Relapsing, remitting, Non- infectious Epidemiology: 2% population Cause: complex Mx Aim: control not cure

7. Types Plaque (most common) GuttateSeborrhoeic FlexuralPustularErythrodermic

8. Hx Scaly plaques ‘Itchy & burning’ Extensor > Flexor common Scratch  bleed (Auspitz sign) 50% - nail changes 5-8% psoriatic arthropathy

9. O/E Site, distribution LOCAL, EXTENSOR, L ARM INSPECT EXTENSOR, ELBOW, PLAQUE, PINK/WHITE, ASSYM, ERYTHEMA, ILL DEFINED MARGIN DESCRIBE PALPABLE, SCALY, IMMOBILE, +/- TENDERNESS, +/- WARM AUSPITZ +ve PALPATE Hair, nails, scalp, joints SYSTEMATIC CHECK

11. Management General measures -avoid precipitating factors Topical - Vitamin D analogues -Corticosteroid -Tar Photo- chemo therapy -Psoralen and UVA Oral – Methotrexate, Ciclosporin

12. Skin Cancer 1) Non melanoma - Basal Cell Carcinoma (BCC) - Squamous Cell Carcinoma (SCC) 2) Melanoma

13. 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

14. Non-melanoma vs Melanoma Melanoma BCCSCC

15. Basal Cell Carcinoma 90% face INSPECT Pearly, Telangectasia, Raised, Rolled (not everted) Edges, ulcers, scabs DESCRIBE Ulcer/rolled edges PALPATE Rodents – destroy face RARELY METS SYSTEMATIC CHECK

16. Squamous Cell Carcinoma Various sites Slow growth INSPECT Irregular ulcer/ slowly growing nodule Raised, everted edges Central scab, Keratin formation DESCRIBE Irregular Raised edge – everted PALPATE Low risk mets, unless lip/ear SYSTEMATIC CHECK

17. 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

18. Melanoma - Distribution Men - trunk (especially the back) Women legs http://info.cancerresearchuk.org/cancerstats/types/skin/incidence/}

19. Asymmetry Border – irregular Colour – non uniform Diameter > 7mm Elevation O/E - Appearance

20. Melanoma - Prognosis Breslow Depth - primary tumour

21. 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

23. Quiz

25. Psoriasis - plaque Erythematous plaques with silvery scale over both knees Plaques are areas of palpable skin change over.5 cm in diameter

27. 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

29. 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

31. Kobner Psoriasis develops at sites of skin trauma (surgery in this example) Koebner’s phenomenon is seen in psoriasis (not pathognomic though)

33. 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)

34. Summary Quiz Skin Cancer Psoriaris Dermatology OSCE

35. Revision - BAD handbook

36. Skin cancer references 1.http://info.cancerresearchuk.org/cancerstats/types/skin/incidencehttp://info.cancerresearchuk.org/cancerstats/types/skin/incidence 2.Lecture Notes: General Surgery. Harold Ellis 3.Medicine at a Glance. Patrick Davey 4.http://info.cancerresearchuk.org/cancerstats/incidence/commoncancer s/#Non-melanomahttp://info.cancerresearchuk.org/cancerstats/incidence/commoncancer s/#Non-melanoma http://www.aafp.org/afp/20000715/357.html Oxford Handbook of Clinical Medicine

37. Thank you for listening. Any questions?