1. Psoriasis & Skin Cancer
Revision

2. Dermatology History PC
What’s the problem? Where is it? How long has it been there?
Hx Of PC
What did it look like to begin with? Has it changed? If so, how?
Itchy? Painful? Bleeding?
Aggravating/ relieving factors
Previous & current treatments (effective or not)
Recent contact with diseases? Stressful events? Illness? Travel?
History of sunburn, use of tanning machines
Skin type? (1-4)

3. Past medical history
History of atopy i.e. asthma, allergic rhinitis, eczema
History of skin cancer & any suspicious skin lesions
Medication & allergies
Family history
Social history
Occupation- alcohol gel, over washing of hands, gloves
Improvement of lesions when on annual leave
Smoke/Drink?
ICE

6. Examination
INSPECT
DESCRIBE
PALPATE
SYSTEMATIC CHECK

7. INSPECT
Where are the lesions & how many are there?
Is there a pattern i.e extensors affected only
DESCRIBE SCAM
Size (at the widest diameter) & Shape
Colour
Associated secondary change
Margin (border)

8. If lesion is pigmented ABCDE
Asymmetry
Irregular Border
Two or more Colours within the lesion
Diameter > 6mm
Evolution- change in size, shape over time? Started to bleed?

9. PALPATE & comment on:
Consistency
Mobility
Tenderness
Temperature
SYSTEMATIC CHECK
Examine:
Nails
Scalp
Hair
mucous membranes
Regional lymph nodes
General examination

10. Psoriasis 1 2 3 1 Describe the lesion 2 What is this? 3 What is this?

11. “Hyperproliferation of keratinocytes & inflammatory cell infiltration”
Psoriasis
Chronic inflammatory skin disease
“Hyperproliferation of keratinocytes & inflammatory cell infiltration”
Chronic plaque psoriasis most common type
Other types include:
Guttate (raindrop lesions),
Seborrhoeic (naso-labial and retro-auricular),
Flexural (body folds),
Pustular (palmar-plantar)
Erythrodermic (total body redness)

12. Which type?
Seborrhoeic
Pustular
Erythrodermic
Flexural
Guttate

13. 2% of population in UK
Complex interaction of genetic, immunological & environmental factors
Precipitating factors inc:
-Trauma
-Infection (e.g. Strep throat)
-Drugs
-Stress
-Alcohol

14. Well-demarcated, erythematous, scaly PLAQUES
Extensor surfaces of the body & over scalp
Auspitz sign (Gentle removal of scales = capillary bleeding)
50% have nail changes (e.g. pitting, onycholysis)
5-8% assc. psoriatic arthropathy:
Symmetrical polyarthritis
Asymmetrical oligomonoarthritis
Lone distal interphalangeal disease
Psoriatic spondylosis
Arthritis mutilans
Lesions itchy, burning, painful
Arthritis Mutilans: flexion deformity of distal interphalangeal joints 14

15. Management Avoid precipitating factors, emollients to reduce scales
Topical therapies (localised & mild psoriasis):
-Vitamin D analogues i.e calcitrol
-Topical corticosteroids
-Coal tar preparations inc. scalp treatments
-Dithranol
-Topical retinoids i.e Tarazotene
-Keratolytics (Urea based creams)

16. Phototherapy (extensive disease)
- Mainly UVA
-UVB can be used when UVA fails- can cause sunburn
Oral therapies (extensive, severe psoriasis & psoriasis with systemic involvement)
-Methotrexate
-Retinoids
-Ciclosporin
-Mycophenolate mofetil
-Biological agents (e.g. infliximab, etanercept, efalizumab)

17. Skin Cancer Skin Cancer Skin Cancer SCC BCC Solar Keratosis
Malignant Melanoma

18. Skin cancer can be divided into:
Non-melanoma (basal cell carcinoma & squamous cell carcinoma)
Melanoma (malignant melanoma).

19. Basal Cell Carcinoma
Slow-growing, locally invasive tumour epidermal keratinocytes- affect basal layers of skin
Malignant but rarely metastasises
Most common malignant skin tumour
Risk factors include:
-UV exposure
-History of frequent/ severe sunburn in childhood
-Skin type 1
-Increasing age
-Being male
-Immunosuppression
-Previous history of skin cancer
-Genetic predisposition

20. Nodular most common
Small, skin-coloured papule or nodule
Surface telangiectasia,
Pearly rolled edge
May have necrotic/ ulcerated centre rodent ulcer
Head & neck involvement
Management
Surgical excision
Radiotherapy - when surgery is not appropriate
Cryotherapy
Topical photodynamic therapy
Topical treatment (imiquimod cream) -small, low- risk lesions

21. Squamous Cell Carcinoma
Locally invasive malignant tumour of epidermal keratinocytes - affect squamous layer of skin.
Potential to metastasise
Causes
Risk factors include:
Excessive UV exposure
Actinic/ Solar keratoses
chronic inflammation (leg ulcers, wound scars)
Immunosuppression
Genetic predisposition

22. Keratotic (scaly, crusty), ill-defined nodule
May ulcerate
Management
Surgical excision - treatment of choice
Radiotherapy - for large, non-resectable tumours

23. The ‘ABCDE Symptoms’ rule → What are they?
Malignant Melanoma
Invasive malignant tumour of epidermal melanocytes
Potential to metastasise
Causes
Risk factors include:
Excessive UV exposure
Skin type 1
History of multiple moles/ atypical moles
Family history or previous history of melanoma
The ‘ABCDE Symptoms’ rule → What are they?
Legs in women & trunk in men

24. Name the types of melanoma
Superficial Spreading Melanoma
Nodular melanoma
Name the types of melanoma
Acral Lentiginous Melanoma
Lentigo Maligna Melanoma

25. Types:
Superficial spreading melanoma – lower limbs, young & middle-aged, intermittent high intensity UV exposure
Nodular melanoma - trunk, in young & middle-aged adults, intermittent high-intensity UV exposure
Lentigo maligna melanoma - face, elderly pop, long-term cumulative UV exposure
Acral lentiginous melanoma - palms, soles & nail beds, elderly pop, no clear relation with UV exposure

26. Management
Surgical excision
Radiotherapy
Chemotherapy for mets

27. Prognosis Recurrence based on Breslow thickness
<0.76mm thick – low risk
0.76mm-1.5mm thick – medium risk
>1.5mm thick – high risk
5-year survival rates based on TNM classification
Stage 1 (T <2mm thick, N0, M0) – 90%
Stage 2 (T>2mm thick, N0, M0) – 80%
Stage 3 (N≥1, M0) – %
Stage 4 (M ≥ 1) – 20-30%

28. Thank You For Listening
&
Good Luck