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S.L.I.M.E. Workshop

S.L.I.M.E. Workshop . Dermatology: Skin cancer & Psoriasis. Dr Rochelle Velho Academic Foundation Year 1. S.L.I.M.E. Workshop. Derm . OSCE. History. Derm . OSCE. O/E. Psoriasis. Psoriasis . Definition: Hyperproliferation keratinocytes and inflammatory cell infiltration

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S.L.I.M.E. Workshop

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

  2. S.L.I.M.E. Workshop

  3. Derm. • OSCE • History

  4. Derm. • OSCE • O/E

  5. Psoriasis

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

  7. Types

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

  9. O/E

  10. Management

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

  12. Epidiemiology

  13. Non-melanoma vs Melanoma

  14. Basal Cell Carcinoma

  15. Squamous Cell Carcinoma

  16. 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

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

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

  19. Melanoma - Prognosis • Breslow Depth - primary tumour

  20. 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

  21. Quiz

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

  23. 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

  24. 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 distalinterphalangeal joints can also be seen

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

  26. 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)

  27. Summary

  28. Revision - BAD handbook

  29. Skin cancer references • http://info.cancerresearchuk.org/cancerstats/types/skin/incidence • Lecture Notes: General Surgery. Harold Ellis • Medicine at a Glance. Patrick Davey • http://info.cancerresearchuk.org/cancerstats/incidence/commoncancers/#Non-melanoma • http://www.aafp.org/afp/20000715/357.html • Oxford Handbook of Clinical Medicine

  30. Thank you for listening. Any questions?

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