10/2/19 1 Dermatology in Primary Care: Recognition and treatment of common disorders of the skin Kanade Shinkai, MD PhD Professor of Clinical Dermatology University of California, San Francisco Disclosures I have no conflicts of interest to disclose. I may discuss off-label use of treatments for cutaneous disease. A preview • Fictional patient • Series of dermatology visits • Numerous concerns • Changing mole • Red leg • Drug eruption “Spots,” skin cancers, melanoma
11
Embed
CME Shinkai Dermatology 2019 for handoutsRecognition and treatment of common disorders of the skin Kanade Shinkai, MD PhD Professor of Clinical Dermatology University of California,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
10/2/19
1
Dermatology in Primary Care:Recognition and treatment of common disorders
of the skin
Kanade Shinkai, MD PhDProfessor of Clinical Dermatology
University of California, San Francisco
Disclosures
I have no conflicts of interest to disclose.
I may discuss off-label use of treatments for cutaneous disease.
A preview
• Fictional patient
• Series of dermatology visits
• Numerous concerns• Changing mole• Red leg• Drug eruption
“Spots,” skin cancers, melanoma
10/2/19
2
Our patient presents with a changing mole
Melanoma
Melanoma
A = asymmetry
B = irregular border
C = color
D = diameter >6mm
E = evolution
complete biopsy
Melanoma: initial evaluation
• Prognosis is DEPENDENT on the depth of lesion (Breslow�s depth)– < 1mm thickness is low risk– > 1mm consider sentinel lymph node
biopsy
D/dx of a pigmented lesion?Seborrheic keratoses
• benign scaly papule• stuck-on tan, ovoid
papule/ plaque• +/- symptoms
Lentigo
• flat, even color• irregular borders• sun-exposed areas:
face, dorsal hands
Pigmented BCC
• pearly papule• prominent
telangiectasias• flecks of pigment
10/2/19
3
Common non-melanoma skin cancers
• pearly papule or plaque - central ulceration- telangiectasia
• slow growing
Basal cell carcinoma Squamous cell carcinoma
• scaly pink plaque, nodule• sun-damaged areas• potential for metastasis,
invasion
What is the recommended frequency of skin cancer screening in asymptomatic adults?• USPTF: 2016 update
- insufficient evidence to assess benefits, harms of visual skin exam by a clinician
JAMA 2016; 316(4):429-435Ann Int Med 2009; 150(3):188-193
- Primary care sensitivity 42-100% melanoma- Primary care specificity 70-98% melanoma
Prevention?Let’s talk about photoprotection
Ultraviolet radiation
UVA: 320-400nmPhotoaging, melanomaNot blocked by glass, clouds, ozone
UVB: 290-320nmSunburn, skin cancer, melanomaBlocked by clouds, ozone
10/2/19
4
Sunscreen and the UV spectrum
Sunscreen ban 2018: Hawaii bans oxybenzone, octinoxate