Psoriasis & Skin Cancer

Psoriasis & Skin Cancer

Revision

Dermatology HistoryPC

What’s the problem? Where is it? How long has it been there?

Hx Of PCWhat did it look like to begin with? Has it changed? If so, how?Itchy? Painful? Bleeding?Aggravating/ relieving factorsPrevious & current treatments (effective or not)Recent contact with diseases? Stressful events? Illness? Travel?History of sunburn, use of tanning machinesSkin type? (1-4)

Past medical history History of atopy i.e. asthma, allergic rhinitis, eczemaHistory 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 leaveSmoke/Drink?

ICE

Examination

• INSPECT

• DESCRIBE

• PALPATE

• SYSTEMATIC CHECK

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)

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?

• PALPATE & comment on:– Consistency– Mobility– Tenderness– Temperature

• SYSTEMATIC CHECK Examine:

– Nails– Scalp– Hair– mucous membranes– Regional lymph nodes

• General examination

Psoriasis

12

31 Describe the lesion

2 What is this?

3 What is this?

2

3

PsoriasisChronic inflammatory skin disease

“Hyperproliferation of keratinocytes & inflammatory cell infiltration”

Chronic plaque psoriasis most common typeOther types include:• Guttate (raindrop lesions), • Seborrhoeic (naso-labial and retro-auricular),• Flexural (body folds), • Pustular (palmar-plantar)• Erythrodermic (total body redness)

Which type?

Seborrhoeic Pustular

Flexural Guttate

Erythrodermic

2% of population in UK

Complex interaction of genetic, immunological & environmental factors

Precipitating factors inc:-Trauma-Infection (e.g. Strep throat)-Drugs-Stress-Alcohol

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 mutilansLesions itchy, burning, painful

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)

• 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)

Skin CancerSkin CancerSkin Cancer

BCCSCC

Solar Keratosis

Malignant Melanoma

Skin cancer can be divided into:

• Non-melanoma (basal cell carcinoma & squamous cell carcinoma)

• Melanoma (malignant melanoma).

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

Basal Cell Carcinoma

Nodular most commonSmall, skin-coloured papule or noduleSurface telangiectasia,Pearly rolled edgeMay have necrotic/ ulcerated centre rodent ulcerHead & neck involvement

Management• Surgical excision• Radiotherapy - when surgery is not appropriate• Cryotherapy• Topical photodynamic therapy• Topical treatment (imiquimod cream) -small, low-

risk lesions

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

Squamous Cell Carcinoma

Keratotic (scaly, crusty), ill-defined noduleMay ulcerate

Management• Surgical excision - treatment of choice• Radiotherapy - for large, non-resectable

tumours

Malignant MelanomaInvasive malignant tumour of epidermal melanocytesPotential 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

Name the types of melanoma

Superficial Spreading Melanoma

Nodular melanoma

Lentigo Maligna Melanoma

Acral Lentiginous Melanoma

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

Management

•Surgical excision

•Radiotherapy

• Chemotherapy for mets

Prognosis

Recurrence based on Breslow thickness <0.76mm thick – low risk0.76mm-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) – 40- 50%Stage 4 (M ≥ 1) – 20-30%

Thank You For Listening&

Good Luck