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Download Top Dermatological Tips on diagnosing skin lesions for busy GPs!
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Top Dermatological Tips on diagnosing skin lesions for busy GPs! Louise Moss GP Moss Valley Medical Practice, Eckington 20th September 2012 Aim for today To consolidate on what has previously been learn’t and feel more confident about how to diagnose and treat some common skin lesions within general practice. To feel confident in using 5FU To know when to refer Objectives • To review the AK pathway- to find out who is using it and whether there are any questions or further learning needs. • To go through the common skin lesions we see in GP and give some diagnostic & management tips to help us to refer appropriately • To talk a little about dermoscopy • To have some fun with a referral QUIZ! Top tips for lesion recognition • Take a good history- sun exposure, pmh/fh • Have a careful look with good light & magnification • Touch and feel- stretch the skin, if there’s a crust what’s beneath? • Look elsewhere for other examples • Is there a pattern? • Have a good atlas! Make sure you look properly...... If there’s a crust take it off.......... What’s that? DESCRIBING SKIN LESIONS Site and size- record measurement Colour Surface or Texture Type of lesion Border/shape Attachment to other structures Single or multiple/ arrangement of lesions IF YOU LOOK CAREFULLY YOU WILL BE ABLE TO DIAGNOSE WITH MORE CONFIDENCE! Macule < 1cm Patch >1cm Plaque Papule <1 cm Nodule >1cm So what do we refer? • All sorts of things! • More lesions than rashes • 80% included :• probable skin cancer • benign naevi • seborrhoeic keratoses • actinic keratoses most can be managed in primary care 2009 GPwSI dermatology data 60% were lesions Lesion 40% Rashes 60% Congenital lesion foot Pilomatrixoma Haematoma 15 Inflammatory lesion 20 Pyogenic granuloma Sebaceous cyst Keloid Dermatofibroma CDNH Bowens Solar lentigo Haemangioma Viral wart Actinic Keratosis Seborrheic wart Benign Naevus ? Skin CA for surgery Frequency of lesions 40 35 100% 30 80% 25 60% Frequency Cumulative frequency % 0 40% 10 20% 5 0% Actinic keratoses • • • • • • COMMON! Sun Exposed sites Like stuck on cornflakes- no induration Can remit spontaneously Risk of skin cancer increased Give sun and lesion advice Actinic Keratosis Pathway North Derbyshire CCG Actinic Keratosis Pathway Version date Version number Status Owner Review date 2 February 2012 1.0 Final Dr Louise Moss February 2013 Document history Version 0.1 1.0 Date 20 Jan 12 2 Feb 12 Details Draft version produced for review by the group Final version issued to the CCG practices Solar (Actinic) Keratoses ALWAYS EXCISE (or refer) IF THICK, INDURATED OR TENDER LESIONS. • Be careful of causing a leg ulcer by excessive cryotherapy or Efudix on the lower leg • CUTANEOUS HORNS are better excised or curretted off with a good chunk of base • Refer immunosupressed patients Cutaneous horn • Can arise from AK, keratoacanthoma,viral wart or SCC • Need excising to get histology • If no induration –could be curretted off with a good scoop of base for histology A spectrum of sun damage? A few superficial “thin” AKs Many small but visible AKs, which may be palpated Multiple “thicker” AKs many of which are quite hyperkeratotic Bowens disease Bowen’s disease • Full thickness dysplasia • 2-5% chance of developing SCC • Common lower legs/ hands/ face • Slow growing sharply demarcated scaly plaque Pink scaly plaques can be hard to diagnose! Treatment of Bowen’s • Confirm diagnosis with biopsy –may not be necessary if patients have had a previous patch • Treat efudix, currettage/ cautery • Follow up to check lesion has resolved Remember if treating lower leg you can cause a leg ulcer Squamous cell carcinoma • • • • • • Rapidly growing Tender Indurated base On sundamaged skin ? Immunosupression ? Worked in tropics Basal cell carcinoma What to look for.......... • • • • • Shine Superficial telangectasia Rolled edge Spots of pigmentation Ulceration • A history of slow growth & bleeding on sun-damaged skin Stretch the skin and look from the side............. • YOU NEED TO TOUCH! Benign naevi? Benign skin lesions Let’s get better at these…. Seborrheic warts Dermoscopic appearance seborrhoeic keratosis Thin seborrhoeic keratosis Viral warts-use wart paint........ DON’T FORGET…….. • • • • • Good Light Good magnification Look it up in an atlas Think about taking a photo & reviewing Think about a trial of betnovate if the differential includes eczema, psoriasis and reviewing.
