Download Psoriasis and Skin Cancer

Psoriasis and Skin Cancer
Edward Pritchard
Long Cases
• You could get these!
• Last year’s finals! - Patient with recurrent
SCC, with no symptoms. History focussing on
skin exposure and social. Was asked about risk
factors, macroscopic and microscopic
appearance of different types of skin cancer
and different treatments
Skin Examination
• Scalp
Auricles
Face
Extremities (upper)
Chest (front and back)
Abdomen (front and back)
Genitalia
Extremities
• If lesions – consider local lymph nodes etc.
Psoriasis
Definition
• Relapsing and remitting chronic skin condition
characterised by scaly plaques
• Or inflammation of the dermis, with
epidermal hyperproliferation
Epidemiology
• ~2% of the population
• Peak incidence in early 20s and 50s
Precipitated by
infection, drugs (antimalarials, B-blockers,
lithium), sunlight, stress, scars, burns
Pathophysiology
Immune mediated leads to increased speed of
skin turnover (28 days to 4), causes thickening of
the epidermis.
Symptoms and Signs
Typically well demarcated red, scaly,
symmetrical, non itchy plaques
• 5 main presentations
Plaque – typically on extensor surfaces
and scalp
Guttate – small eruptions over trunk –
typically 2 weeks post B streptococcal
throat infection
Pustular – widespread sterile pustules
Flexural – affects flexural aspects
Erythrodermic – extreme form
affecting 90%+ of body – can be fatal
Management
Conservative – diet, weight loss, smoking cessation, exercise advice
Medical
Topical
•Emolients
•Vitamin D analogues
•Topical steroids (mild to moderate)
•Coal tar
•Salicylic acid
Phototherapy
•UVB
•PUVA ( Psoralen + UVA)
Systemic
•Immunosuppresent – Methotrexate, ciclosporin
•Biologics – Infliximab, Adalimumab
Surgical – no real role
Skin Cancer
Aetiology/Risk Factors
• Squamous cell – UV light exposure (sunbathing), fair
skin, radiation exposure, carcinogens, metastasise
quickly
• Basal Cell – UV light exposure, radiation exposure,
arsenic exposure, “never” metastasise – local tissue
destruction
• Malignant melanoma – UV light exposure,
metastasise rapidly
Symptoms and signs
• Squamous cell – rapidly enlarging lesion, ill
defined (variable), pink colouration, may have
ulceration, scaling, bleeding or weep
• Basal cell – slow growing lesion, well demarcated
papule, raised rolled pearly edges with central
depression
• Malignant melanoma – a new or changing mole.
Squamous Cell Carcinoma
• ~20% of cutaneous malignancies
• ~70% on head or neck
• Premalignant conditions (Bowen’s disease, actinic
Keratosis)
• 95% cure rate with excision if localised disease.
But metastasises rapidly to lymph with poor
outcome
Basal Cell Carcinoma
Malignant Melanoma
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•
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Asymmetrical
Border irregularity
Colour variation
Diameter >6mm
Evolution
Investigations
Biopsy/Excisional biopsy (Breslow depth, Clark
level – for melanoma)
Stage – CT/PET
Tx + Prognosis
Management
•
Conservative – reduce risk factors, smoking cessation
•
Medical – if for chemotherapy
•
Surgical – excision biopsy +/- lymph node resections
Prognosis
•
Basal cell – very good, fatality rare
•
Squamous cell – poor
•
Malignant melanoma – poorer (often metastasised at
presentation)
Questions
• Thanks