Skin Cancer A Personal Approach. Dr Matthew Strack Dunedin New Zealand
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1 Skin Cancer A Personal Approach Dr Matthew Strack Dunedin New Zealand
2 Outline Dermoscopy Instruments and setup Photochemosurgery Clinical Aim: Leave with 2-3 ideas
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5 JLE
6 Benign Junctional Nevus
7 Management Resect Reassure Refer Rebook
8 My struggle with Dermoscopy The Scream Edvard Munch 1895
9 Terms Dermatoscopy Epiluminescent Microscopy Skin Surface Microscopy Dermoscopy
10 Dermoscopy - Brilliant for: Small Angiomas Seborrhoeic Keratosies
11 Dermatologists: In total, 4691 lesions were examined. The overall mean NNT was 6.3, with a range of for each of nine consultant dermatologists. The mean NNT was 7.6 for female and 4.8 for male patients. Clin Exp Dermatol Jan;37(1):6-9. doi: /j x. Epub 2011 Oct 7. The number of benign moles excised for each malignant melanoma: the number needed to treat. Sidhu S, Bodger O, Williams N, Roberts DL.
12 Benign Nevus: Melanoma Excision Ratios by Time NSCS = Non Specialized Skin Clinic SCS = Specialized Skin Clinic Accuracy in melanoma detection: A 10-year multicenter survey Giuseppe Argenziano, MD et al, Journal of the American academy of Dermatology,
13 General Practice, New Zealand All excisions, semirural practice, 3 year period B Wood, NZFP, 2006;v6, n4, pp256-8
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26 jrm
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28 Melanoma in situ
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31 Dysplastic nevus
32 92y M
33 Biopsies Lower: Pigmented Keratosis Upper: BCC
34 Algorithms You see but you do not observe
35 ABCD rule Stolz method Criteria Asymmetry In perpendicular axes: contour, colours and structures Borders 8 segments: abrupt ending of pigment pattern Colours White, red, light-brown (tan), dark-brown, blue-grey, black Score X Factor = Results Differential structural components Total score Benign <4.76 Suspicious Melanoma >5.45
36 Blum's modified ABC-point list A B C D E lesion asymmetry of outer shape or differential structures inside the in at least 1 axis the abrupt cutoff of network at the border in at least one quarter of circumference 3 or more colors 3 or more differential structures noticed change (evolution) in the last 3 months
37 Menzies method Negative features (benign lesions): Symmetrical pattern (colours, structure) Single colour Positive features (melanoma): Blue-white veil Multiple brown dots Pseudopods Radial streaming Scar-like depigmentation Multiple (5-6) colours Multiple blue/grey dots Broadened network
38 Seven-point rule Three or more indicates melanoma Atypical pigment network (2) Blue-whitish veil (2) Atypical vascular pattern (2) Irregular streaks (1) Irregular dots/globules (1) Irregular blotches (1) Regression structures (1)
39 ABCD
40 Did you look twice?
41 More Cases
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55 RMS
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57 jcd
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59 HB
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61 PJM
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64 MAP
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66 Pigmented Lesion Assessment
67 Pigmented Lesion Assessment
68 The Dance of Life Aasgardstrand
69 1:5-10
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72 Lesion was benign Seborrhoeic Keratosis
73 91y M
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75 Melanoma In-Situ 0.6mm Diagnosis
76 73y M My Diagnosis: Seborrhoeic Keratosis Benign Solar Lentigo
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78 Instruments
79 Blades
80 Sutures Ask for free samples!
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82 Curettage Relies on physical differences between affected and normal tissue Diathermy - hemostasis Useful for BCC Histology will report incomplete removal
83 Lighting
84 Eyewear Try before you buy!
85 Local Anaesthetic 2.2ml cartridge 27g 22g 18g
86 Most important things: Use enough Time Reassurance
87 Photography
88 Consent Lighting System
89 Examinaton
90 Examination
91 Photochemosurgery for Basal Cell Carcinoma
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93 Photodynamic Therapy
94 d
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97 BCC, pre Photochemosurgery
98 Post Photochemosurgery
99 Basal Cell Carcinoma Commonest Skin Cancer Rarely Life Threatening Treatment ranges from easy to very challenging Many treatment options
100 Treatment Options Surgery Excison Curetage Mohs Radiotherapy Photochemosurgery (Photodynamic Therapy) Topical No Treatment rare
101 Waxy with capillaries
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104 BCC
105 BCC post Imiquimod
106 Bowen s Disease Squamous Cell Carcinoma in Situ Prognosis unclear? 10% progress to SCC Main Treatment Options: Cryotherapy Topical 5 Flourouracil Scaring may be due to lesion not treatment
107 Post 5FU
108 Cutaneous Horn?Cause Often Painful
109 What I think of:
110 What s Under a Cutaneous Horn Solar Keratosis Basal Cell Carcinoma Squamous Cell Carcinoma This Case Nonspecific Change
111 BCC
112 Subungual Pigmented Lesions
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114 Lab Write brief details of history Diagnosis Differential Diagnosis Consider ringing pathologist Consider second opinion
115 Trapdoor Problem with a Flap 94y F, result painful and not happy with appearance
116 Squamous Cell Carcionma
117 84y F Summer Winter
118 Actinic Chelitis High risk for SCC Topical treatment OK Follow up mandatory
119 94y M, confused
120 66y M, change over 2 months
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122 Wart, present 6/12
123 Wart GP x1 first seen >1y ago Nurse x2 Podiatrist x1
124 Take Home Messages #1 Have equipment you enjoy using Get chaperone consent in writing When in doubt refer but you can sometimes reassess Biopsies are your friend If you don t have loupes get some on loan Have your eyes checked
125 Take Home Messages #2 Consider Polarizing Dermoscope Printed Handouts Last Point: call me Follow up Surgery incl Sutures Cryotherapy
126
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