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Tag: Lesions
Skin cancer nurses play a vital role in the management and education of their patients, and advanced nursing has been found to correlate with high patient satisfaction (Wong and Chung 2006). Many skin cancer nurses also assess skin lesions at follow-up visits but have not progressed to a primary screening role. A study tested whether a skin cancer nurse’s understanding and powers of discrimination would make it safe for her to screen out patients whose lesions were definitely benign. Continue reading “[8 min read] The role of skin cancer nurses in screening patients”
This week we have an interesting case from Dr Tracey Zeelie. We don’t have a history or clinical picture.
What is your opinion on this dermoscopy image? If you would biopsy, what technique would you use?
Continue reading “Case discussion: How would you treat this patient? [27 May]”
This week we have an interesting case from Dr Renuka Ranasinghe. An elderly male presented for a skin check for benign seb k’s noticed by his wife.
The below shown pigmented lesion was noted – what do you make of the clinical and dermoscopic pictures? How would you biopsy this lesion?
Continue reading “Case discussion: How would you treat this patient? [20 May]”
Can dermoscopy aid in the differentiation of subungual melanoma in situ from benign longitudinal melanonychia? A recent study investigated the characteristic dermoscopic findings of subungual melanoma in situ to establish a predictive scoring model for the diagnosis of the disease in patients with adult-onset longitudinal melanonychia affecting a single digit. Continue reading “[5 min read] Predictive scoring model for subungual melanoma in situ”
A study conducted in 2004 assessed the rate of skin cancer in a cohort of paediatric organ transplant recipients. Five to 16 years post-transplantation, none of the participants had developed skin cancer. Researchers have now re-evaluated the same cohort 10 years later to determine the prevalence of pre-malignant and malignant skin lesions and to identify the known risk factors associated with melanocytic naevi in a paediatric organ transplant population in the UK.
All 98 paediatric organ transplant recipients from the original 2004 study were invited to participate in the longitudinal follow-up study. History of sun exposure, demographics and transplantation details were collected using face‐to‐face interviews, questionnaires and case note reviews. Skin examination was performed for regional count of malignant lesions, benign and atypical naevi.
Of the 98 patients involved in the initial study, eight kidney and 37 liver transplant recipients, with an average follow‐up of 19 years, agreed to participate. Neither skin cancer nor pre-malignant lesions were detected in any of these patients.
Although skin cancer was not observed in the cohort in 2004 or 2014, researchers identified a significant increase in the number of benign naevi, particularly in those reporting frequent sunburn and sunscreen use. When compared with the 2004 cohort, 41 patients in the current cohort had increased numbers of benign naevi, with 11 patients having more than 50 benign naevi. Seventy‐one per cent of benign naevi in the 2014 cohort occurred on sun‐exposed sites (13% head/neck, 35% arms and 23% legs). Patients who regularly used sunscreen had more benign naevi on their arms.
This result is encouraging in not finding an increased risk of skin cancer after a follow-up period of 15–26 years post-transplantation. This may reflect increased sun protection, although in the last 10 years of this 20-year study, patients were using sunbeds, taking sunny holidays and experiencing sunburn more often, despite the earlier sun protection advice. This may reflect that these patients have reached their teenage and early adult years when much advice is ignored. If these high-risk factors continue, then increased skin cancers may be expected if the study continues for another 10 years.
Better ways of providing the sun protection message are needed. As the number of moles correlates with the risk of melanoma, paediatric organ transplant recipients still need regular skin checks and sun protection advice.
Source: Foo, S. , Nightingale, P. , Gazzani, P. , Bader, E. , Ogboli, M. , Martin‐Clavijo, A. , Milford, D. , Kelly, D. , Moss, C. and Thomson, M. (2018), A 10‐year longitudinal follow‐up study of a U.K. paediatric transplant population to assess for skin cancer. Br J Dermatol, 179: 1368-1375. doi:10.1111/bjd.16697
Interested in skin cancer medicine?
The HealthCert Professional Diploma programs offer foundation to advanced training in skin cancer medicine, skin cancer surgery or dermoscopy and provide an essential step towards subspecialisation. All programs are university quality-assured, CPD-accredited and count towards multiple Master degree pathways and clinical attachment programs in Australia and overseas. The programs are delivered online and/or face-to-face across most major cities of Australia.
Courses in Skin Cancer Medicine:
Melbourne | Adelaide | Gold Coast | Brisbane | Perth | Sydney | OnlineCourses in Skin Cancer Surgery:
Melbourne | Adelaide | Gold Coast | Brisbane | Perth | SydneyOnline courses in Dermoscopy:
Trimester 1: Jan | Trimester 2: May | Trimester 3: Sep
This month, I share a useful review article on the often vexed topic of dysplastic naevi. The article summarises new understandings about the genetic makeup of benign and dysplastic naevi, as well as melanoma.
The summary by Ardakani is well worth reading for everyone, and if you want to explore issues around dysplastic naevi more, read the whole article.
In short, what Ardakani shows is that there does seem to be a subset of dysplastic naevi that has a distinct genetic makeup that is different from other dysplastic naevi. However, it is not clear what the genetic changes mean in a biological or clinical way.
So, while our understanding of the detailed biology of naevi continues to grow, we (as GPs) can continue to manage dysplastic naevi as we do now.
That is, any suspicious pigmented skin lesion should be biopsied by excision biopsy (2mm margins). If the pathology report is of mild or moderate dysplasia, no further treatment is needed. If the report is of severe dysplasia, the lesion should be treated as melanoma in situ, and a re-excision with 5mm margins done.
Professor David Wilkinson
Read more from Professor David Wilkinson on recent research:
- What to do when a partial biopsy of a suspected melanoma is performed
- Artificial Intelligence in clinical practice
- Prof David Wilkinson on melanoma guidelines: Dermoscopy
- How will artificial intelligence benefit GPs in skin cancer medicine?
- The problem of dysplastic naevi
Interested in skin cancer medicine?
The HealthCert Professional Diploma programs offer foundation to advanced training in skin cancer medicine, skin cancer surgery or dermoscopy and provide an essential step towards subspecialisation. All programs are university quality-assured, CPD-accredited and count towards multiple Master degree pathways and clinical attachment programs in Australia and overseas. The programs are delivered online and/or face-to-face across most major cities of Australia.
Courses in Skin Cancer Medicine:
Melbourne | Adelaide | Gold Coast | Brisbane | Perth | Sydney | OnlineCourses in Skin Cancer Surgery:
Melbourne | Adelaide | Gold Coast | Brisbane | Perth | SydneyOnline courses in Dermoscopy:
Trimester 1: Jan | Trimester 2: May | Trimester 3: Sep
This week we have an interesting case from Dr Risto Cvetkovic. Have a look at the clinical and dermoscopy images.
What is your differential and what would you do next? What approach do you take here? Biopsy? If so, how?
Continue reading “Case discussion: How would you treat this patient? [8 April]”
In this month’s skin cancer update video, Professor Giuseppe Argenziano continues his discussion from last month about atypical melanocytic lesions: lesions that are histopathologically in between a melanoma and a naevus, with subtle melanoma criteria that are not enough for the pathologist to diagnose the lesion as a melanoma. Continue reading “[9 min watch] Skin Cancer Update with Prof Giuseppe Argenziano [April 2019]”
This week we have an engaging case from Dr David Stewart. There is no history, but that is often our reality.
What do you make of the clinical and dermoscopy pictures here? What approach do you take here? Biopsy? If so, how?
Continue reading “Case discussion: How would you treat this patient? [1 April]”
This month, we consider what to do when a partial biopsy of a suspected melanoma is performed.
The general advice is that if a punch or shave (partial) biopsy has been done, then an excision biopsy should be done before a formal wide-local excision. This is so that complete staging (of Breslow thickness) can be assured before the excision is done. Continue reading “[3 min read] What to do when a partial biopsy of a suspected melanoma is performed”
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