Case 16 - 68 yo with skin lesion

Question 1

Skin cancer screening

Answer 1

Annual skin cancer screening skin exam does not have sufficient evidence to be recommended

Question 2

ABCDE rule of increased suspicion for skin cancer

Answer 2

Asymmetry
Border
Color
Diameter
Enlargement

Question 3

Tinea pedis

Answer 3

Dermatophyte infection, risk factors include local friction, moisture, diabetes, immunosuppression
Diagnosis is usually clinical

Question 4

BPH sx on hx

Answer 4

Lower urinary tract symptoms that appear slowly and progress over years including

• increased frequency
• nocturia
• hesitancy
• urgency
• weak urinary stream

Question 5

Diff Dx of Skin Lesion

Answer 5

1. Skin cancer
   - Squamous cell - scaly, thick, macular area with erythematous raised base, often found on sun exposed extremities
   - Basal cell - plaque like, waxy with ulceration, common on face
   - Melanoma - growing, spreading or pigmented lesions, dark brown or black, hx of intermittent, intense sun exposure,
2. Eczema (flexor surfaces)
3. Actinic keratosis - scaly keratotic patches, more felt than seen
4. fungal infections - more acute
   Less likely: psoriasis, lichen planus, seborrheic keratosis

Question 6

Risk factors for non-melanoma skin cancer

Answer 6

• lifetime sun exposure
• white race
• fair complexion

Question 7

risk factors for melanoma skin cancer

Answer 7

• intense intermittent sun exposure (blistering)
• radiation exposure
• fam hx
• large number of benign nevi

Question 8

Studies for skin lesion

Answer 8

• incisional biopsy
• punch biopsy - best to evaluate depth of lesion
• excisional biopsy
• shave biopsy

Question 9

Evaluation of suspected BPH

Answer 9

• r/o URI, meds, prostatitis, prostate cancer
• U/A, BUN, Cr
• test maximal urinary flow rate (low = <15 mL/sec)
• post voice residual urine volume

Question 10

Management of skin cancer

Answer 10

• surgical excision - good for SCC
• MOHS surgery - cosmetically sensitive regions, or those with indistinct borders or close to important structures
• 5-FU - not approved for SCC but often used
• Cryotherapy - used for small SCC
• radiation therapy - can be used as initial therapy in older pts who are not good surgical candidates
• patient education - stay out of sun, wear sunblock, perform skin examinations

Question 11

Management of BPH

Answer 11

• behavior modifications - avoid fluids before bed, reduce alcohol and caffeine
• medical management - alpha-adrenergic antagonists, 5-alpha reductase inhibitors or combination treatment
• surgical management - if pharmacologic treatment fails,

Question 12

Treatment of tinea

Answer 12

1. tinea capitus - oral antifungal (griseofulvin)
2. Tinea unguium - Terbinafine or itraconazole
3. Tinea pedis, magnum, corporis or cruris, treat with topical antifungals “azole” or “allylamine”

Question 13

Topical corticosteroids indications

Answer 13

• for inflammation, hyperproliferation, immunologic involvement
• provides relief of pruritis or burning

Question 14

Side effects of topical corticosteroids

Answer 14

Skin atrophy, hypopigmentation, systemic side effects like HPA syppression, septic necrosis of femoral head, hyperglycemia, hypertension