Who you are:
You are an FY2 doctor.Who the patient is:
Nina Callahan, a 70-year-old female, with some concerns regarding a skin lesion has booked a phone consultation today.Additional information:
She has emailed you a picture of her lesion.What u are supposed to do:
Talk to her and address her concerns and discuss a plan of management.
Dr: Hello, how can I help you?
Pt: I noticed a lesion on my chest P1
Dr: Tell me more about it. OPEN Q
Pt: Well, I just want to get it checked out.
Dr: When did you notice it? Duration
Pt: 2 months ago.
Dr: Can you describe its Shape, Size, Color?
Pt: Reddish in colour, coin shaped, appears to be stuck on my skin. (Warty-looking lesion in sun exposed areas)
Dr: Has it changed in shape, size or colour?
Pt: It has increased in size.
Dr: Has the lesion appeared anywhere else?
Pt: No.
Dr: Does anything make it better?
Pt: No.
Dr: Does anything make it worse?
Pt: No.
Dr: Any discharge?
Pt: No.
Dr: Any Pain/ itchiness?
Pt: No.
Dr: Any bleeding?
Pt: No.
Dr: Any other symptoms?
Dr: Do you go out in in the sun a lot? Sun Exposure is very important
Pt: No, I don’t
Dr: Any tanning beds?
Pt: No.
FLAWS
Dr: Any fever?
Pt: No.
Dr: Any recent weight loss?
Pt: No.
Dr: Any lumps or bumps?
Pt: No.
Dr: Loss of appetite?
Pt: No.
P2+ MAFTOSA
Dr: Have you been diagnosed with any medical condition in the past?
Pt: No.
Dr: Any DM, HTN, heart disease or high cholesterol?
Pt: No.
Dr: Are you taking any medications including OTC or supplements?
Pt: No.
Dr: Any allergies from any food or medications?
Pt: No.
Dr: Any previous hospital stays or surgeries?
Pt: No.
Dr: Has anyone in your family been diagnosed with any medical condition?
Pt: My mother had skin cancer.
Dr: How is she now?
P: She passed away a few years ago.
D: Sorry about that please accept my condolences.
DESAS
D: Do you smoke?
Pt: Yes/No
Dr: Do you drink alcohol?
Pt: Yes/No
Dr: Tell me about your diet?
Pt: I try to eat healthy.
Dr: Do you do physical exercise?
Pt: I don’t have much time.
Dr: What you do for living?
Pt: I am retired.
Dr: With whom do you live?
Pt: My husband.
Dr: Do you have any kind of stress?
Pt: No.
Examination
If you could come in I would like to check your vitals, i.e., your BP, pulse, temperature and respiratory rate. I would also like to examine your breasts for lesions (Picture is in the cubicle)
ALWAYS ASK ABOUT ICE IDEAS/CONCERNS AND EXPECTATIONS
CONCERNS:
IS IT CANCER? NO, BUT IT RARELY MAY BECOME SOMETHING MORE SINISTER SO EDUCATE ABOUT THE
RED FLAGS.
Management
Diagnosis:
From what you have told me & the picture you have emailed me, it appears that you have a skin lesion called seborrheic keratosis. They are harmless growths on the skin and can vary in colour from skin colour to almost black.
I would like for you to come visit the GP clinic for an examination of the lesion with a special tool called a dermatoscope. If needed, we can refer you to the hospital for the biopsy.
Senior
Investigations
- Examine it with dermoscopy which is a tool to give more details about the lesion.
Treatment:
Seborrheic warts do not require treatment, as they are usually harmless, but you may want them to be removed for cosmetic reasons or if they become large, irritated, itch, or bleed easily (get stuck in clothes or jewelry), once removed they usually do not
return.
- Scraping the wart away under local anaesthetic (where the skin is made numb) or by freezing it with liquid nitrogen.
- Cryosurgery: Liquid nitrogen, a very cold liquid gas, is applied to the growth the lesion usually falls off within a few weeks. Occasionally, there will be a small dark or light spot that usually fades over time.
- Curettage
- Electrosurgery
Lifestyle Advice:
it’s important to avoid any further sun damage. This will stop you getting more skin patches and will lower your chance of getting skin cancer.
- use sunscreen with a sun protection factor (30 SPF or more)
- wear a hat and clothing that fully covers your legs and arms when you’re out in the sunlight
Don’t
− Use sunlamps or sunbeds.
− Do not go into the sun between 11am and 3pm – this is when the sun is at its strongest.
Skin specialist so that he can also assess you.
Safety netting
If you do notice a change in a seborrhoeic wart, it is worth asking your doctor to examine it.
− ABCDE
− Grows rapidly
− Bleeds or scabs
− Red or irritable
Follow up:
In a month. In the meantime if you feel that your lesion is growing, changing its color, any bleeding from it or any weight loss, please let us know. Thank you.
REFERENCE INFORMATION:
Seborrhoeic keratoses are often confused with warts or moles, but they are quite different. Seborrhoeic keratoses are non-cancerous growths of the outer layer of skin. They occur as a single lesion or clusters. They are usually brown, waxy with a stuck-on appearance. More common in elderly with frequent sun exposure.
5 POINTS RECAP:
- SUN EXPOSURE
- TYPICAL DISC SHAPE LESION WAXY BROWN
- ALL RED FLAGS NEGATIVE
- NO NEED FOR TREATMENT UNLESS INTERFERES WITH LIFESTYLE MOOD
- SAFETY NET
