32 HOW TO TREAT : PRACTICAL PROCEDURES IN DERMATOLOGY
32 HOW TO TREAT : PRACTICAL PROCEDURES IN DERMATOLOGY
11 OCTOBER 2024 ausdoc . com . au
A
Figure 8A . Biopsyproven Bowen ’ s disease of the left lateral eyebrow , pre-treatment .
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Figure 7 . Plantar wart .
Figure 8B . Two Bowen ’ s disease lesions on the same patient , after six weeks of treatment with 5-fluorouracil cream .
Bowen ’ s disease for both lesions .
The GP explains the condition to Peter and he is reassured that the risk of progression to invasive SCC is only 3-5 %. They discuss the different treatment options ( surgical excision ,
1 . Which ONE is the greatest risk factor for the development of BCC ? a Advanced age . b Chronic sun exposure . c A personal or family history of skin cancer . d Fair skin ( Fitzpatrick types
I and II ).
2 . Which THREE are differential diagnoses for a non-ulcerated BCC ? a Molluscum contagiosum . b Squamous cell carcinoma . c Amelanotic melanoma . d Sebaceous hyperplasia .
3 . Which TWO statements regarding the treatment of BCC are correct ? a Mohs micrographic surgery remains the favoured and most common treatment for BCC . b The appropriate treatment for a BCC necessitates a tailored approach . c Photodynamic and topical therapies result in local inflammatory effect . d The recurrence rates for radiotherapy and surgery are similar .
4 . Which THREE statements regarding the treatment of BCC are correct ? a Topical therapies may be topical treatments [ imiquimod , 5-fluorouracil ], cryotherapy , photodynamic therapy and C & C ), including the risks , benefits , complications and approximate recurrence of each treatment modality . Given the cosmetically
How to Treat Quiz .
appropriate for superficial BCC greater than 2cm in diameter . b Mohs micrographic surgery is best suited to morphoeic , infiltrating and recurrent BCC , those with clinically ill-defined borders , and lesions in highrisk areas of the face . c Surgical excision usually involves elliptical removal of the lesion and repair of the defect by primary closure . d Educate patients on the importance of sun protection and regular full skin examinations .
5 . Which THREE statements regarding Bowen ’ s disease are correct ? a HPV infection , particularly types 16 and 18 , has been implicated in the development of Bowen ’ s disease . b The condition typically presents as well-demarcated , erythematous , scaly patches or plaques , most commonly on sun-exposed areas of the head , neck and extremities . sensitive area , Peter elects for topical treatment with 5-fluorouracil cream .
The GP prescribes 5-fluorouracil cream twice daily for six weeks and counsels Peter on the application and expected side effects , including
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c Lesions are usually symptomatic , with patients seeking treatment early . d Histopathological examination is the gold standard for confirmation of diagnosis .
6 . Which ONE is not dermoscopy findings suggestive of Bowen ’ s disease ? a White scales . b Multiple brown dots . c A red , scaly plaque with irregular pigment network . d Coiled glomerular vessels .
7 . Which THREE statements regarding the treatment of Bowen ’ s disease are correct ? a Curettage and cautery is the favoured option for solitary Bowen ’ s disease lesions on accessible areas of the body . b Cryotherapy has a relatively high recurrence rate . c Topical formulations containing a keratolytic agent can provide symptomatic relief . d All lesions require treatment because of the potential for malignant transformation .
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PRACTICAL PROCEDURES IN DERMATOLOGY
irritation , burning , redness , flaking and mild scabbing to the area . The GP also explains that 5-fluorouracil can make Peter more sensitive to sunlight and advises Peter to wear a wide-brimmed hat to reduce the
8 . Which THREE are features of the common wart ? a Smooth , flat-topped and typically occurring in clusters . b Cauliflower-like appearance with raised , rough-surfaced growths . c Grey , brown or flesh-coloured . d Often on the hands , fingers and periungual areas .
9 . Which TWO statements regarding warts are correct ? a Warts are most commonly found on the hands , knees , feet and around the fingernails . b A plantar corn or callus has the characteristic black dots of thrombosed capillaries . c Two-thirds of warts in children will resolve spontaneously without treatment within two years . d Cutaneous warts are usually diagnosed on skin biopsy .
10 . Which THREE statements regarding the treatment of warts are correct ? a Podophyllin is contraindicated in pregnant women because off the risk of teratogenicity . b One treatment of cantharidin will clear most warts . c Curettage and cautery may leave a permanent scar . d Cantharidin is the favoured treatment . likelihood of unwanted side effects . He should avoid direct application of sunscreen to the treatment site .
On review six weeks later , after the prescribed course of 5-fluorouracil cream , Peter ’ s lesions appear erythematous with mild scabbing ( see figure 8B ). His GP is happy with this and reassures Peter that this appearance is as expected and will improve with time . The GP books a review in 12 weeks to ensure resolution after the inflammation settles and to also undertake a full skin examination . In the interim , Peter is reminded on the importance of sun protection .
CONCLUSION
GPs are at the forefront of diagnosing and managing skin lesions , including BCC , Bowen ’ s disease and cutaneous warts . Many treatment options exist for these lesions , and success begins with selecting , together with the patient , the most appropriate option .
Mastering practical dermatological therapies takes practice and experience , and is essential for providing optimal care and achieving successful patient outcomes .
RESOURCES
• Australasian College of Dermatologists , A-Z of Skin : ‘ Skin cancer – an overview ’ bit . ly / 3zgh67h
• Cancer Council Australia , ‘ Clinical practice guidelines for keratinocyte cancer ’ bit . ly / 45Flfxu
• DermNet NZ , ‘ Histological clearance and recurrence of keratinocyte cancers ’ bit . ly / 3xAoU3e
• Truong K , et al . Destructive therapies for cutaneous warts : a review of the evidence . Australian Journal of General Practice 2022 ; 51:10 bit . ly / 3VYd0JF
References Available on request from howtotreat @ adg . com . au