Return to Scenario ListShow Learning Points most relevant to Phase 1:

Skin tumours

Clinical Discipline(s)/Organ System(s)
Dermatology, General Surgery, Plastic Surgery, Anatomical Pathology, General Practice, Oncology
Progress Test Topic(s)
A 78 year old NZ European woman presents to her GP with a few months' history of a lesion on her nose. She believes it has slowly been growing since it was first noticeable. It has bled once or twice. As a lifelong keen gardener, she has always enjoyed an outdoor lifestyle.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3 | Question 4
Applied Science for Medicine 
   - Biology of skin cancer including photo-carcinogenesis and repair of ultraviolet (UV) damage
   - Histopathology of melanoma, basal cell carcinoma and squamous cell carcinoma
   - Describe Breslow depth and the implication for prognosis of melanoma
   - Recognise the different types of melanoma
Clinical and Communication Skills 
   - History from a patient with a skin lesion
   - Examine and describe a lesion with use of appropriate dermatological terminology
   - Recognise features of the history and examination that alert the clinician to the need for investigation and intervention
   - Recognise the importance of performing a
full skin examination, particularly in a high-risk individual, to detect asymptomatic lesions

   - Discuss the differential diagnoses of non-pigmented and pigmented skin lesions
   - Describe the technique of dermoscopy
   - Discuss indications for skin biopsy including excision biopsy and describe how to perform a skin (punch) biopsy
   - Briefly discuss the role of and limitations of cryotherapy, fluorouracil, imiquimod, curettage and electrodessication in the management of superficial non-melanoma skin cancers
   - Describe the surgical management of melanoma and non-melanoma skin cancer
   - Patient education in photo-protection, discuss avoidance of sun exposure particularly at times of high UV radiation, use of physical barriers, use and choice of sunscreen
Personal and Professional Skills 
   - The appropriate management of uncertain diagnoses
Hauora Māori 
   - Awareness of differing risk profiles for skin cancer between Māori compared with non-Māori in New Zealand
   - Culturally safe engagement with this patient, whānau and communities
Population Health 
   - Prevention campaigns: sun safety information
   - Epidemiology of skin cancers
   - Legislation around sun beds
Conditions to be considered relating to this scenario
seborrhoeic keratosis, ephelis, naevus, actinic keratosis, carcinoma in situ, melanoma, basal cell carcinoma, squamous cell carcinoma
Less common but 'important not to miss'
Merkel cell carcinoma