Disease Mole Melanoma Basal Cell CA Squamous Cell Seborrheic Syphilis

(Harmless lesion of (Cancerous Pigmented (Cancerous non- (Cancerous non-

Lesions pigmented lesion of skin) pigmented lesion of skin) Keratosis (harmless (STI)
skin) lesion of skin) growth of skin)
Presentation 30y/F 55Y/M 55y/M 62t/M 60y/F Penile ulcer
Mole on Left -Right shoulder/ Head lesion for -Lesion on the Lesion on breast
shoulder for 8M -Lesion behind ear 6M Head for 6M Stony/stock-on
from 10 years (Usually above neck) (usually below neck)
appearance (like
a rock)
Presenting -No change in -Now increasing in -Wife noticed and -Now increasing -Increase in size -Single
Complaint: SSC (Size, shape, size+ shape from asked to check in size>1M and number -No Pain,
color) last 6 Months -Hx of same lesion -Reddish + -NO PID Bleeding/
-NO PID -Irregular margin (froze my head)-3y bleeding on -No breast discharge.
-Blackish lesion+ ago touch symptoms Neurological
-Wants to Different shade of -Small/shiny pink/ +Yellowish -FLAWS negative
remove because black in lesion history must
pearly white lump discharge
of coming -Itchy+ tingling +- with translucent -No itching ask
marriage in 1 Y Bleeding+ no pain worry appearance

Rule out FLAWS FLAWS FLAWS FLAWS FLAWS Neurological

+-Psychosocial impact syphilis
Risk Factor Nil -Sun exposure Sun exposure Sun exposure Sun exposure Sexual history
/Sun bathing hx Profession Profession Profession of multiple
-Profession Fair skin Aging Family history (*) partners
( Gardener) Aging Of Skin CA
Low immunity (Melanoma)
Examination Examination of -Obs -Obs -Obs -Obs -Obs
-Lesion -Lesion -Lesion -Lesion
lesion -Lesion
-Lumps and bumps -Lumps and bumps -Lumps and bumps -Lumps and bumps
-Neurological

Investigation Nil CBC, ESR/CRP, CXR Nil Nil Routine

Management 1.Treatment not 1.Urgernt (2W) 1.Lesion on 1.Urgent 2W 1.Reaasurance 1.Refer to
covered by NHS referral to face/nose: referral (Accumulation of GUM clinic
for cosmetic Urgent 2W referral Dermatologist: dead cells/tissue
dermatology. 1.Furtehr
reason Otherwise: 1. Further assess. +Unlikely to be
(Dermatologist will
cancerous)
reassessment
2. Tx Options Routine referral 2.Tissue sample
1. Further assess. 2.Swab test for
1.Surgical removal (slow growing) to confirm dx and 2.If Family Hx (+)
2.Tissue sample to other STI+UTIs
Dermatologist: look for spread Urgent referral to
under LA (shortest time confirm dx and look 3.Treatment
but big scar) (1 session) 1. Further assess. 3.Treatment: dermatologist but
for spread (Single dose of
(Scab/Bleeding/infection) 2.Tissue sample to Surgical/chemo/ not on cancer
3.Treatment:
2. Laser (intense light confirm dx and look radio. pathway. IM Benzyl
radiation)2-3 sessions Surgical/Freezing/bi
for spread 1. Further assess. penicillin)
3. Freezing with ological tx) 2.Tissue sample to
3. Melanoma 3.Treatment: confirm dx and look for If allergic
liquid Nitrogen (4-6 Surgical/Freezing.
support group spread (dermoscope) (doxycycline
sessions (Pain/blistering/ (Cryotherapy)
thermal injury to surrounding 3.Treatment: Surgical BD for 1 M)
structures) curettage/Freezing
4.Partner Ix+
4.Topical salicylic with liquid nitrogen/
acid cream from 3M Electrical cautery. Treatment
(Skin irritation) (longest
time with minimum scar)
Safety Net 1.Avoid sun 1.Bleeding, SOB 1.Bleeding, SOB 1.Bleeding, SOB 1.Scaring/Chang -Avoid Sex till
exposure (Wear 2.Metastasis 2.Metastasis 2.Metastasis e in color/ treated
wide brimmed hat+ (Lumps and bumps (Lumps and bumps and (Lumps and bumps
and weight loss)
bleeding -Retest after
protective clothing) and weight loss) weight loss)
3.Can spread quickly 2.Don`t Scratch 2 week of
2.ABCD safety 3.Use Sun Screen treatment
in 6 weeks and can
netting be life-threating after every 30
3.Can come back min /Cover the
again. lesion
A-Asymmetry B-irregular border C-color charge D-Discharge

Lesion (SSSC) Rash (FODIPARA)

A. Site, size, shape and color A. Frequency (ODIPARA)
B. Change in size, shape and color B. Prodromal symptoms (fever, runny nose
C. Fever, lump and bumps, weight loss and sneezing
D. Melanoma, SCC Pain, Itching, discharge
E. Psychosocial C. Fever
F. Family hx, travel, Occupation(gardner), D. Anaphylaxis +Meningitis
Sun tanning/sun exposure E. Systemic review
Disease Measles Chicken Pox Eczema Psoriasis Urticarial Rash Acne
Rashes (Viral) (Viral) (Flexor Surface/ (Autoimmune/ (Allergic Rash /Heat (Infected gland)
Allergic) Extensor surface) bump)
Presentation 15Y/M Child with rash 15Y/M 30Y M/F Rash after hot 30Y/ M
Rash behind the on face spread Dry Scaly rash on Non-itchy rash shower Multiple
Back of knees/ for 4W
ear spread to to whole body Dry Plaque and Resolve after pimples on
whole body Front Elbow/ scale with purplish few min-hours face
Hands edge on Knee front
Presenting -Associated with -Associated with -Itchy rash is -Pain+ Itchy Pinkish Rash -Hx of migraine>
Complaint: fever, cough, runny fever, cough, runny disturbing sleep -Can be on No PID Use ibuprofen
nose (Prodromal sym) nose (Prodromal sym)
-Lesion in the Mouth back of elbow
-Fluid filled
(Koplik spots)
vesicles of
/Scalp/Back of
-No PID knees
different age
Rash>Scale>Plaque
-No PD

Contagious Time +4 days after -2 to +5 (Until Non-contagious Non-contagious Non-contagious Non-contagious

appearance of rash lesions crusted)
Rule out -Meningitis Meningitis Psoriasis -Eczema Anaphylaxis Fever/Pain
-IBD (Mouth ulcer/ joint Insect Bite -R/O Systemic Psychosocial
pain/ Eye/ Bowel sym)
Asthma symptoms (joint Meningitis
Contact Hx+ Fhx Hx(RED flags)
-Insect bite Allergies+ School Symptoms pain, PUl, CVS,nail) Insect bite PCOS (F)
-Seborrheic
Contact history+ FHX /Nursery contact Sun exposure Pregnancy
Keratitis
-Intertigo/Fungal
Risk Factor+ Highly infectious -Infectious -Fhx/Medical Hx -Autoimmune -Skin reaction to -More prone
discription condition caused condition of Asthma/ -Taking Steroids heat(Hot to oily skin
by a virus caused by a Allergic history -Medication/IDS shower/Hot -Oil Base
-New/Rough -Skin injury - weather/Sun)
Not had MMR virus clothe//soap/Food/
Cosmetics
Family Hx -Allergen-
vaccine Carpet/Dust/Pollen/ triggering factors like -Not due to
Medication/4P
Pets hormones, stress , skin Hygiene prob
injury , excessive
alcohol consumption.
Examination OBS (High temp) OBS (High temp) OBS (High temp) OBS (High temp) OBS (High temp) OBS+ Face
GPE GPE GPE GPE GPE Chest/Back
Rash examination Rash examination Rash examination Rash examination Rash examination

Investigation Nil -Routine+ Routine/Allergic Biopsy/Allergy/ Routine/Allergic Routine

Inflammatory testing testing FSH,LH,TESTOSTEO
Routine
marker NE, USG
ABDOMEN
Management 1.Self-resolving in 1.Self-resolving in 1.Topical Emollient No TX, Can only 1.Self-limiting 1.Benzyl
control symptoms.
a week a week (Moisturize)+ 2.Symptomatic peroxide cream
2.Local Health 2.Symptomatic- Steroid (To reduce 1.Topical Evening for 3M
Emollient(Dermol)( -Anti-histamine (skin Irritation)
protection team PCM for swelling)
Moisturize) 30min -Painkiller 2.Topical
3.Symptomatic- fever/pain (Apply emollient 30min
before steroids)
before Steroid -Vit-C Clindamycin if
PCM/Ibuprofen for -Chlorpheneramine (for 1-2W) (To
2.Anti-Histamine 3. Topical no effect in 3M
fever/pain for itching reduce swelling)
for Itching moisturizer 3.Refer to derma
4.Rest+PO fluids -Cooling Cream/ (Once rash resolves
3.Refer to Derma stop using it) cream+ loose if red flags
5.MMR Vaccine Bath in cold water
(if Tx not affecting/ADL Vit-D analogue fitting clothes 4.Use Water
when recovered 3.Fluids to avoid base cosmetics
effected) 2.Phototherapy
dehydration+Rest
 3.Oral Steroids
4.Oral/IV
Methotrexate
5.Refer to derma
6. Use liquid and
cream bases skin
product to cover up
the rashes
7.Avoid Stress, Sun
bathing, Drinking
alcohol, Smoking,
Hot weather.
Safety Net 1.Highly contagious 1. Highly contagious 1.Redness/swelli 1.Joint pain 1. Prevention of 1.Avoid oil base
for <1M old, preg, for <1M old, preg, ng/Fluid filled (arthritis) triggers ( Hot cosmetics
Immunocompromised Immunocompromised Dehydration/ 2.Avoid picking
blister shower)+Trigger
people+Unvaccinated people+Unvaccinated Malabsorption and scratching
2.Avoid sharing 2.Don`t Scratch/ diary
2.No Ibuprofen 2.If infected 3.Avoid freq face
clothes and towel. Baby mittens/ (Pus) refer to watch (Only BD)
3.Keep rash clean 3.Meningitis.
Cut nails emergency for 4.Avoid pregnancy
and dry 4.Wear light cloths+
admission while on Tx
cut nails 4.Avoid triggers 3.Stop Steroids
once rash
disappears
4.F/U > 4W
5.Leaflets
Disease Scabies Impetigo Herpes labialis Ring Worm LYME DISEASE Cellulitis
Rashes (Bacterial-Staph (Viral Infection) (Fungal Infection) (Tick bite) (Sec to insect
aureu)(V. Contagious) (Cold sore) (Contagious) Borrelia burgdorferi bite)
Presentation 5Y/kid 24Y/F-GP/Baby 28Y/F 50Y/M 40Y/F rash on leg 36Y/F-GP
-Rash on body and Rash on Upper -Rash on lower lip -Raised lesion -Increasing in size -Insect bite on
B/W the fingers from 2 W for 1 week leg> Swelling
lip for 1 Week on arm for 1M -Went for forest
and in armpit -Painful at the of leg.
/woodland walk
beginning
Presenting -Contact Hx -Spreading -Rash>Blister>Lower Appears Target lesion -Getting
Complaint: -Itching all the Gradually lip swelling gradually like rash bigger
-Honey crusted -OTC Cream Non- Progressing in
time. lesion (Color) effective size (Round/Ring -Also has
-Occasional itching No PID like rash) fever
and pain -Baby 6M Reddish
-Allergic to penicillin Partner Asymptomatic Very Itchy
Rule out Insect Bite Syphilis (ulcers Private area Lyme Disease -Ring-worm -Shape of
Anaphylaxis on genital area?) lesion Cellulitis infection insect
Meningitis Contact Hx IBD Meningitis+ -Urticaria -Dm
Insect Bite Anaphylaxis -Cellulitis/DVT
(meds/insect)
Risk Factor 1.Camping for a Practice oral sex R/o Pets/ Forest Visit
week IV drugs use Contact ICE
2.Nursery Visit Travelling hx
(Parasitic Systemic review
infestation) Drug hx
Examination OBS +GPE Obs +Lesion OBS +GPE OBs -OBS+ LESION OBS + Leg
RASH +Neck and Armpit RASH Skin Lesion -Lyme Antibody
Neck and Armpit
test (ELISA)

Investigation Routine + Inflam Nil Routine +RBS Routine +RBS

Inflammatory Inflammatory
Swab/ Scrapping
of the area

-Bug lives under the skin
Management of armpit and fingers.
1. Permethrin 5% (On
whole body Two doses 1
week apart)> Allow it to air
dry before getting dressed.
>Washed away after 8-
12Hour (can apply at night
before going to sleep)
-Don’t apply after hot
shower > Allow body to air
dry before applying
2.All family member,
sexual partner, and close
contact need treatment to
clear it up.
3.Bedding, Clothes and
towels need
decontamination at high
temp of 60O and dried in
hot drier or dry cleaner>
-Very Contagious > Can 1.Self Limiting -Fungal infection of 1.Refer to 1.Admit her to
spread to other parts of the skin
body. (Non-contagious
within 10 days Infectious disease the hospital
1.Supportive:
when patches are dried 2. Things you do: Anti-itching cream specialist under acute
out/ Crusted over/After 1- Eat cool + soft 2.Anti-fungal ( Prescribe abx medical team
48 H of starting food They will
Tab & cream or Gel
treatment. Doxycycline
-Take 7-10 days to resolve 2- Use antiseptic or spray every day reassess you and
without scar. mouth wash if for 4 weeks (Tab 100mg tab BD for start you on IV
1.Antibiotic cream brushing teeth hurt Turbinate 4 weeks) 21 Days) antibiotics.
(Fusidic cream TD 3- Wash your hands 2.Life-Style Modi: <9Y old> 2.Pain Killer.
A) Minimize chance
for 5days) + Oral with soap and water Amoxicillin 3.Advice:
of contact with
flucloxacillin if it is 4- Use sun block lips others 30mg/kg. 1.Elevate the limb
widespread. (SPF 15) B) Regularly keep 2.May take 2. Take short walks
(Contineu to use it 5- Don’t rub it -Wear protective
washing your several months to
until full resolved) 6- Wash hand before hands, and make socks when going
year to resolve. to out
and after applying sure you clean hand
after touching 3.Drink plenty of
animals fluids.
 then seal in plastic bag for 2.Stay away from cream (Acyclovir 5%) C) Don’t scratch the
72hours/ 3days. ringworm rash as it
school/Work till 7- Plenty of fluids
4.Should not attend can spread the
school till first
contagious. 8- Ibuprofen or
infection
application. 3.Advice: paracetamol for the
D)Wash towels and
5.Anti-itching -Wash area with pain. bed sheets
cream/calamine lotion water, DON’T: regularly
for itching. -Wash your hands 1- Don’t have oral sex, E) Don’t share
regularly after breastfeeding & Kiss clothes
touching the affected anyone (New born> 4.Pets Also need
areas. Neonatal herpes) treatment > Vet.
2- Don’t Share anything
that comes in contact
with cold sores
3- Don’t Touch your
cold sores.
Safety Net S/N: itching and Avoid: S/N: 1.Wife is 1.Take shower/bath 1.Confusion
1.Sharing towels, face Pregnant/Steroid after returning from
fever. 1.Avoid contact with /Drowsiness.
clothes, > Usually not tick infected area
F/W after 1 week. pregnant woman 2.Cover exposed
2.Scratching the pass but avoid
2.Contagious from skin/apply insect
affected area, 3.Kissing contact bcz Anti-
other people as it can tingling sensation till repellent against ticks
healed. fungal are 3.Check body for tick
spread.
4.People with weak Admission: contraindicated bite
immunity or DM. in pregnancy.
1.Pregnant
Safety Net: 2.S/N: S/N:
2.Neonate 1.Tiredness
1.No improvement Fever
3.Unable to Swallow 2.Systemic
2.High fever Bleeding.
Compromise.
Disease Hemangioma Cherry Mollascum Inter-trigo Genital Herpes Genital
Hemangioma Contagiosm (Fungal infection) Warts
(benign skin lesion) (Pox virus) (Sweat rash)
Presentation 1W/Baby 50Y/M with 5Y-Hx of Itchy 35Y/F with 15Y/F
umblicated rash on
Rash/ lesion on reddish spots/rash rash under Swellings on
chest and armpit (1-30
thigh since birth Lesions are lesions), smooth breast(B/L) the private
increasing in surface, dome shape,
Bra irritating area for 1
number and size pearly white papules
with central dimple, me week -
Asymptomatic
affect trunk and
flexures)+Itchy
Presenting Reddish in color. 1-3 mm in size -28 Week preg NO- -Partner is
Complaint: Rest in normal Bright cherry red mom concerned bleeding/pain 33Y/M for 6M
colour/blue (no effect) Itching(embarrass -No safe sex
Non-blanching ing) practice
-Is it Chicken pox?
Trunk/Upper (No prodomal No change of -Consensual sexual
extremities symptoms, not acute, relationship
bra
no dimple on top)

Rule out Bleeding -Malignant -Acne (Vulgaris) -Contact -Syphilis

melanoma -Urticaria Dermatitis -Chancroid
-Spider naevi -Childhood -Fungal/Bacterial -(See page
-Congenital infection number 2 for
chicken pox
hemangioma -Eczema further details)
-Inflammatory
breast disease
Risk Factor -Not known Due to dilated -Close Contact hx Due to skin to -Due to
(home, relatives, unprotected
small blood skin friction
school) sexual
vessels called /Obese intercourse
Immunocompromise
capillaries d -Skin to skin
contact
Relevant hx BIRD DDD ICE PMAFS+BIRD -ICE ICE
Effect of hx+ travel hx -Teacher MAF
symptoms ICE embarrassing at PARTNER +
Effect of sym work where she SEXUAL HX*
need to scratch
Examination + OBS +Lesion -OBS+ LESION OBS + Lesion -OBS+ LESION OBS+LESION_+
+Routine blood test GENITAL+ORAL+
Investigation
SPECULUM
Management Benign overgrowth 1.Reassurance Caused by Virus 1.Antifungal 1.<28W pregnant- 1.Refer to gum
of blood vessel. 2.If wide spread (molluscum cream acyclovir until birth clinic (1.Swab for
1.Reassurance (Clotrimazole 2.>28W- c-section. all STIs +partner
Resolve own its no tx required Cont-MCV- topical) for 7 ix+tx)
own.> Shrink > 3.Sclerotherapy/ 1.Reassurance days. 2.Self-resolving
electrocautery/
disappear without -Self-limiting in 2.Mild steroid in 6M
scar. curettage cream
9-18M 3.Topical
2.Apply Vaseline over it (Hydrocortisone Warticon cream
+ Sun cream if on 2.Anti-histamine 1% cream) for 7 BD for 3 D+ 4 D
exposed part. if itching) days break+ repeat 3 D
3. if ulcerated/ large/ 3.Can apply 3.Advice: (After application
goes to lips/nose > Beta recovery) (irritation in the
blocker/ Laser /Surgery Mollu-DAB beginning)
1.Use barrier
(not NHS covered) cream (OTC) cream. Take 1-6M to
work.
4.Freezing/ heat 2.Keep it dry
3.Well supported 4.Might consider
therapy bra Cryotherapy
4.Cotton Clothing /electrocautery
5.Good Hygiene
Safety Net 1.Avoid bubble bath Pain, itching, -Contagious lesions 1.Aviod 1. Use Condoms
and trauma to lesion. Discharge/bleeding 1.avoid sharing
F/U Scratching 2.Report
Flaws towels/clothing/ about
S/N: Bleeding /Ulcer.
beddings
2.Can go relationship
school/cover the
lesion >Inform
school nurse.
3.Cut nails
S/N:Come back if
PID
Leaflet

*Sexual History:

• Sexually active?
• Stable relations?
• Safe sex?
• How old is your partner?
• How did you meet?
• How long have you been together?
• Kind of sexual intercourse - Oral, anal or vaginal sex?

Abuse relationship

• How are things with your partner?

• Has your partner ever forced you to have sexual intercourse? (Sexual abuse)
• Has he ever been abusive to you in any way? Verbally, physically or emotionally?
Raise your Concerns

• Your partner seem to be much older than you. How did you meet?
• Do you feel comfortable in your relationship?
• Do you ever get concerned that he might be far older than you?
• Do you ever worry that the relationship could be wrong because of your partner's age?
Parents
• Do your parents know about your relationship?

• Do they know that your sexually active?

• Is there any particular reason why you have not told your parents?

• Do you ever worry how your parents are going to react if they found out about your relationship?

Management

Address the sexual abuse issues

• There is a big age difference between yourself and your partners

• And he is your teacher (he has authority over you) so it is not a balanced relationship. he is abusing his
position.

• Your partner holds a position of trust (such as teacher, sports coach, minister of religion)
Explain why it's a not a right relationship

• Because of the age of your partner, you being under 16 years of age and your partner holding a position of
trust.

• The relationship you are in is not legal

Further management

Take a second opinion from your senior

Inform the social services and the local authority
(As a medical professional I am required to inform social services and police as well I would advise to
inform your parents as well
Disease Herpetic Cat Bite Erythema Folliculitis Furunculosis: Alopecia
Whitlow Nodosum (Not
(Not contagious) contagious)
Presentation 33y/M 36y/F Rash on both legs 18Y/F
Wild Cat bite on L for few weeks Painful rash in
Blistery red Rash
hand -NO bleeding genital area for
On fingers for 3 Pain and mild discharge, Itching
days few weeks
redness over finger. and ulceration
Presenting -Severely painful -Washed his hand Multiple reddish Painful , multiple
with soap and water swollen and painful rounded rash ,
Complaint: and itchy.
immediately (First warm nodules +Joint painful to touch,
-Before rash aid) pain pus filled
tingling on the Vaccinated including Sexually active ,
same place 5 doses of tetanus practice safe sex,
and last dose was 12 has stable partner
month Never screened
ago.(Vaccination for STI
+last dose)
Rule out Cellulitis Last Vaccination Sarcoidosis -Furunculosis folliculitis,
Insect bite Infected Wound DVT, Cellulitis -Cellulitis cellulitis,
-Hidradentis
Allergy Hand exam Drug reaction -Herpes hidradentis,
(motor+ nerve) herpes
Risk Factor Cold sore 2 -Unknown cause Brazellian wax Waxing
weeks back- -May be flu-like Shaving
Infection caused infection,
by silent herpes pregnancy or
simplex virus drug reaction
Whole past hx is negative
Relevant hx Sexual hx -Incident history 1. Routine+ Inflam
Contact history -Cat appearance 2. Urine test
3. Throat swab
(domestic/Stray) 4.Scan:X-ray chest
(r/o TB and
sarcoidosis)
Examination + -OBS+GPE -OBS+GPE OBs+GPE+ Rash OBs+GPE+ Rash
Investigation LESION -Wound site
(hand movement
and neurology)
-Routine +
inflammatory
marker
Management 1.Antiviral 1.Don`t need -Inflammation of It is infection of It is infection of
(acyclovir for 5 vaccination as adipose tissue. skin caused by skin caused by
days) -Unknown cause> bacteria. bacteria.
last one is 1Y no treatment 1.Self resolving in 1-
2.PCM for pain ago. 1.Self-limiting in 3-8 2 w if not resolved
3.Anti-histamine
2.Pain killer. weeks without scar. > antibiotic.
for itching 2.PRICE (ibuprofen/ 2.Can try OTC
3.Prophylactic
Naproxen, rest, Cool antiseptic cream.
antibiotics for 3
compression with Advice: 1. Put warm
days. wet cloth, leg raise) compression 2.
Maintain hygiene
Safety Net 1.Rash will go away 1.RBS(Redness, S/N: Bleeding, 1.Usually those
F/U in 2-4 Weeks. bleeding/dischar severe pain or boils are not
contagious, but the
ulcer. pus inside can
2.Don`t Scratch/ ge, Soreness and Can go to Work> spread infection if
Squeeze /drain/ swelling) +Fever. wear protective come to skin to skin
touch. contact
clothing.
3.Don`t touch other
body areas with this F/U in 6W
finger specially eyes.
4.Keep it dry and
clean.
5.Cover it with
dressing.