What?

I have never felt particularly confident with skin, despite the fact that as MSK clinicians we see so much of it! I feel that if I was asked to describe a lesion at present, I could probably do a mediocre job of it. I would like to improve on this, particularly using specific dermatology jargon that makes it clear what you are describing. I also don't feel particularly confident at recognising red flag signs for a lesion, or what is obviously benign. Finally, I recognise that I have a very poor understanding on rashes, and with what level of urgency they should be referred, so would like to improve on this so as not to incur delays where red flag signs may be present.

Notes

Description examples

So what?

Whilst it is not appropriate for MSK clinicians to be correctly diagnosing skin lesions or rashes, it is important to recognise "barn door" clinical signs that either increase suspicion of malignancies, or that clearly demonstrate that a lesion is benign. This is important for achieving correct thresholds for referral, with the correct level of urgency, and also being able to reassure service users if they are anxious about lesions that are clearly benign. I would like to improve on these areas as part of  KSF 5 for Quality improvement, and encourage others to do so by use of credible resources like DermNetNZ

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Dermatology

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Now what?

I attended a lecture GP-led lecture outlining dermatology basics which was kindly hosted by The Royal College of Chiropractors. The lecture covered describing a lesion for the purposes of referral, red flag signs of the 3 most common skin cancers, common benign lesions and how to recognise them, and common rashes seen in primary/community care.

What I took away most was the importance of early recognition and treatment of skin cancers, particularly malignant melanoma, due to its high propensity for metastasising once established (40% once 4mm deep, 30% 5-year survival rate once stage 4), yet excellent outcomes if caught early (5% change of metastasising if 1mm deep, ~100% survival rate at Stage 1). I felt much more confident in my ability to recognise red flag signs of a lesion via use of ABCDEs, and looking out for signs such as keratinous plugging (squamous cell carcinoma), ulceration and pearlescent rims (basal cell carcinoma), and lesions on the palms or soles of feet (malignant melanoma).  

Having a reference list to work through for describing lesions, and confirmation of the correct terminology for particular types of lesion has made me feel much more confident in being able to write my own referral independently, rather than having to rely on a GP to look at the lesion first and incur further delays for the service user. I would, however, like to improve this by applying similar learning to lumps, as I have come across many lumps in primary care that I do not know how to describe clearly in written notes. The drawback of not being able to correctly describe a lump, is that the temptation is to jump straight to a diagnosis ("feels like a ganglion" etc) where I may not be best placed to do so or may be making diagnostic errors at the detriment of the service user.  

Finally, I felt much more confident in the ability to recognise lesions that are clearly benign, such as solar lentigos and seborrhoeic keratoses, with which I had a little familiarity before. I was delighted to learn for the first time about slate grey naevi, which I had never heard of before, because it is incredibly important to be able to recognise conditions that affect certain ethnic groups more than others in order to reduce health inequalities. Slate grey naevi are also particularly important for physiotherapists to recognise, as they can easily be mistaken for bruises or signs of abuse, and should therefore be on a clinician's radar for discussion or monitoring. 

Whilst we did cover some common types of rashes, I must be honest in that I still don't feel particularly confident in being able to distinguish a benign rash from one that requires further clinical attention. I feel that I could recognise scabies, shingles and non-blanching meningeal rashes, but apart from these I do not feel I would have any confidence if one presented, and would likely have to seek help from colleagues. 

This is certainly as area I would like to improve on, and will look to doing further learning on this in future.

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SMART goal - KSF Core 5

Updated on July 23, 2021; 464 page visits from 16 July 2021 at 9:10 to 3 October 2025 at 23:51