CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Dermatology – DER003

You can self-report this CPD/PDP activity by logging it online with the RACGP/ACRRM. The activity has been allocated 1 hour (0.5 hour EA and 0.5 hour RP). Certificates are not available for this CPD.

Test your clinical knowledge by taking the 6 quizzes below. If you select the wrong answer, have another go — you can try as many times as you like.

RACGP Activity Number: DER003

ACRRM Activity Number: DER003

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1. Scrotal lesions pose riddle

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Mike, a 34-year-old builder, presents with a one-month history of dark red, dome-shaped papules on the scrotum.</p><p>These are not itchy or painful, but he has had a single episode of spontaneous bleeding from one of the lesions. There is no history of trauma.</p><p>Mike identifies as heterosexual and had a negative STI screen two months previously, as did his new partner at the time.</p><p>Mike’s father, also a builder, has had multiple non-melanoma skin cancers excised from the face and chest. There is no other significant medical history.</p><p>Examination is unremarkable apart from the scrotal lesions pictured (on next screen). Dermatoscopically, dark lacunae and a whitish veil are noted.</p></p> <ul> <li>a. Melanoma</li> <li>b. Angiokeratoma of Fordyce</li> <li>c. Cherry angioma</li> <li>d. Fabry disease</li> </ul> </section> <p> </p> <p> </p> <p></p>Photo: Reproduced from The BMJ, He Y, Xiong J. A man with multiple dome shaped dark red papules on the scrotum BMJ 2022; 378 :e071708

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

2. What’s causing these annular lesions?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 73-year-old Caucasian man presents with a six-month history of smooth, circular or ring-shaped lesions on both hands.</p><p>The lesions have not progressed, are non-pruritic and do not bleed. He has trialled topical steroids with no effect. </p><p>He has a past history of type 2 diabetes, hypertension and Graves’ disease and is currently taking metformin, candesartan and vitamin C and D supplements.</p><p>On examination, the lesions are smooth, annular plaques with discolouration on the borders. They appear bilaterally on the dorsum of the hands.</p><p>Examination findings are otherwise unremarkable.</p></p> <ul> <li>a. Pityriasis rosea</li> <li>b. Sarcoidosis</li> <li>c. Tinea corporis</li> <li>d. Granuloma annulare</li> </ul> </section> <p></p>Photo: Supplied by Professor Dedee Murrell

Author

Author: Professor Dedee Murrell is head of the department of dermatology at St George Hospital, Sydney; and conjoint professor at the University of NSW. This article was co-authored by Madeline Wang, a medical student at the University of NSW; and Dr Anna Wilson, a clinical research fellow at St George Hospital.

3. What’s behind these painful vesicles?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Jessica is a 42-year-old marketing manager who presents with several days of painful, pruritic vesicles on the tips of her fingers and thumbs. She has had associated fatigue, fever, headache and joint stiffness. Jessica is usually very well, with no past or family history of note, no regular medications and no known allergies. She had a manicure with gel nails a week prior, which has never previously caused any issue. On examination she is afebrile, and skin and joint examination is unremarkable apart from the local nail findings of periungual erythema, oedema, subungual hyperkeratosis and petechiae. Pathology including FBC, LFT, inflammatory markers, CK and antinuclear antibody is unremarkable.</p></p> <ul> <li>a. Psoriasis</li> <li>b. Allergic contact dermatitis</li> <li>c. Dermatomyositis</li> <li>d. Lupus</li> </ul> </section> <p></p>Photo: Reproduced from the BMJ, G Kuceki, 375, e067253 2021 with permission from BMJ Publishing Group Ltd.

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

4. What's this painless rash overlying a scar?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 54-year-old woman presents as a new patient with a one-year history of worsening painless erythema overlying a scar on her dorsal left wrist. She reports she is otherwise well, apart from schizophrenia, which is stable on a depot antipsychotic administered by the local community mental health team. She is vague in her recall of historical details. She has previously fractured her distal radius and ulna bilaterally after a trip and fall. She also states she had a mole excised at this site years ago but does not recall any details about histopathology. She has not been attending routine skin surveillance, but she thinks this was recommended. On examination, in addition to the lesion shown, she has a firm, non-tender 2cm left axillary lymph node.</p></p> <ul> <li>a. SCC</li> <li>b. BCC</li> <li>c. Invasive melanoma</li> <li>d. Eczema</li> </ul> </section> <p></p>Photo: Supplied by Professor Dedee Murrell

Author

Author: Professor Dedee Murrell is head of the department of dermatology at St George Hospital, Sydney, and conjoint professor at the University of NSW. This article was co-authored by Dr Timothy Cowan, a dermatology registrar at St George Hospital.

5. What are these lumps lurking under the skin?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Janice, a 45-year-old baker, presents to her GP complaining of multiple soft lumps on her trunk and limbs. Some of them, like the one on her left forearm, are tender to touch and becoming increasingly bothersome. She is unsure how they have come about. She noticed a few on her back five years ago, but since then, they seem to have multiplied.</p><p>Janice was recently diagnosed with impaired fasting glycaemia. She admits to letting her diet and lifestyle slip over the past decade and plans to address this issue.</p><p>Examination findings reveal Janice is normotensive and apyrexial. Her BMI is in the obese range.</p><p>She is found to have multiple lipomatous lesions on her trunk and limbs, some of which are tender to palpation. Her blood tests, which include a serum cortisol level and thyroid function tests, are unremarkable except for her known impaired fasting glycaemia.</p><p>She takes no medication and has no other significant past medical history. She has three siblings and is unaware of anyone else in her family experiencing a similar problem.</p></p> <ul> <li>a. Madelung syndrome</li> <li>b. Dercum disease</li> <li>c. Proteus syndrome</li> <li>d. Hypothyroidism</li> </ul> </section> <p></p>Photo: Dermnet NZ

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

6. What's producing this patchy pattern?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A nine-year-old Caucasian girl presents with four weeks of brown patches over the lateral and dorsal aspects of her dominant left hand and wrist. They initially appeared as erythematous, non-blistering, oedematous patches and are not tender, painful or pruritic. She has never experienced anything similar in the past and is otherwise well. There is no significant past medical history or allergies, and she takes no medications. She lives with her parents and one dog. There is no family history of any skin or immunologic conditions. During the recent school holidays, the family spent lots of time outdoors in the sun in their home garden and citrus orchard, as well as spending time cooking and juicing the fruits of their labours. Topical antifungals were trialled for one week but stopped as there was no visible improvement.</p></p> <ul> <li>a. Burn</li> <li>b. Tinea nigra</li> <li>c. Phytophotodermatitis</li> <li>d. Allergic contact dermatitis</li> </ul> </section> <p></p>Photo: Supplied by Professor Dedee Murrell

Author

Author: Professor Dedee Murrell is head of the department of dermatology at St George Hospital, Sydney, and conjoint professor at the University of NSW. This article is co-authored by Joslin Johal, a medical student at the University of NSW, and Dr Timothy Cowan, a dermatology registrar at St George Hospital.

References on request from kate.kelso@adg.com.au