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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Ken Anderson, a 60-year-old Caucasian farmer. A clinical photograph of Ken’s skin problem will be available to you on request. (Refer to Figure 4) Please discuss with Ken the management of the condition.

Scenario

Ken Anderson is a 60-year-old sheep and cattle farmer who is a regular patient. He is usually healthy, but you have seen him for hypertension and hyperlipidaemia (both well-controlled), as well as for minor physical injuries.

The following information is on his summary sheet:

  • Past medical history

  • Hypertension

  • Hyperlipidaemia

  • Medication

  • Telmisartan 40 mg od

  • Rosuvastatin 10 mg od

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Married

  • Smokes 15 cigarettes per day.

INSTRUCTIONS FOR THE PATIENT, KEN ANDERSON

You’ve noticed a scaly lesion on your right cheek, which has been there for about six weeks. You have scratched it off a couple of times but it seems to come back. It is not painful, tender or itchy and does not bleed. It is pink or flesh-coloured, is slowly growing and is now about 3 mm in diameter. If asked you don’t think you have had any previous skin lesions apart from the usual bumps, bruises and scratches that come with farming.

You are fair skinned but tend to tan rather than burn. You have spent your whole life in rural Australia and most of your days are in the sun. You wear a hat and usually long-sleeved clothes but don’t use sun protection creams regularly. If asked, your father had a number of skin lesions removed by his doctor but you don’t think any were melanomas.

You are fit and healthy and generally pretty cavalier about your health, although you are worried this spot might be a skin cancer.

The following information is on your summary sheet:

  • Past medical history

  • Hypertension

  • Hyperlipidaemia

  • Medication

  • Telmisartan 40 mg od

  • Rosuvastatin 10 mg od

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Smokes 15 cigarettes per day.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Explore Ken’s concerns about the lesion.

Specific questions

Duration of the lesion

Bleeding, itching or pain

Any treatment applied

Any previous lesions

Sun exposure

Skin type

Family history of skin conditions

General health

Request permission to examine.

Examination

Exposure—adequate lighting and magnification

Dermatoscopy

Check rest of skin for other lesions.

Diagnosis

Hyperkeratotic actinic keratosis

Background sun damage.

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