Author: Antony Willman

My new book has been uploaded to Amazon Kindle and is available to download now. The book contains over 220 colour image based case discussions …

My skin cancer diagnostics e-book is now published

This lesion seems to be tracing along the natural skin stretch lines, I have seen BCCs do this a few times on the neck. The lesion is poorly defined,…

Feature-rich basal cell cancer on neck

By contrast with the last case I posted, here is one of the 4 small non-melanoma skin cancers I picked up in a single clinic recently, doing check …

Small skin cancer picked up on a routine check

Some good points here. In Military Primary Care, we perhaps don’t see as much but melanoma is probably the commonest cancers we do see. I also see a younger population with tours of Iraq and Afghanistan under their belt with sun damaged skin. Dermoscopy in DPHC is a skill worth considering. You will use it far more than POCUS so maintaining competency shouldn’t be an issue.

Thanks to Stephen once again.

Capsaicin 8% Patch Treatment in Non-Freezing Cold Injury: Evidence for Pain Relief and Nerve Regeneration. https://doi.org/10.3389/fneur.2021.722875

An interesting paper purely from a research perspective. Cohort of 20 patients, 16 of whom completed the trial. Mean duration of symptoms 49 months (looks skewed – median should have been used). Not blinded, in fact no control group. 8% capsaicin patch applied and followed up in 3 months. Pain scores improved and histology improved – useful from a research perspective. However, from a pain perspective, we cannot say anything without a control arm. The authors acknowledge this in their discussion.

I have a small issue with the terminology. The paper describes the duration of NFCI in months. This should be duration of pain symptoms. NFCIs are usually measured in hours or occasionally repeated over days (unless your are Scott of the Antarctic & that didn’t end well!).

Tools, Time, Training, and Team—Military Primary Care Providers’
Perspectives on Improving Chronic Pain Assessment and
Management. https://doi.org/10.1093/milmed/usab367

This was a qualitative study of US Military Primary Care Physicians who were interviewed about their experiences managing CNCP in primary care. It’s worth just reading the conclusion in the abstract as, funnily enough, they drew similar conclusions to what I found. The study itself seems solid – iterative and inductive thematic analysis, 12 interviewees. If you do have time, the themes they encountered are worth a look, especially the quotes. I’ve only skimmed it but will have a closer look especially if there is reference to problem based learning.

Nothing much to say about this lesion, just a big, bad, bleeding skin cancer. This is the back of an older white man that has a lot of brown marks on…

Beware of new, firm and growing skin lumps

Thanks again to Stephen for these excellent blog posts. If you haven’t heard it, a nice PodCast from the RCGP on dermatology in skin of colour: https://podcasts.apple.com/gb/podcast/rcgp-elearning-podcast/id1474942018?i=1000534675021

This patient presented with a wart. As they were an older white person, a skin check was carried out and 2 lesions of interest were discovered on the…

Two cancers picked up on a skin check

Experienced skin cancer diagnosticians are wary of nondescript pink spots and lumps especially on older white sun-damaged skin. The cancer we fear …

Pink mark on sun damaged arm was skin cancer

A young female presented with a very dark mole on a foot. It had been present for as long as she could remember, more than 10 years at least. Another…

A black mole on the foot

My friend Professor Aimilios Lallas, President of the International Dermoscopy Society, has posted this great video on a new approach to …

Diagnosing lentigo maligna-the inverse approach

This older white man had a large lump on his skin. It started to itch and bleed, so he went to see his GP, who as anxious enough to refer him on the …

Photographing your skin lesions can really help