GP - Referral

Question 1

What are Seborrhoeic Keratoses?

Answer 1

Benign epidermal skin lesions (commonly seen in elderly)

• Also call seborrhoeic warts (even though warts are technically only called by HPV)
• Form due to proliferation of the basal layer of epidermis
• Increased incidence with 1) Sun 2) Age

Question 2

What are the features of Seborrhoeic Keratoses?

Answer 2

Seborrhoeic keratoses features:

• Colour - large variation from flesh-coloured to light-brown to black
• Size - few mm-cm
• Trunk - commonly seen here but can appear anywhere (apart from palms or soles)
• Can be itchy
• ‘stuck on’ appearance - as they only involve the top layer of skin
• Keratotic plugs may be seen on surface (see image)

Question 3

How are Seborrhoeic keratoses managed?

Answer 3

Don’t require treatment!

Often continue to grow (slowly) and become darker

If removal is required (e.g. itchyness / unsightly):

• Curretage - local anaesthetic and then ‘scraping’ with surgical instrument
• Liquid nitrogen - warts are killed and drop off within a few days (normal skin replaces the area left behind)
  
  • Not suitable for large warts

Question 4

Can Seborrhoeic warts become cancerous?

Answer 4

No - they are benign

Question 5

What scoring system produced by NICE can be used to determine if skin lesions require a 2-week referral?

Answer 5

Weighted 7 point checklist

Question 6

What features in the weighted 7-point checklist for 2-week referral for suspected skin cancer?

Answer 6

Suspicious skin lesion features:

Major features of lesion (score 2-points each):

• change in size
• irregular shape
• irregular colour

Minor features of lesion (score 1-point each):

• largest diameter 7 mm or more
• inflammation
• oozing
• change in sensation

Question 7

When should GP’s refer a patient for suspected melanoma based on the weighted 7-point checklist?

Answer 7

Score of 3 or more

on weighted 7-point checklist

Question 8

What does the GP need to confirm / do before making a 2-week wait referral?

Answer 8

1. Referral to be made within 24hrs of seeing pt
2. Confirm pts contact info
3. Confirm that pt is available in the next 2-weeks
4. Ensure pt is aware the referral is for suspected cancer BUT referral does not confirm that it is cancer
5. Book an appointment in 3-weeks time to check the pt has been seen (this is for additional saftey-netting & is optional)

Question 9

What does the SPIKES framework for breaking bad news stand for?

Answer 9

• S: SETTING UP the interview
• P: Assessing the patient’s PERCEPTION
• I: INVITATION to share and how much to share
• K: Sharing KNOWLEDGE and information
• E: Addressing the Patient’s EMOTIONS with empathic responses
• S: Strategy and Summary

Question 10

Patients often attend practice with ‘patient-facing media’ to discuss e.g. news articles - when questioned / presented with these what is the best course of action for the GP?

Answer 10

1. Ask pt to leave the article or refer you to it
2. Arrange a follow-up appointment to allow you time to review the material and dicuss it with the pt alongisde current best practice guidelines