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feel free to ask on D, and also, if you have questions or if you want to repeat anything, that's absolutely fine. Um, so it's any interactive session. I will ask you questions and, um, yeah, let's see how it goes. So my name is, um, it on one of the dermatology registered nurse that does that count the hospital, And then this is the unit skin lesions. So started the question. Who is willing, Teo? Describe or maybe know what is going on with this rather busy back of a patient. Anyone, Any description? Just fire away. Feel free. Can you see my mouth ready So anyone can describe this one? Someone in the chat box has said Seborrhea keratosis light. Absolutely perfect that that's Western will done. Yes, it is seborrheic keratosis. It is very, very, very, very common. You It's here. Nearly every patient that comes to our dermatology clinic when we do, um, skin examination, full skin or just normal examination is when they referred. So let's talk about separate. It is well done detecting this So this is another picture, and by the way, I took all the pictures from then n z ast. They put the know going to information, so that's really nice. So basically the cause, it is unknown, Um, sometime calls like solar keratosis. Well, and it's, um, uti in. As I mentioned, in majority of patients above the age of 60 it can be anywhere. But there is that I can see in the practice very, very common, affecting the scalp, the face, um, the back and on the upper part off the trunk. However, it can affect any areas. But from practice point of view, these are the areas that's involved. So usually the lesion is not like bizarre religion. You can see the lesion, they can be flat, and sometimes they can be like a wart desiccation, which I'll have more pictures. Um, they can be dark pigmented, which can be scary looking. And then what? We might get some referrals thinking that could be melanoma for those when they're like dark pigmented or sometimes they can be nice looking like those in this picture. Now the size it can be small, or it can reach a couple of centimeters or even more in diameter. Now you might hear a term. Let's run if they call it stuck on appearance or Sakon lesions. The reason being you can literally, when you see the patient as if they are someone stuck thumb on the skin like they are on the skin. Even when you see the pathology under the microscope, you can see as if there is a layer of stuck on. This can save these look. They were flying this. Now the diagnosis is mainly for those. Mainly it's clinical. So for the trained eyes, sorry. So for the train dies, it would be easy to detect them from with experience, you it seem more and more as I mentioned, you seen plenty of patients, so even if you are diagnosing other entity, you would see them as well. So this would train your eyes to detect them rather quickly. Again. Democracy is a right hand fishing, so we would see them under the drum oscopy. They can be looking as a war two lesion as this one, Um, or if they're flat, you would look at there is a pigmentation or, if there is, um, pigmented network just to separated from other conditions that have big meeting network and skin biopsies sometimes taken from those so as I mentioned because something they prison, they might be scared looking. You might have a GP referral thing. I want to exclude melanoma now themselves. The's sub regulators. Is there usually painless, not causing issues. But sometimes they can be itchy. So once the patient started it, they might bleed. Then they might be cause what's called everything to separate your associations. So when that happens, the subject keratoses might increase in size, change in shape and changing car. So all this happened. These would be alarming signs, um, to non specialist in in dermatology, because they we think Okay, we're dealing with something. Cancers. In fact, it looks like separate irritations. So a lot of those lesions, unfortunately being removed, thinking it's a skin cancer when they're know looking benign, but majority of them, they just look benign and nice. So these are the treatment options, as in mentioned one a patient presents with this lesion. If they're not causing any problems, we just reassure discharge and keeping on the legion tiny lesions. We can just use the gun, use the cryotherapy or it can be just curated and then burn the area, which is C. N. C. Work a curettage, negatory or excision, which was the full excision and send it for pathology. Any questions about separate practices? It's very common, So feel free to ask. I don't wanna be quick any questions so far, but I would guess you know that's going on. No more lesions. All right, let's come on. Which is some evidence more cysts know everything, My sister. It's also, um um, come on. But it's not as separate criticizes. It can affect young and middle eight Haven't seen in elderly people. To be honest, it's mostly seen in Put it in young people. He's got some melted humorous, your 2 to 1, or it could be just equal. And so, um, usually these are tend to be filled with current in on a lipid difference. And then that lesion you can just move it over the scale are like when you move, the skin lesion just moves with it. It is usually paying us and not tender unless there is an issue with it. So if it's got infected, or if there is a trauma to this area and then it can be painful. And as you can see, there is a center puncture, but we can see it, and this is very, very important to differentiate it from other lesions. So what happens here is that was my my So what happened here is like, um, this lesion will this is usually originates from the infundibulum and then encapsulate in the Dermus. And then the divers just started to collect their if it's squeezed, especially in the early stages, one inning when you squeeze it, these materials can be, um, release from the from the center, and it can be like four smelling. To be honest, um, it has been associated so with other conditions or vice versa, especially if it's multiple. And does anyone know what is Gardner syndrome? Especially if there are any fifth graders here or fourth graders? Gardner syndrome. Anyone that would come on her exam? Gunderson drama. Quite sure. No, Elena, you're the president with his gardener syndrome. I'm gonna take on people so you would answer. No one answers anything Lawrence's wrote in the chart characterized by multiple colorectal polyps. And then Watson has said, dominant APC gene mutation. Yeah, forcing can use the microwave be great. If not, then are open the chest. I would see the chart as well? Yes. Perfect. So, yes. Um, these are called like these are stimulant polypoid my diseases, and it's yes, APC gene mutation. Correct. They can be multiple. And when they happen with the guard or send on okay and gargle multiple epidermal since yes, yes, yes. Correct. Perfect. Well done. Um ser other conditions is basal cell nevus syndrome. It's been basically basis. That comes trauma multiple basal cell carcinoma and back when you clean genotype two. It's an autism, a dominant condition undone, which is basically a cure it in disease. But they have hypertrophy. So that is thinking off the palms or soles on doll. So thinking off the nails I don't think you need to know about the gardener is is the main one here. To be honest, this is just for a week. She no, as a cyst. There is a possibility for that cyst to be infected. As I mentioned before, no one isn't gets infected, it can rupture. It can be paying for orders can get bacteria infection on, and when it causes these troubles than it needs to be treated Otherwise, you don't do anything for you. Just monitor it know when that happens, and it started to increase in size and causing problems, and it's getting infected. Then it can be drained with with antibiotics as well, or it can be excised on it is rarely read a really assertions with a C. C. So diagnosis clinically, you can just have a look on once the patient. Sure you don't like. Yes, I know it. It's a bitter much is you can see the center punked. Um, have a look at the central puncture, Um, and in the skin it's rather fragile. And when you squeeze it, material can be expressed from the central puncture, um, which is false, Molly. So you need to remember those not highlighted points. Any questions? Every time we insist, you know, perfect. Let's see, we're still kind of assist. There's a pile assist. No pylarcis can resemble epidermal cyst. That's why I meant to put them back to back. So you differentiate between each other now. The origin of this one is rather different, which is from the sheet as covering the hair route. This one is cart in, felt basically to the most common size or actually the most common side for addition would be this cow. Uh, it's kind of thick. This protime I've seen. A couple of patients are thinking that scrotum a swell, and it's most affecting middle aged people, as you can see in the picture here and and it's also, you can move this. You can move it with this can, and it's again. It's painless. Unless it is causing trouble, such as infection, then it can be painful and tender to touch. And again, it can be multiple as well. Now the trick here. As you can see, there is no center punked, Um, and the science can be big. It can refuse. Centimeters in size. Know the skin is thicker in this one, too. It's less left to be prone to rupture. Okay, so if you can see this picture, it's a smaller here, and the diagnosis is usually clinical. Now I put histology, which is basically means you with excites the lesion and send it to the pathology to be to be examined. No, it would be excised only when it's causing trouble or the lesion is suspicious. It's not clear diagnosis, and when we have unclear skin problem diagnosis, then it's the best way. Then you would see it for another tool of investigation would be pathology. So their motor fast energy so helpful it's usually the treatment a symptomatic. You just leave it alone. Give the patient reassurance. Explain to them that this is benign in nature, less likely to cause any trouble unless it gets infected. Keep an eye on it. If there is any trouble than they can get back again to be examined and see what you need to do for it, Okay? Any questions? Thinking it's going to get more difficult? No snow was lying so late for on anyone can tell him about life over. Let's see. So I'm gonna take people. That's the best way. Let's see me. That, um, was in the endless Seen, um Louis Anything? No, Darlie, you wanna say something or worsen anyone? I'm just trying to get this session interactive, right? And me Give the talk. Just fire away. Any ideas? You How No. Cool, is it? Is it like a soft tissue swelling made from that Sounds Yes, you're absolutely correct. And it's factitious funny. Yes. And then do you think it's painful or painless? From what you said it sounds painless. Yes, it is painless. Do you think it's when I get painful? Um, may No, I don't think so. Anything is possible. Is it? Yeah, basically, it's anything is possible. So yes may be painful if got infected. Yes, or if it's pressing on the underlying structure with so it could be muscle or never or wherever it's on, because it can be anywhere. Basically now, in terms of size, where do you think? Do you think it's gonna be really big? Or it can get big Or it's just like tiny bit or yes, perfect. Yes, Darlie, Correct. If it's the Exelon. Exactly. So in terms of sun is what do you think? Canada in size like it can be. Small big ends? Yes, so it can breathe to several centimeters in size, you know. Um, perfect. So what do you think? That the modalities off diagnosis there. So how would we diagnose like? So you had a like a sneak peek at the picture. And then because we talked about it now? So how do we diagnose it? And it's a just sense guys. Clinically. Yes, perfect. Clinically. Exactly. So, if clinically difficult, how would you diagnose it. It's usually straightforward, but never say never. Sometimes nations are difficult, and they just get mixed up with the other. Um, diagnosis. So how would you diagnose it if it's clinically difficult or you're suspected? Something else? Any suggestions? Kinds? I mean, this might sound stupid, but would you take a biopsy just to see what it is? Yes. Great. So you might take a biopsy. Or, um, if you're suspecting the lesion and it's resembling something more sinister And if this surgeon decided to move it and then everything that was removed, we send it to the pathology. We send it there. Matter of mythology, have a look under the microscope. So this might also ate in the diagnosis. You're correct. Histology. Yes, darling. Perfect. And, um on it was an offer, son. We do know. Use it frequently. Unless we are suspecting something else there, um, or the examination Dean's. Otherwise, then we might refer for ultrasound off. We think that it is needed based on the clinical examination. Yeah, that's that's great. So yeah, I think we've answered everything effects and it can go. It can grow anywhere. The back is really, really good common side, the neck it can feel like looks like a hum. Um, you know, on the back of the neck also. But yet the back pain's still have from It's a really good come on site, but it's so management plan. Obviously, if it's not causing a problem, we just leave it there. Surgical excision. As we said, if it's causing problems compressing infected, we are suspecting another sinister lesion that is difficult to exclude from both of them. Then we might just remove it. Or if it's big, then leper section can be done. Um, I've seen different approaches. Some people, they make a small incision and and remove the, um, thie. I promo gradually from small incision, and some people make bigger decisions. So depending on the surgeon and that experience Okay, my favorites, very common. Very common. And you would see some in a federal for this one. And this is classical sign. And, um, who's gonna answer? Come on, people. I know all of you were really smart. I'm not going to answer this one. I put it here. Did the answer send you one? Raise your hand? I'll write something in the charts, then you want to comment anything? What do you What do you concede here? What's the difference between this one and this one with have we done to the skin? Um, no, no. In fact, it says, um, So if you can see this one and then if you can see those two fingers, what have we done to the skin and then the lesion depressed now, as you can see, So once we pinched it, this is called pinch sign. So once you been to the skin from both side the lesion sons or get becomes depressed. Very. Come on. Ah, Gp practice these here all the time and they write you the pinch test was done. The lesion is no regressing or not depressed. Yes, been well done. Thank you. Correct. You're actually correct s three months if I bromo. So when you hear the word pinch sign, you just think about the amount of fibroma is one of the thing that happens with it now with their motto fibroma It can be, um, red, pinkish or white in color. It can be anywhere. No. Um, anyone. So been since you started with the diagnosis? Um, what are the common size of the matter fibroma so more would you expect to see it? Um, faith back tests limbs just fine away. Anything? Um, maybe. Thank you. Yes, yet Perfect. Yes. So both of you said limbs. Correct. Um Okay. So what do you do for the amount of fiber? Um, would you do something for Would you, um, send the patient to be, you know, for for the lesion to be excised, what you're going to do for the amount of fiber? Um, yeah, yeah. Content you. So far, the amount of fibroma is usually it's a benign lesion. So you don't investigate. You do not do much. So the things that you would do for the amount of fiber. Um, first of all, it's clinically. Do you see a clinically see? See the lesion on the limbs and then you pinch the lesion. So first of all, you can you can see, like, a small popular or not you on the limbs, especially on the arms on down your attention. The legion. Not all of them. Pinchable. But if you see when you when you pinch, it goes down. Now that's great. That really helps the diagnosis. Then the next step, you would take her there, matter scope and have a look. So where did your muscle scrappy you would just depends on the on the color of the lesion, but in the center E, we would expect a white ish area and then surrounded by the color off the lesion. You know, do we think that this could be this couldn't get infected or it's just ah, lovely lesion that doesn't do anything. And the suggestions maybe can get infected? Yes. When do you think it? What other symptoms you think it can give the patient in? In addition, if it's infected, Yes, I think it was more painful tender more at first. Um, see, uh, correct. And let's just say if it's not infected with it, cause them symptoms, perhaps one of the most common symptoms to the skin. Do you think was the most common thing that happens to the skin for skin lesions? What what do they do to the skin? And it's collusion. A lot of people have itching so it can be intensely itchy. That was one of the reason, but the patient go to see the doctor. So initially, when the lesion appears, Um, some people are not bothers with it, but it's sometimes it's intensely itching and during the night and really affecting them. So they start itching, scratching the area. And that's where sometimes get infected. Now these lesions know, always straightforward. Um, sometimes they don't look easy. They don't have the pinch line, and therefore they might be sent for biopsy. Or they might as well just take the the lesion. They just excise it just to make sure that it's no resembling any other sinister, um, lesions. I can't say that was one of the treatment options. Okay, so this is what we talked about that insulin, usually asymptomatic, and it can be tender or itchy. Current therapy also can be done in the primary care on in the dermatology, and usually we just keep the area without any treatment. We just If it's not bothering them that much, we just ask them to moisturize the area, look after it and keep an eye for conservative treatment on again. If we're so suspecting, the lesion can be removed by excision and send for histology, and then we'll get the results from them and then we'll discuss with the patients are reassured that, but bear in mind the matter Fibroma is very important. Many people gets it wrong, So just try to train your eyes by looking to more pictures. It can be pink whites. Brownish pink. That's right. But get the next one for you Worth. What do you think? What do you know about one? So you had a look at the world's have a sneak teach and then we will go to backwards. So can you tell me anything about warts? Um, I think most of us know lowers about warts, anything. Just fire away each one of you guys. One piece of information would be really appreciated. What wasn't already set it in the chart, but my contribution was going to be that you can have a bottle for more words. Yes. Yes, all of you at see Christ. No. Um, hate leaving virus? Yes. And then do you guys know? What are the common ones? I think they love her in the exam. They would ask what are the most common? Um, tires off HPV. It is coming on it. Yes. So there are There are types. You are absolutely correct. Yes. What else. So no 1 to 4 to three. Yes. Yeah, yes. You're getting closer. Increase the number. Okay, so I'm obviously I'm gonna provide them to you, But please just make sure that you know those because I know they love them and even, um, and other specialties, like when you graduate, they and they love these. Um, perfect. Do you know how do they get, um, transferred? Of how people get infected? Anyone has any suggestion? Come around people. No question. You know, you know a lot how do they get spread the ranking calculation off? Want actually correct? Any other way? Um okay. Yes. So yes, the world by themselves. Yes. Skin to skin contact. Yes. Perfect. All of you, Actually. Right now, have you heard of a term called Auto Inoculation? And if you heard of off this time, can you please see What is it? Personal things? Yes. You know what? His daughter inoculation. It's very close to um but you said before, but it's just little bit different. Bye. Anyone knows was autoinoculation Does just say someone How the direct inoculation. Okay, so someone got infected from a friend apartment on anyone, and then they have viral warts on their right arm had been itching. Then after a while, maybe even months and months, they noticed that on the track off the aging they did loved a track of viral warts. Or they spread the warts on their body. Uh huh. Corporatization, actually. Correct. So this is called pseudo Gardner ization. Okay, So do you guys know what is corporatization, if not, please tell me. No, I write. I can see you shaking your head now, so I don't want to go away from the topic. But do you know anything about psoriasis? Just say yes or no. That's, uh, yes. So cognition is a shins, and psoriasis is when you do the corporate phenomenal. When when you when you like to try Teo with with the nail, just move on the on the skin when this can tells. Okay, So all this Eric, unkind of love. Psoriasis. This is called koebner phenomenon. No, this is for what? It's not a really cope nostril. Normal, but this is called pseudo carpenters or pseudo cognizant a shin, which means that this is the autoinoculation. So if you ask you this area and then which is obviously you have warts on this area. But you keep eating around and each around other area than after months and months, or maybe even a year. And then you have viral on that track like, Oh, why this happened. So this is autoinoculation you Come on down, Sudhakar. Been ization. So auto regulation, which means you can, in fact, other areas off yourself. This means so you can affect limbed other like if you're on the left, then goes to the right that go is here and there. That's why we need to be cautious and give you, um, information to the patients to explain things to them. Because if they're not cautious, then it's a disaster. All right. So anyone can see just how can we, um, diagnose it? And I want someone else to say, How can we treat it? Just fire away anything you have? I just wanna hear your thoughts, anything just think about like, how How would you diagnose it? So a lot of you mentioned that this is very walls Immediately. Would you do anything else to diagnose it? Mm, Nothing. Okay, wasn't you've been reading a lot to us a sense, you know, she knows a lot about your sounds like acid in chaos. Yes, correct. So anyone knows how kinetic agents? Yes. Brilliance. And then how would you be? Diagnose it before we start talking about the management? The diagnosis is chronic. Um, yes. Well, that would you do any other thing? In addition to the chemical So clinical includes for dermatology. We do there must copy. Like in medicine. We put a scope in their McDonald's. You, but the did it must be. And then we'll have it. So you would see the portal looking lesion. It has, like, a distinctive features, really things. And if you can see here, um, these dotted areas, especially this is the common one. So you can see these dotted areas that looks like a cauliflower. That's like it's got distinctive futures. It catches the iron once you see it once, you would diagnose it immediately. So one a patient doesn't have. This is this is like, Yes, I know what you have. Just weather coming. Know the common ones? I mentioned them here. Please, please. No, them on. They love them in examines. So 1234 as you mentioned guys and then if you go further, turn 27 29 57. Um, no. Basically, we are talking about the cutaneous wards, and then there are subtypes off the cutaneous. Worse. So we have the common. We have the planter, and, um, you also have the plain words which there tend to be flat on. Then we have the fill it from which, basically their self explanatory. Come on. What's the one that we saw plain wanted? Slice here is and you can see these areas. And then planter on the plantar surface is and they fill it for but can be anywhere. Um, company face is usually affected. Like even, um um, inside the nose. Um, on also in the hands on the bed line as well. Now regarding treatment. So, for instance, it is the what is usually very, very common and school age Children. They went to the GP the GP immediately. Notice this is a wart. What do you think the gp gonna do? A one time treatment that would like they can deliver and immediates treatment. What do you think it's gonna be? Yes. Perfect said cryotherapy. Cryotherapy is, um, one of the treatment options that we use. It's amazing. It's effective. And about poor kids. When they have it, it's just painful, But it's really good treatment. It's crazy. So this is quiet. Not be as you can see why this is an adult. And as you can see here, you just directed exactly on there. Had you ever seen trying therapy down in front of your eyes? Or have you done yourself cryotherapy by any chance? Anyone I have seen an MRI. Dermatology placement. Yeah, I think it was for Ward and then Yeah. Okay. Um, so can you tell us how how was it Did Did they like, um, did as burst or as in one go? Yeah, um, the patients that it was really cold. Yes. I painful patient. Yes, you're correct. So when you do the cryo hurting, obviously there are different machines, but this one on the picture is one of the most common ones on. It's basically liquid nitrogen. So that's why it But there's a cause it just caused burning to the surrounding tissue in and the line to see if possible. If it's Tim Reacher and then it just felt off after after after a while. one of the complications is gonna leave Sometimes a white area in the place. It can be painful afterwards, and obviously it's been from during the procedure. But it is effective. So you just apply it there directly to delusion, as if you are aiming. Um and then you just flying away. That's it. It's nice. It's easy on. But I would suggest for you guys to take the initiative. If you have clinics in the future, just say I want to do cryotherapy. I think they will allow you. There are so many lesions needs cryotherapy on, but they will allow you to do one. Okay, They can just resolve by themselves on def. No. Then, as we mentioned you mentioned guide the topic of treatment. This a sonic I said the emergent cryotherapy. Then again, we can do, um, country for for the lesion you just been the area and also it's commonly than in GP practice. Usually we do not remove force in dermatology, sutures done and GP a practice is they they do it that no anyone knows what this old are. You come on in people's you know it. You heard of older? I'm hoping you heard about that? Yes. And you can most correct. So these also can be applied, but it's and can be used for both and also for, um um can be applied that Sorry. Yes, it can be applied directly there. And the problems with the old are it's the local a complication. It can cause some local reaction from bread nous pain there, but it's also affected. Um, however, it takes long time. Um, for this Richman Okay. No vascular lesions have using any pensions with vascular lesions, management's even family members or anyone friends. Um, that's usually, um um middle and old age. They usually have them like family, friends or anyone. Have you ever seen such thing? Then you would wonder. What is that? It's very, very going. So we will start with my gyn internal, um, so finding, going over there Obviously they are benign. No. What happens is that it's basically a proliferation off the capital blood vessels. And then we call them like, over enthusiastic broad vessels. And then they just developed like this, and then they can increase in size rather quickly. That's why it's a little bit concerning when the patient was referred to dermatology because the lesion is development really quickly. Now, they can lead easily if, um, you know, if the patient picks them up or if there is, um, a minute trauma to the area. They can bleed, especially when we have our patients over there on aspirin or any blood thinning agents. No, Um, it has been shown that it might be also associate it with other conditions such as pregnancy, so these can develop during pregnancy. These, um okay. 90 pinkish color lesions can also be associated with contrast, the pills trauma, an immune compromise. So with me and compromise patient, that can be multiple as well. Um, with trauma, I have seen it commonly actually happens with trauma. Um, patient they like have from when they're gardening or anything. Like banging the there too. Sometimes it can result in such a lesion is just when the healing happens, If you have a group of blood vessels, they are profiting quickly. Then this happens. It's usually painless, but the problem is the growth. It is quick. And I, um, sure, these pictures. So can you see this one? So this isn't you. After two weeks, it's really big for two weeks and four weeks is huge to dust, alarming the patients really alarming. Then they would seek immediate advice. Unfortunately, some patients at this stage, like, where are the two big stays? They tend to pick the lesion, trying to just remove it from the skin, and it starts to bleed, and it gets bigger and bigger. That's one. Now, with, um, diagnosis is the way we diagnosis as any on the legions possible. Clinically. And you can see easily clinically come back. If you are still in doubt, you can do their much as copy. And when you do the dermis copy. Can you see these white lines? Yes. Separating these grow bills. These are linear lines. Okay, so these are really distinctive. You can you can see them, Um, with the, uh, with Fiji? No, um, the cannot can be pink, purple or even dark purple on when they're dark purple. Sometimes they're suspicious, and it's very difficult to exclude. Um, cancerous lesions such as, for instance, melanoma. And today I've removed one Ah, lesion that was measuring seven millimeters percent to me. A suspected melanoma on the right thigh on, But the lesion was really, really dark. Oh, then we knew What is it? But it was really dark. So, um, we had to remove a just to make sure that this is not minimum. Then again, you send it to histology and to find out the results, see a minute differential diagnosis. You know, the important one is a million or take melanoma if they are pink and if they're dark than million, bio means it could be minimal. Um, I also mentioned that they can be multiple and any in compromised patients. Onda also composes are comma when you have an immune compromise patient with these lesions that developed really quickly a letter of dark area, then you should always have the diagnosis off campus Is sarcoma in your mind? You know, I know that it's easy to diagnose, um are are genetically long, but And if you think that there is another diagnosis and then by all means think laterally about other conditions, my syringe um, ato says it's basically, um, bacterials can affection. Now the treatment, um, you just remove the triggering medication, for instance, if they're on aspirin clopidogrel, if possible, to find alternative or not, um, I'll that have been mentioned to be used, but I haven't used it to be honest now, Byetta blockers? Yes, they are mean use, especially on big lesions on bacon use. Um, Tim Algia four. Um, other approaches. You can just, um, curate the area and cauterize it, or there can be just excised on. And there is also a laser, but I haven't seen many people to go for laser civilians. Usually the most common options will be those three the beta blockers, the CNC or the surgical excision. No. Last but not the least Cherry angioma. Anyone knows what it's cherry angioma or seeing cherry angioma. This is my last topic. I'm gonna grow you in this one. It's very easy. Anyone? Come on. Okay, let's see who is here. I'm gonna only you three guys open your covers. All right. So, um, let's see. Did you Becky. Oh, dear. Yeah. Just fire away anything. It's cherry in June. What would you know about Or Heavy? Seen at all before? Um, really, Um, picture is never in person. Yeah, and I know there was a coal camp about Morgan sports. Yes. What else? How do they look? What do they do so. The one that I've seen in pictures, I think tend to be quite small, almost like nodular on. But the because the vascular be lesions, they're always very rare. Ultimate is so bright bread usually, Um but I don't think they cause any problems. From what I've seen, it's not painful or anything for the patient. It just It just exist? Yes. Can they be in a different country? Maybe darker in color or No, I think they can. I go? Yeah, I never say never. You know, with humans, it's difficult to tell, but yeah. Do you think that they can deceive you to be any other skin condition? Because, you know, with, um, skin lesions, there is no black and white, Um, immediately like, this is this. Sometimes you might find difficulty in diagnosing the skin lesions. And then China and drama could make something else. Or it was just definitely. This is just an angel. I'm not too sure, but I think try and dramas have quite like a characteristic it parents that makes it may be difficult to confuse them with anything else. Um, at the same time, with variation. Um, maybe that could be and, uh, the diagnosis that you would confuse it for maybe, like, um, absolutely. So what do you think? If you are confused with the diagnosis? So with skin lesions, there is always one day, you know, since we don't want to get it wrong. First of all, patients might die from a second. It's legal obligations. If you miss it, then you come to the court. What is that? Met diagnosis one day. And I said that everyone talking about TV dermatology. I just can't, Er which one? That is one skin cancer. That everyone is a scared. Oh, it's a killer. Yes, yes. So I'm not saying this. Definitely. You need to make sure that this is not a melanoma, but I'm saying that when we look at the lesions, we have melanoma at the back of our head or mine. We just think melanoma can be a million ascetic. Melanoma can be different colors know, always dark. Um, minimal can be scary looking or can be very settled on. So we just need to make sure like, okay, we are confident this is nothing else. And as I told you, this is a very common lesion. beach area and German, and it's it's very nice, like 75% in people above the age of 75. They would have some of these, um and then they can be multiple or can be, like an ear active form or can be just a few areas. Okay, Um yeah. And normally, just affecting your chest or or back when you examined the patient, you will see that. Do you know, how would we diagnose them so clinically you mentioned any other way? Alina, the demos copy. Um, attention. I don't think you did by all. See, where do you you could do is hers? Yes. So, um so, depending on the lesion, how confidence you are And if you're not confident that this is not a change on it and by all means, if you are trying to exclude any other skin problems such as melanoma or anything, when you saw the patient and you said about something else and then you cannot quiet definitively make sure that this is the right diagnosis, then yes, you can use a skin biopsy or you just excited the lesion and send it for pathology. And so, clinically, you just have a look clinically. And then you use your thumb oscopy. And then for the characteristic features. Okay? And which I have mentioned here it is called lacking or pattern. So, um, so I told you that it can be different colors, so it can be just right. Right? And it can be like purple or dark. Purple? No, the Lackner pattern. Can you see my much? Can you see those? Yes. Yeah, yeah, yeah, Yeah. So those you would see them. They're really, really distinctive. And when you put your democratic like, let's just say 60% or 70%. When you saw the patient, just I bought the patient. And and you're like, Yes, this is cherry angioma. You put your democracy, you show those patterns, you take the history from the patients and you've seen a couple of those on the chest or the back or anywhere that would increase. The likelihood of the diagnosis is you would be, like, almost confident or even confident to say yes. This is China and German. We would not do anything for you. Go home. Um, for we can excite them. A Z I mentioned if they're suspicious lesions, anything suspicious, and you can't make the diagnosis it if it's cancer or not, then you can take a biopsy from it, or you can them excise it and send it to pathology. And also basket. A laser can be used for for this one as well. Okay, cool. Any question about cherry angiomas or any questions at all? No. Yes. And that, girls, wonder mythology, Suspicious lesions. That's what we have. You noticed any suspicious lesions? All right, Thank you so so much doctors way. And, um, if a room participant in the feedback form, uh, that's how you get access to this, Larry. So should direct you to another platform. Cold metal. Um, where you sort of If you don't have an account already, sign up. And then, um, get access to this place. That way if you, uh if he back. Sorry. If your coats don't work for you, I'm just gonna send the link for the, um, people form on the chart books. You guys can access it that way. I think he's so much or just one. Honestly, that, like she was really helpful. There were a lot of things that I had forgotten. Master and really need a revision on. So thank you so much. Problem. My pleasure. And I'm happy to answer questions if you guys have any. If not, um, I'll go help my lunch slash dinner. Yeah. Yeah. Well, for you, Honestly, you've done a lot. Thank you. So you've had a very long day, so good luck, guys. Thank you. No. Yeah. So just to remind everyone we're not going to email out any slides of certificates, they're all gonna be accessible through metal, Which that feedback link should have taken you to the QR code. If anyone's having any difficulties and just national message us on our social media. So live little dancer, I think is our Facebook and then lived. Um, Sock is our instagram, and we can send you the link if you have any issues. Yeah, Thank you, guys. So much for attending. And we've got a couple more lectures covering Mawr undergraduate dermatology that you need to know a spot of, like, a national undergraduate curriculum. So follow us on Instagram and based. Look to see when the next election will be on that. Thank you guys so much. On of I said, feel free to mistress if you have any questions about anything. Thank you