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We look further down at two quite rare skin diseases, which can suffer from misdiagnosis. Those cases matter and should be given consideration, although they also highlight a broader need in dermatology.
Experience and good use of technology contribute to sound diagnosis, as does careful thought when there is no immediate conclusion. In that situation, knowledge held by patients may bring answers.
Thorough history taking can prove vital during consultation, by helping consultants to rule out, or include similar conditions.
Merkel Cell Carcinoma
Merkel cell carcinoma (MCC) is an aggressive form of skin cancer, which usually occurs in sun exposed areas. There are around 200 cases a year in the UK, of a disease which can spread rapidly around the body and is life threatening.
Early stage MCC is generally asymptomatic and may appear similar to a cyst, acneiform lesion, or lipoma, a fatty lump which grows under the skin. A fair percentage of MCC Cases are initially diagnosed as one of these.
Understanding that a nodule had grown rapidly can be a pointer to better understanding, as can age, immunosuppression, previous history of non-melanoma skin cancer, sun damaged skin, or high sun exposure.
Sound history taking and discussion with a patient can suggest the need for a biopsy, which for MCC will normally be conclusive.
Actinic Prurigo
Another uncommon condition, actinic prurigo, is a form of photodermatosis which appears on sun exposed areas, such as the face, neck, limbs, or lips.
This can develop into a chronic disease, typified by papules, or nodules which become intensely itchy and excoriated plaques which follow. The early stages can however appear similar to other conditions.
Actinic prurigo being confused with urticaria is not unknown, or with common rashes triggered by sun exposure. In adult, or often younger patients, the disease can be similar to types of dermatitis, perhaps with photosensitive links.
A difference is that actinic prurigo tends to be more persistent and more likely to spread to none sun exposed areas. A range of indicators over the longer term are likely, adding to a need to understand the past.
Clear Benefits
Early diagnosis and sound management are important for the conditions mentioned above and for a number of issues within dermatology. What could be a life compromising condition may be far less so with timely treatment.
A consultant should have the time to assess a patient’s history and the knowledge to understand the implications. This applies to unusual dermatologic diseases but can shorten the road to recovery in many cases.
The reality is that diagnosis in dermatology is not always an immediate, finite art. Listening to patients and asking the right questions matters.