CCE-CE-071

CASE INFORMATION

Case ID: CCE-DERM-031
Case Name: Michael Jennings
Age: 52
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S26 – Skin Examination/Screening

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages the patient
1.2 Explores the patient’s concerns, ideas, and expectations
1.3 Provides clear and structured explanations about the skin check, findings, and follow-up
2. Clinical Information Gathering and Interpretation2.1 Takes a structured dermatological history, including sun exposure, family history, and previous skin lesions
2.2 Identifies key risk factors for skin malignancies
3. Diagnosis, Decision-Making and Reasoning3.1 Differentiates between benign and suspicious skin lesions
3.2 Identifies when further investigations (e.g., dermoscopy, biopsy) or specialist referral is required
4. Clinical Management and Therapeutic Reasoning4.1 Provides an evidence-based management plan, including lesion monitoring, biopsy, or excision
4.2 Educates the patient on sun safety, self-monitoring, and preventive measures
5. Preventive and Population Health5.1 Identifies high-risk patients for skin cancer and advises on screening intervals
5.2 Encourages early detection through self-examination and professional follow-up
6. Professionalism6.1 Demonstrates empathy and a patient-centred approach
7. General Practice Systems and Regulatory Requirements7.1 Ensures appropriate documentation and follow-up for suspicious lesions
8. Procedural Skills8.1 Identifies when skin lesion biopsy or excision is indicated
9. Managing Uncertainty9.1 Recognises when to monitor a lesion versus performing a biopsy or referring to a dermatologist
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies suspicious skin lesions requiring urgent intervention

CASE FEATURES

  • Need for structured skin cancer risk assessment, education, and appropriate follow-up
  • Middle-aged man requesting a routine skin check
  • History of significant sun exposure due to outdoor work and hobbies
  • Concern about a new mole on his back

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history.
  2. Outline the differential diagnosis and key investigations required.
  3. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

Michael Jennings, a 52-year-old outdoor landscaper, presents for a routine skin check.

His main concerns include:

  • A new mole on his back that his wife noticed a few months ago.
  • History of multiple sunburns over the years, but no previous skin cancers.
  • Curious if he should be having regular skin checks due to his sun exposure.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Jennings
Age: 52
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known drug allergies

Medications

  • None regularly

Past History

  • Multiple sunburns as a teenager and young adult
  • No previous history of skin cancer

Social History

  • Works outdoors as a landscaper (30+ years of sun exposure)

Family History

  • Father had a melanoma removed at 68 years old
  • Mother had multiple non-melanoma skin cancers (BCCs, SCCs) in her 70s

Vaccination and Preventative Activities

  • Up to date with vaccinations

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, I just wanted to get my skin checked. My wife noticed a mole on my back that wasn’t there before.”

General Information

Michael Jennings is a 52-year-old landscaper presenting for a routine skin check.

  • Feels well, no specific symptoms or concerns other than the new mole.
  • Has never had a full-body skin check before.
  • Works outdoors daily and has had significant sun exposure over the years.

Specific Information

(To be revealed only when asked)

Background Information

  • Has had multiple sunburns, especially as a teenager and young adult.
  • Doesn’t routinely check his moles but wants to be proactive.
  • Has a family history of melanoma (father) and non-melanoma skin cancers (mother).

His main concerns are:

  • “My wife noticed this mole on my back a few months ago, and I have no idea how long it’s been there.”
  • “I don’t know what to look for when checking my skin.”
  • “Should I be worried because my dad had melanoma?”
  • “How often should I have my skin checked?”

Mole Description

(Michael will provide the following details if asked about the mole.)

  • His wife noticed it about three months ago.
  • Located on his upper back, near the shoulder blade.
  • Hard for him to see, so he hasn’t been able to monitor changes.
  • No symptoms – no pain, no itching, no bleeding.
  • Unsure if it has changed in size or colour.

(If the candidate asks the right questions, Michael will recall his wife saying:)

  • “She thought it looked a bit darker than the other moles on my back.”
  • “She wasn’t sure if it had an irregular shape, but she said it caught her attention.”

Sun Exposure and Protection

(Michael will discuss the following details if asked about his sun habits.)

  • Works outdoors daily as a landscaper, often in direct sunlight for long hours.
  • Enjoys fishing and golf on weekends, rarely wears long sleeves for sun protection.
  • Occasionally wears a hat but forgets sunscreen unless it’s very hot.
  • Has had multiple sunburns in the past, including peeling burns as a teenager.
  • Never had a professional skin check before, but is now wondering if he should have regular ones.

Family and Personal Medical History

(Michael will provide the following details if asked about his medical and family history.)

  • Father had melanoma removed at 68 years old, unsure if it had spread.
  • Mother had multiple basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) in her 70s.
  • No personal history of skin cancers, but has had a few moles in the past that were monitored by his GP.

Concerns About Skin Cancer and Prevention

(Michael is open to advice and will ask about prevention if the candidate does not bring it up.)

  • “I know skin cancer is common in Australia, but I don’t know what to look for in my own moles.”
  • “Is there a way to check my back if I can’t see it?”
  • “Should I be checking my skin every month, or is that too often?”
  • “What’s the difference between a normal mole and a dangerous one?”
  • “How dangerous is melanoma if you catch it early?”

Emotional Cues

  • Not overly anxious but wants reassurance about the mole.
  • Interested in learning more about prevention and early detection.
  • Would appreciate clear, practical advice about monitoring his own skin.
  • Will be reassured by a structured approach to the skin check and next steps.

(If the candidate is vague or dismissive, Michael may feel unsure about what to do next.)

Questions for the Candidate

Michael may ask:

  1. “Is this mole something I should be worried about?”
  2. “How often should I have my skin checked?”
  3. “What’s the difference between a normal mole and a dangerous one?”
  4. “What can I do to reduce my risk of skin cancer?”
  5. “What happens if this mole needs to be removed?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

  • Michael will feel reassured and confident in his next steps.
  • He may say: “Thanks, I’ll book regular checks and start using sunscreen more often.”

If the candidate is vague or dismissive:

  • Michael may remain uncertain about whether his mole is concerning.
  • He may not feel motivated to follow through with prevention strategies.

Key Takeaways for the Candidate

  • Take a structured dermatological history, including sun exposure, family history, and risk factors.
  • Assess skin cancer risk, identifying suspicious lesions and need for biopsy or monitoring.
  • Provide education on self-monitoring, sun safety, and regular professional skin checks.
  • Ensure clear follow-up for any suspicious findings.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including sun exposure, family history of skin cancer, history of previous lesions, and patient concerns.

The competent candidate should:

  • Obtain a structured dermatological history, including:
    • Onset and progression of the mole (noticed by his wife 3 months ago, no known changes).
    • Symptoms (no pain, itching, or bleeding).
    • History of previous moles or skin cancer (none removed before, no previous skin checks).
    • Sun exposure history (significant outdoor work, multiple sunburns, inconsistent sunscreen use).
    • Family history of skin cancer (father with melanoma, mother with BCCs and SCCs).
  • Assess the patient’s concerns and expectations, ensuring an understanding of the reasons for the skin check.
  • Identify risk factors for skin cancer, including fair skin, history of sunburns, outdoor occupation, and family history.

Task 2: Conduct a risk assessment for skin cancer and discuss any suspicious lesions requiring further evaluation.

The competent candidate should:

  • Perform a structured skin cancer risk assessment, considering:
    • Fitzpatrick skin type (lighter skin types at higher risk).
    • Cumulative UV exposure (outdoor work, frequent recreational sun exposure).
    • Personal and family history of skin cancer (father’s melanoma increases risk).
  • Identify key features of concerning moles (ABCDE criteria):
    • Asymmetry – One half different from the other.
    • Border – Irregular or poorly defined.
    • Colour – Multiple or uneven pigmentation.
    • Diameter – Greater than 6 mm.
    • Evolution – Any recent changes in size, shape, or symptoms.
  • If lesion is suspicious, recommend dermoscopy, biopsy, or referral to a dermatologist.
  • If lesion is benign but patient is high risk, discuss regular skin checks and self-monitoring.

Task 3: Provide a diagnosis or outline the next steps, including monitoring, biopsy, excision, or referral.

The competent candidate should:

  • Explain the findings clearly and reassure the patient if the lesion appears benign.
  • If lesion is concerning, discuss the need for a biopsy or excision:
    • Excision biopsy for definitive diagnosis if melanoma is suspected.
    • Shave or punch biopsy for non-melanoma skin cancers.
    • Referral to a dermatologist if the lesion is difficult to assess.
  • If lesion is low risk, recommend:
    • Monitoring with photographic documentation.
    • Follow-up in 3–6 months to assess for changes.

Task 4: Educate the patient on sun safety, self-monitoring, and the importance of regular skin checks.

The competent candidate should:

  • Explain the importance of sun protection:
    • Use of SPF 50+ sunscreen daily, even on cloudy days.
    • Wearing protective clothing, wide-brimmed hats, and sunglasses.
    • Seeking shade during peak sun hours (10 AM – 4 PM).
  • Teach self-examination techniques:
    • Check skin monthly using a mirror or help from a partner.
    • Look for new or changing moles and apply the ABCDE rule.
    • Photographic monitoring of moles if needed.
  • Recommend regular skin checks:
    • Annual professional skin checks due to high-risk profile.
    • Immediate review if new or changing lesions develop.

SUMMARY OF A COMPETENT ANSWER

  • Takes a structured history, assessing sun exposure, risk factors, and patient concerns.
  • Uses the ABCDE rule to assess the mole and determines whether further evaluation is needed.
  • Explains findings clearly and provides a structured management plan (monitoring, biopsy, or referral).
  • Educates the patient on sun protection, self-monitoring, and regular skin checks.
  • Provides appropriate follow-up and safety-netting advice.

PITFALLS

  • Failing to assess red flags, such as rapidly changing moles or personal history of suspicious lesions.
  • Dismissing the patient’s concerns without a thorough skin check, leading to missed early skin cancers.
  • Not discussing sun protection and prevention strategies, missing an opportunity for long-term risk reduction.
  • Overlooking the importance of self-monitoring, leaving the patient unsure about what to watch for.
  • Failing to provide a structured follow-up plan, leading to delayed detection of high-risk lesions.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
1.3 Provides clear and structured explanations about diagnosis, prognosis, and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured dermatological history, including sun exposure, family history, and previous lesions.
2.2 Identifies key risk factors for skin malignancies.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between benign and suspicious skin lesions.
3.2 Identifies when further investigations (e.g., dermoscopy, biopsy) or specialist referral is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an evidence-based management plan, including lesion monitoring, biopsy, or excision.
4.2 Educates the patient on sun safety, self-monitoring, and preventive measures.

5. Preventive and Population Health

5.1 Identifies high-risk patients for skin cancer and advises on screening intervals.
5.2 Encourages early detection through self-examination and professional follow-up.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and follow-up for suspicious lesions.

8. Procedural Skills

8.1 Identifies when skin lesion biopsy or excision is indicated.

9. Managing Uncertainty

9.1 Recognises when to monitor a lesion versus performing a biopsy or referring to a dermatologist.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies suspicious skin lesions requiring urgent intervention.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD