How do I prepare for the Membership of the Royal College of Physicians (MRCP) dermatology exam?

MRCP Dermatology Preparation Strategy

Focus your preparation on British Association of Dermatologists (BAD) guidelines, as these represent the authoritative, evidence-based resources most relevant to MRCP dermatology content. 1

Core Resource Framework

Primary Resources

• BAD guidelines are your foundation - these are NHS Evidence-accredited and follow rigorous AGREE methodology for guideline development 1
• BAD guidelines provide strength of recommendations (A-E) and quality of evidence ratings (I-IV), which mirrors the evidence-based approach tested in MRCP 1
• These guidelines cover the common dermatological conditions frequently tested in postgraduate examinations, including contact dermatitis, basal cell carcinoma, and squamous cell carcinoma 1

High-Yield Clinical Conditions

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) - this is a critical emergency topic:

• Master the SCORTEN prognostic scoring system 2
• Know the immediate management steps: discontinue culprit drugs, calculate body surface area involvement using Lund and Browder charts, assess airway patency with anaesthetic involvement 2
• Understand the investigation panel: full blood count, C-reactive protein, urea and electrolytes, liver function tests, coagulation studies, mycoplasma and chlamydia serology, HSV swabs 2
• Recognize admission criteria: >10% BSA epidermal involvement, relevant comorbidities (malignancy, previous stem cell transplant), or need for ventilation 2

Melanoma staging and prognostic factors:

• Breslow thickness, ulceration status, and mitotic rate are the critical pathology parameters 2
• For stage III disease, know that number of metastatic nodes and clinical nodal status (nonpalpable vs. palpable) are most important predictors 2
• For stage IV disease, site of metastasis and elevated LDH are the significant predictors 2
• Sentinel lymph node biopsy status is the most important prognostic factor in localized melanoma 2

Basal Cell Carcinoma (BCC) - understand the clinical variants:

• Recognize morphological presentations: nodular, cystic, superficial, morphoeic (sclerosing), keratotic, and pigmented variants 3
• Identify warning signs of aggressive behavior: poorly defined clinical margins, rapid growth, neurologic symptoms, high-risk locations (central face, eyelids, periorbital skin, nose, lips, ears) 3
• Know that basosquamous carcinoma has higher metastatic potential than typical BCC 3
• Risk factors include fair skin, red/blond hair, light eye color, extensive sun exposure in childhood, immunosuppression, and previous radiation therapy 3

Study Approach

Systematic Learning Method

• Use the BAD guideline structure to organize your knowledge - each guideline follows a consistent format with clear recommendations and evidence levels 2
• Focus on strong recommendations (most people should receive the intervention) versus weak recommendations (consider pros/cons for individual patients) 2
• Pay attention to the GRADE methodology used in BAD guidelines from 2016 onwards, as this reflects modern evidence-based medicine principles tested in MRCP 2

Clinical Examination Skills

• Practice systematic dermatological assessment: record vital signs, assess airway patency, examine respiratory system, examine skin for target lesions, atypical targets, purpuric macules, blisters, and epidermal detachment 2
• For any skin lesion, document: Breslow thickness, ulceration status, mitotic rate, margin status, satellitosis, and Clark level 2
• Master body surface area estimation using standardized charts 2

Common Pitfalls to Avoid

• Don't underestimate BCC - while it rarely metastasizes (<0.1%), it causes substantial local destruction if untreated, and aggressive histologic subtypes recur more frequently 3
• Don't miss SJS/TEN airway compromise - early involvement of paediatric anaesthetist or intensivist is critical, with immediate availability of difficult intubation equipment 2
• Don't forget multidisciplinary team involvement - SJS/TEN requires coordinated care from dermatology, burns, intensive care, ophthalmology, infectious diseases, and other specialties 2

Evidence Quality Recognition

• Understand that BAD guidelines undergo peer review by the Therapy & Guidelines subcommittee and consultation with all relevant stakeholders including patient groups 2
• Guidelines are updated every 5 years or more frequently for fast-moving topics 2
• The consultation process includes BAD members, British Dermatological Nursing Group, and Primary Care Dermatological Society 2