16- skin lesion Flashcards
primary skin lesion (vs secondary)
uncomplicated lesions that represent initial pathologic change, uninfluenced by secondary alterations such as infection, trauma, or therapy.
size difference between macule and patch, or papule and plaque, or a vesicle and a bulla
1 cm in diameter
what commonly affects extensor surfaces of joints, and what impacts flexor surface of joints
flexor: atopic eczema
extensor: psoriasis
what affects palms and soles
erythema multiforme, secondary syphilis eczema. coxsackie rocky mountain spotted fever
Annular macules are observed in
drug eruptions, secondary syphilis and lupus erythematosus.
squamous cell carcinoma
scaly and erythematous but, unlike actinic keratoses, tend have a raised base.
patch, plaque, or nodule, sometimes with scaling and/or an ulcerated center.
Borders are often irregular and bleed easily.
Unlike basal cell carcinomas, the heaped-up edges of a squamous cell carcinoma are fleshy rather than clear in appearance.
actinic keratosis
scaly keratotic patches that are often more easily felt than seen.
A history of significant sun exposure is a risk factor for actinic keratosis.
basal cell carcinoma
plaque-like or nodular with a waxy, translucent appearance, often with ulceration and/or telangiectasia.
Usually there is no associated itching or change in skin color.
Basal cell carcinoma is common on the face and on other exposed skin surfaces but may occur anywhere.
melanoma
Lesions that are growing, spreading or pigmented, or those that occur on exposed areas of skin are of particular concern for melanoma.
dark brown or black.
Slowly spreading irregular outline in the initial phase.
Since not all malignant melanomas are visibly pigmented, physicians should be suspicious of any lesion that is growing or that bleeds with minor trauma.
More than half of melanoma in women occurs on the legs.
percentges of prevalence of skin cancers
squamous: 20%
basal 60%
melanoma 1% (but 60% of deaths)
lichen planus
2-10 mm flat-topped papules with an irregular, angulated border (polygonal papules)- multiple
located on the flexor surface of wrists and and on the legs immediately above the ankles.
Seborrheic keratoses
Elevated hyperpigmented lesions with a well-circumscribed border, stuck-on appearance, and variable tan-brown-black color and are most commonly located on the face and trunk.
different forms of topical steroids
Creams:
- It can be used in nearly any area and therefore most often prescribed.
- It is cosmetically most acceptable.
- It has a drying effect with continuous use, therefore best for acute exudative inflammation.
Ointments:
- petroleum jelly, with little or no water.
- desirable for drier skin and has a greater penetration of medicine than a cream and therefore has enhanced potency.
Lotions :
- contain alcohol, which has drying effect on an oozing lesion.
- useful in the scalp area because they penetrate easily and leave little residue.
Gels
- jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy.
indications for group 1 and 2 potency steroids (strongest)
Psoriasis, lichen planus, severe hand eczema, and alopecia areata.
indications for group 3,4,5 steroids
Atopic dermatitis, nummular eczema, stasis dermatitis, and seborrheic dermatitis.
indications for group 6, 7 steroids (weakest)- hydrocortisone 1%
Dermatitis in eyelids and diaper area, mild dermatitis on face, and mild intertrigo.
The most common side effect of topical corticosteroid is
skin atrophy.
It also can cause hypopigmentation. This is more apparent with darker skin tones.
can topical steroids cause systemic effects?
yes, if high and ultra high potency corticosteroids
Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension and other systemic side effects have been reported.
which tinea need to be treated with systemic antifungal agents? (oral) and with what medication
Tinea capitis- Griseofulvin or terbinafine
Tinea unguium (onychomycosis)- Griseofulvin or itraconazole
Incisional / punch biopsy
Incisional biopsy means taking out a part of the skin lesion
Punch biopsy is a specific incisional biopsy using a cylindrical dermal biopsy tool.
convenient and available from two to eight millimeters in size.
excisional biopsy
involves removing the whole lesion with a two to three millimeter margin, depending on the nature of the lesion.
strong suspicion of malignant melanoma.
shave biopsy
feasible when the lesion is elevated above the surface.
Most widely used treatment for cutaneous squamous-cell carcinomas (SCCs), particularly high risk lesions.
surgical excision
well defined, small (<2mm)
Patients with any nonmelanoma skin cancer greater than two centimeters, lesions with indistinct margins, recurrent lesions, and those close to important structures, including the eyes, nose, and mouth, should be considered for referral for
complete excision via Mohs micrographic surgery, with possible plastic repair.
cosmetically sensitive areas
when is Topical 5-fluorouracil (5-FU) for skin lesions
it is widely used in these diseases when other treatment modalities are impractical and for patients who refuse surgical treatment
when and how is cryotherapy used for skin lesions
Useful for small, well defined, low risk invasive SCCs and Bowen’s disease.
Destroys malignant cells by freezing and thawing.
when is radiation used for skin lesions?
An option for the initial management of small, well-defined, primary SCCs, especially older patients and those who are not surgical candidates.
when is radiation contraindicated for skin lesions?
contraindicated on tumors located on trunk and extremities. These areas are subjected to greater trauma and tension than skin on the head and neck, and they are more prone to break down and ulcerate as a result of the atrophy and poor vascularity of irradiated tissue.
symptoms of prostatitis
include pain (in the perineum, lower abdomen, testicles and penis, and with ejaculation), bladder irritation, bladder outlet obstruction, and sometimes blood in the semen.
Recommended Evaluation of Suspected Benign Prostatic Hypertrophy
A. Presence of classic lower urinary tract symptoms (LUTS).
B. Examination of prostate.
C. Urinalysis.
D. Serum prostate specific antigen (PSA).
G. Serum BUN and creatinine.
Complications of untreated BPH
urinary tract infections
acute urinary retention
obstructive nephropathy
what should min. urinary flow rates be? and what about min. voided volume
15 ml/sec
150 ml
Post-void residual urine volume can be determined by
in-out catheterization,
radiographic methods,
ultrasonography.
The bladder scanner, which can be used in an office,
Behavior modifications to decrease lower urinary tract symptoms:
avoiding fluids prior to bedtime or before going out
reducing consumption of mild diuretics such as caffeine and alcohol
limiting the use of salt and spices
maintaining voiding schedules
Do not take decongestants like Sudafed.
Do not take antihistamines like Benadryl.
which med decreases urinary symptoms in most men with mild to moderate BPH
Alpha-adrenergic antagonists (zosins)
which meds are more effective in men with larger prostates
5-alpha-reductase inhibitors: finasteride and dutasteride.
when should surgery be considered for BPH?
if bladder outlet obstruction is creating a risk for upper urinary tract injury such as:
hydronephrosis, renal insufficiency, or lower urinary tract injury such as urinary retention, recurrent urinary tract infection, or bladder decompensation
or if combo treatment doesnt work
which melanoma is seen more often in dark-skinned people, and typically appears on the palms and soles of feet, including under the nails.
Acral lentiginous melanoma
