Aquifer Case 16: Skin Lesions Flashcards
what is a primary skin lesions?
uncomplicated lesions that represent initial pathologic change, uninfluenced by secondary alterations such as infection, trauma, or therapy
ex: macule, patch, papule, plaque, nodule, tumor, vesicle, bulla, pustule and wheal
what is a secondary skin lesion?
changes that occur as consequences of progression of the disease, scratching, or infection of the primary lesions
what is a macule?
change in the color of the skin; flat
less than 1 cm
what is a patch?
macule greater than 1 cm in diameter
aka flat colored lesion
what is a plaque?
solid, raised, flat-topped lesion greater than 1 cm in diameter
what is a nodule?
a raised solid lesion and may be in the epidermis, dermis, or subcutaneous tissue
generally larger and deeper than a papule
what is a papule?
a solid raised lesion that has distinct borders and is less than 1 cm in diameter
what is a tumor?
solid mass of the skin or subcutaneous tissue; larger than a nodule
what is a vesicle?
raised lesion less than 1 cm in diameter and is filled with clear fluid
what is a bulla?
circumscribed fluid filled lesion that is greater than 1 cm in diameter
what is a pustule?
circumscribed elevated lesion that contains pus
what is a wheal?
area of elevated edema in the upper epidermis
what is the skin cancer screening recommendation?
annual skin cancer screening by full body skin examination by a health care provider is an I recommendation by USPSTF
what features of a skin lesion must be noted?
- associated symptoms
- arrangement of lesions
- distribution of skin lesions
- shape of indivual lesions
- size of lesions `
what are the risk factors for non melanoma skin cancer?
- previous skin cancer of any type gives 36% to 52% five-year risk of second skin cancer
- 80% of lifetime sun exposure is obtained before 18 years of age (single greatest risk factor)
- celtic ancestry
- fair complexions
- people who burn easily
- people who tan poorly and freckle
- red, blonde, or light brown hair
Increasing age - use of coal-tar products
- tobacco use
- soralen use (PUVA therapy)
- male»_space;> female
- living near equator (UV exposure)
- outdoor work
- chronic osteomyelitis sinus tracts
- burn scars
- chronic skin ulcers
- xeroderma pigmentosum
- human papillomavirus infection
what are the risk factors for melanoma skin cancer?
- previous melanoma
- Celtic ancestry
- fair complexion
- burning easily
- tan poorly and freackle
- red, blonde or light brown hair
- early adulthood and later in life
- intense, intermittent exposure and blistering sunburns in childhood and adolescence
- radiation exposure
- melanoma in first or second degree realtive
- familial atypical mole-melanoma syndrome
- male
- living near equator (UV exposure)
- indoor work
- higher incidence in those with more education and/or income
- nonfamilial dysplastic nevi
- large number of benign pigmented nevi
- giant pigmented congenital nevi
- nondysplastic nevi (markers for risk, not precursor lesions)
- xeroderma pigmentosum
- immunosuppression
- previous nonmelanoma skin cancer
- other malignancies
where is eczema usually located?
behind the ears and on flexor surfaces
what does squamous cell carcinoma usually look like?
scaly and red with a raised base usually in sun exposed areas
can be a patch, plaque or nodule +/- scaling and ulceration
borders are usually irregular and bleed easily
heaped up edges are fleshy rather than clear with BCC
what does actinic keratoses look like?
scaly keratotic patches more easily felt than seen
what does basal cell carcinoma look like?
plaque or nodule with waxy, translucent appearance usually with ulceration and/or telangiectasia
usually no itching or change in skin color
what does melanoma look like?
slowly spreading irregular outlines that bleed with minor trauma
what does psoriasis look like?
usually bilateral and involves extensor surfaces of elbows and knees
usually scaly elevated lesions
what does seborrheic keratoses look like?
elevated hyper pigmented lesions with a well-circumscribed border, stuck on appearance and variable tan brown black color
usually on the face and trunk
which fungal infections need systemic antifungals?
tinea unguium (onychomycosis)
tinea wapitis
what is an incisional biopsy?
take out part of the skin lesion
what is an excision biopsy?
remove the whole lesion with a 2-3 mm margin
what is a shave biopsy?
for when the lesion is elevated above the surface
what should be included in a consent form?
- name of procedure
- diagnosis
- risk of procedure
- benefits of procedure
- alternative to procedure
what tests do you do when evaluation BPH?
- examine prostate
- presence of classic lower urinary tract symtpoms
- serum BUN and creatinine
- serum PSA
- urinalysis
how do you treat BPH?
- behavior modification = avoid fluids before bed, reduce consumption of mild diuretics like caffeine or alcohol, limit salt, maintain voiding schedule
- alpha adrenergic antagonist like tamsulosin
5-alpha-reductase inhibitors are more effective in males with larger prostates: finasteride and dutasteride
