Aquifer Case 16: Skin Lesions

Question 1

what is a primary skin lesions?

Answer 1

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

Question 2

what is a secondary skin lesion?

Answer 2

changes that occur as consequences of progression of the disease, scratching, or infection of the primary lesions

Question 3

what is a macule?

Answer 3

change in the color of the skin; flat

less than 1 cm

Question 4

what is a patch?

Answer 4

macule greater than 1 cm in diameter

aka flat colored lesion

Question 5

what is a plaque?

Answer 5

solid, raised, flat-topped lesion greater than 1 cm in diameter

Question 6

what is a nodule?

Answer 6

a raised solid lesion and may be in the epidermis, dermis, or subcutaneous tissue

generally larger and deeper than a papule

Question 7

what is a papule?

Answer 7

a solid raised lesion that has distinct borders and is less than 1 cm in diameter

Question 8

what is a tumor?

Answer 8

solid mass of the skin or subcutaneous tissue; larger than a nodule

Question 9

what is a vesicle?

Answer 9

raised lesion less than 1 cm in diameter and is filled with clear fluid

Question 10

what is a bulla?

Answer 10

circumscribed fluid filled lesion that is greater than 1 cm in diameter

Question 11

what is a pustule?

Answer 11

circumscribed elevated lesion that contains pus

Question 12

what is a wheal?

Answer 12

area of elevated edema in the upper epidermis

Question 13

what is the skin cancer screening recommendation?

Answer 13

annual skin cancer screening by full body skin examination by a health care provider is an I recommendation by USPSTF

Question 14

what features of a skin lesion must be noted?

Answer 14

1. associated symptoms
2. arrangement of lesions
3. distribution of skin lesions
4. shape of indivual lesions
5. size of lesions `

Question 15

what are the risk factors for non melanoma skin cancer?

Answer 15

1. previous skin cancer of any type gives 36% to 52% five-year risk of second skin cancer
2. 80% of lifetime sun exposure is obtained before 18 years of age (single greatest risk factor)
3. celtic ancestry
4. fair complexions
5. people who burn easily
6. people who tan poorly and freckle
7. red, blonde, or light brown hair
   Increasing age
8. use of coal-tar products
9. tobacco use
10. soralen use (PUVA therapy)
11. male&raquo_space;> female
12. living near equator (UV exposure)
13. outdoor work
14. chronic osteomyelitis sinus tracts
15. burn scars
16. chronic skin ulcers
17. xeroderma pigmentosum
18. human papillomavirus infection

Question 16

what are the risk factors for melanoma skin cancer?

Answer 16

1. previous melanoma
2. Celtic ancestry
3. fair complexion
4. burning easily
5. tan poorly and freackle
6. red, blonde or light brown hair
7. early adulthood and later in life
8. intense, intermittent exposure and blistering sunburns in childhood and adolescence
9. radiation exposure
10. melanoma in first or second degree realtive
11. familial atypical mole-melanoma syndrome
12. male
13. living near equator (UV exposure)
14. indoor work
15. higher incidence in those with more education and/or income
16. nonfamilial dysplastic nevi
17. large number of benign pigmented nevi
18. giant pigmented congenital nevi
19. nondysplastic nevi (markers for risk, not precursor lesions)
20. xeroderma pigmentosum
21. immunosuppression
22. previous nonmelanoma skin cancer
23. other malignancies

Question 17

where is eczema usually located?

Answer 17

behind the ears and on flexor surfaces

Question 18

what does squamous cell carcinoma usually look like?

Answer 18

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

Question 19

what does actinic keratoses look like?

Answer 19

scaly keratotic patches more easily felt than seen

Question 20

what does basal cell carcinoma look like?

Answer 20

plaque or nodule with waxy, translucent appearance usually with ulceration and/or telangiectasia

usually no itching or change in skin color

Question 21

what does melanoma look like?

Answer 21

slowly spreading irregular outlines that bleed with minor trauma

Question 22

what does psoriasis look like?

Answer 22

usually bilateral and involves extensor surfaces of elbows and knees

usually scaly elevated lesions

Question 23

what does seborrheic keratoses look like?

Answer 23

elevated hyper pigmented lesions with a well-circumscribed border, stuck on appearance and variable tan brown black color

usually on the face and trunk

Question 24

which fungal infections need systemic antifungals?

Answer 24

tinea unguium (onychomycosis)

tinea wapitis

Question 25

what is an incisional biopsy?

Answer 25

take out part of the skin lesion

Question 26

what is an excision biopsy?

Answer 26

remove the whole lesion with a 2-3 mm margin

Question 27

what is a shave biopsy?

Answer 27

for when the lesion is elevated above the surface

Question 28

what should be included in a consent form?

Answer 28

1. name of procedure
2. diagnosis
3. risk of procedure
4. benefits of procedure
5. alternative to procedure

Question 29

what tests do you do when evaluation BPH?

Answer 29

1. examine prostate
2. presence of classic lower urinary tract symtpoms
3. serum BUN and creatinine
4. serum PSA
5. urinalysis

Question 30

how do you treat BPH?

Answer 30

1. behavior modification = avoid fluids before bed, reduce consumption of mild diuretics like caffeine or alcohol, limit salt, maintain voiding schedule
2. alpha adrenergic antagonist like tamsulosin

5-alpha-reductase inhibitors are more effective in males with larger prostates: finasteride and dutasteride