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IM - PRECANCEROUS AND CANCEROUS DISEASES OF THE SKIN

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tonystep1's version from 2017-08-16 18:56

CLINICAL FEATURES OF PRECANCEROUS AND CANCEROUS DISEASES OF THE SKIN

Question Answer
Actinic Keratosis 􀂍Also Called Solar Keratosis)Small, rough, scaly lesions due to prolonged and repeated sun exposure // Most commonly seen i n fair-skinned people. Lesions are typically o n the face.
Basal Cell Carcinoma 􀂍BCC)The most important risk factor is sun exposure. // The classic appearance is a pearly, smooth papule with rolled edges and surface telangiectases (3 Ps pearly, pink, papule)
Squamous Cell Carcinoma 􀂍SCC)Sunlight exposure is the most important risk factor. Chronic skin damage and immunosuppressive therapy are also risk factors. // It is typically described as a crusting, ulcerated nodule or erosion
MelanomaThe lesion is a nevi present with some or all of the following features. // Asymmetry // Border irregularity // Color variegation-ranging from pink to blue to black // Diameter greater than 6 mm // Elevation-typically has a raised surface
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DIAGNOSIS & TREATMENT OF PRECANCEROUS AND CANCEROUS DISEASES OF THE SKIN

Question Answer
Actinic KeratosisAlthough the risk of malignancy is low, biopsy is still recommended for lesions to exclude squamous cell carcinoma (SCC) // Treatment options include surgical removal (scraping) , freezing with liquid nitrogen, or application of topical 5-FU for multiple lesions (destroys sun-damaged skin cells).
Basal Cell Carcinoma 􀂍BCC)Metastasis i s extremely rare, but can be locally destructive // Surgical resection is curative.
Squamous Cell Carcinoma 􀂍SCC)The prognosis is excellent if it is completely excised (95% cure rate). Lymph node involvement, however, carries a poor prognosis.
MelanomaExcision biopsy is the standard of care for diagnosis of any suspicious lesion - Acceptable skin margins are 1 to 3 em for most lesions, as determined by depth of invasion. // Early detection is the most important way to prevent death, because prognosis is directly related to depth of invasion.
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MISCELLANEOUS SKIN CONDITIONS

Question Answer
Decubitus UlcersRisk factors include immobilization for any reason, peripheral vascular disease, and dementia. // They typically occur over bony prominences. // The sacrum, greater tuberosity, and ischial tuberosity are the most common sites
PsoriasisThis is a chronic condition characterized by exacerbations and remissions-it improves during the summer (sun exposure) and worsens in the winter (dries skin). // Well-demarcated, erythematous papules or plaques that are covered by a thick, silvery scaling; pruritus is often present // Auspitz􀃩 sign-Removal of the scale causes pinpoint bleeding. // It can involve any part of the body, but the most common areas are the extensor surfaces of extremities (knees, elbows), scalp, intergluteal cleft, palms, and soles. // Pitting of the surface of nails, or onycholysis (distal separation of the nail from the nail bed)
Seborrheic KeratosisThere is no association with sunlight // They can be located anywhere, but are common on the face and trunk. They increase in number with time, and some patients have many of them. // They are slightly elevated plaques, gradually turning darker in color, and appear as if they were "stuck" on the skin
VitiligoChronic, depigmenting condition due to unknown cause; hereditary component is suspected // Sharply demarcated areas of skin become amelanotic-most common on the face // Associated with diabetes mellitus, hypothyroidism, pernicious anemia, and Addison's disease
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TREATMENT OF MISCELLANEOUS SKIN CONDITIONS

Question Answer
Decubitus UlcersLocal wound care (e.g. , for more superficial ulcers) // Wet-to-dry dressings or wound gel for deeper ulcers // Surgical debridement of necrotic tissue // Antibiotics if evidence of infection (e.g., surrounding cellulitis)
PsoriasisTopical therapy - Corticosteroids are the most commonly prescribed first-line agents, but they have adverse side effects with prolonged use // Calcipotriene is a vitamin D derivative that has become a first- or second-line agent. It is very effective in most patients
Seborrheic KeratosisTreatment is not necessary and is only for cosmetic reasons: liquid nitrogen cryotherapy or curettage is effective and easily performed in the office setting
VitiligoTopical glucocorticoids and photochemotherapy are used to promote repigmentation with varying degrees of success.
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ALLERGIC REACTIONS CLINICAL FEATURES

Question Answer
Urticaria (Hives)Findings--edematous wheals (hives) that are fleeting in nature, i.e., they disappear within hours only to return in another location // They blanch with pressure, and may cause intense pruritus or stinging. Lesions get worse with scratching
Angioedemaangioedema usually affects the eyelids, lips and tongue, genitalia, hands, or feet. // characterized by localized edema of deep subcutaneous tissue, resulting in nonpitting, puffy skin with firm swelling that is more tender and "burning" than pruritic
Drug AllergyDermatologic eruptions (most common) // Pulmonary findings // Renal manifestations-e.g. , interstitial nephritis, nephrotic syndrome // Hematologic manifestations-e.g., thrombocytopenia, hemolytic anemia, eosinophilia, agranulocytosis
Food AllergyDermatologic manifestations (most common)-e.g. , pruritus, erythema, urticaria, angioedema // GI manifestations (second-most common)-e.g. , nausea, vomiting, abdominal cramps, diarrhea // Anaphylactic reactions-can affect the respiratory system and can be fatal // Cutaneous manifestations-e.g., angioedema, urticaria
Insect Sting AllergyLocal (nonallergic) reaction is localized swelling, pain, pruritus, and redness, all of which subside in several hours. This is the normal reaction to an insect sting vs -- Large local (allergic) reaction is marked swelling and erythema over a large area around the sting site. Can be confused with cellulitis. It may last for several days, and sometimes presents with mild, systemic manifestations (malaise, nausea). // Anaphylaxis may occur and can be fatal.
AnaphylaxisIt occurs within seconds to minutes after exposure to antigen // It can progress within seconds to minutes to a life-threatening situation characterized by shock or respiratory compromise (airway obstruction, vascular collapse). // Typically, the initial findings are cutaneous, followed by respiratory symptoms.
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TREATMENT OF ALLERGIC REACTIONS

Question Answer
Urticaria (Hives)Treatment involves removal of the offending agent. Antihistamines are effective for symptomatic relief. Systemic corticosteroids may help in more severe cases.
AngioedemaTreatment is similar to treatment of urticaria. Give SC epinephrine for laryngeal edema or bronchospasm.
Drug AllergyDiscontinue the drug (if known) . Give antihistamines for symptomatic relief. Treat as for anaphylaxis if severe.
Food AllergyTreatment for mild reactions is supportive, with administration of antihistamines to lessen symptoms. If the reaction is more severe, treat as for anaphylaxis. Avoid the offending agent.
Insect Sting AllergyTreatment: ice and oral antihistamines for mild local reactions; if severe, treat as for anaphylaxis
AnaphylaxisABCs-Secure the airway; intubation may be necessary // Give epinephrine immediately. Give IV if severe ( 1 /10,000), SC if less severe ( 1 /1,000). // Give antihistamines (both H 1 and H2 blockers) and corticosteroids as well (although they have a minimal effect in hyperacute condition) // Supportive care-IV fluids, oxygen
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