Exam (elaborations)
Medicine 16 Week 7 case summary Family Medicine 16 (68 year old male with skin lesion)
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- Medicine 16
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Medicine 16 Week 7 case summary Family Medicine 16 (68 year old male with skin lesion)
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Family Medicine 16: 68-year-old male with skin lesionUser: Daniel E Castineira
Email: liensdano75@stu.southuniversity.edu
Date: April 2, 2020 5:29PM
Learning Objectives
The student should be able to:
Describe skin lesions with accuracy.
Define terms that describe the morphology, shape, and pattern of skin lesions.
Formulate the treatment principles of topical corticosteroid and local and systemic antifungal agents.
Apply the ABCDE criteria for the evaluation of hyperpigmented lesions as possible melanoma.
Describe common biopsy procedures, including shave biopsy, punch biopsy, and incisional and excisional biopsies.
Discuss the treatment modalities for squamous cell carcinoma.
Describe the importance and methods of prevention of skin cancers.
Develop initial workup and management of benign prostatic hyperplasia.
Knowledge
Primary and Secondary Skin Lesions
Primary skin lesions are uncomplicated lesions that represent initial pathologic change, uninfluenced by secondary alterations
such as infection, trauma, or therapy.
Secondary skin lesions are changes that occur as consequences of progression of the disease, scratching, or infection of the
primary lesions.
Primary Skin Lesions
Macule: A macule is a change in the color of the skin. It is flat, and if you were to close your eyes and run your fingers over the
surface of a purely macular lesion, you could not detect it. It is less than 1 cm in diameter. Some authors use 5 mm for size
criterion. Sometimes "macule" is used for flat lesion of any size.
Patch: A patch is a macule greater than 1 cm in diameter.
Papule: A papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter.
Plaque: A plaque is a solid, raised, flat-topped lesion greater than 1 cm in diameter. It is analogous to the geological formation,
the plateau.
Nodule: A nodule is a raised solid lesion and may be in the epidermis, dermis or subcutaneous tissue.
Tumor: A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a nodule.
Vesicle: A vesicle is a raised lesion less than 1 cm in diameter and is filled with clear fluid.
Bulla: A bulla is a circumscribed fluid filled lesion that is greater than 1 cm in diameter.
Pustule: A pustule is a circumscribed elevated lesion that contains pus.
Wheal: A wheal is an area of elevated edema in the upper epidermis.
Complete list of primary and secondary skin lesions with images.
Skin Cancer Screening Recommendations
The annual skin cancer screening by full body skin examination by health care provider is an I recommendation by USPSTF. I
recommendation means that current evidence is insufficient to assess the balance of benefits and harms of a primary care
clinician performing a whole body skin examination or a patient doing a skin self-examination for the early detection of skin
cancers.
However, the American Cancer Society recommends appropriate cancer screening by a physician, including a skin examination,
during a periodic health examination. The American Academy of Dermatology promotes free skin examinations by volunteer
dermatologists for the general population through the Academy's Melanoma/Skin Cancer Screening Program. It also encourages
regular self-examinations by individuals.
In the context of apparently conflicting recommendations by different organizations and when there is no sufficient evidence for
the benefit or harm of certain recommendations, (like USPSTF I recommendation), the best policy may be to discuss the
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, the patient's choice.
Risk For Skin Cancer
Risk factors for nonmelanoma skin cancers include:
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
8. Increasing age
9. Use of coal-tar products
10. Tobacco use
11. Psoralen use (PUVA therapy)
12. Male >>> female
13. Living near equator (UV exposure)
14. Outdoor work
15. Chronic osteomyelitis sinus tracts
16. Burn scars
17. Chronic skin ulcers
18. Xeroderma pigmentosum
19. Human papillomavirus infection
Risk factors for melanoma skin cancer include:
1. Previous melanoma
2. Celtic ancestry
3. Fair complexions
4. People who burn easily
5. People who tan poorly and freckle
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 are associated with increased risk"
9. Radiation exposure
10. Melanoma in 1st or 2nd degree relative
11. Familial atypical mole-melanoma syndrome (FAMMS)
12. Male > female (slight)
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
While incidence of skin cancer is higher among individuals with fair skin, patients with darker skin are also at risk for developing
skin cancer and should also undergo regular screenings; conduct self examinations; and protect themselves from UV radiation.
Consent Form for Procedures
A procedure consent form aims to document adherence to one of the four principles of medical ethics: respect for autonomy.
Patients can not be viewed as making their own autonomous decisions if they are not adequately informed as to the true nature of
the decision. An autonomous decision to allow providers to perform a procedure requires an understanding of the the reason for
the procedure, the nature of the procedure, as well as its risks, benefits, and alternatives.
Thus, a consent form should contain:
the name of the procedure
the diagnosis
the risks of the procedure
the benefits of the procedure
the alternative to the procedure that was proposed
Patient Education for Protection Against Sun Damage
The key to preventing a skin cancer is to stay out of the sun and not to use a sunlamp. If you are going to be in the sun, you should
wear clothes made from tightly woven cloth so the sun's rays can't get to your skin. You should also stay in the shade when you
can.
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