module 2 week 2 finale skin cancer Flashcards
(23 cards)
Skin cancer
- The most prevalent form of cancer
- Most rapidly increasing form of cancer
- UVB exposure causes most types
- Protection during the first and second decades significantly decreases the risk
Categories
* Benign
* Malignant
* Melanoma
* Non-melanoma
Criteria of suspicious lesions
skin cancer
Rapid growth over weeks to months
Diameter ≥6 mm
Changes in pigmentation
Inflamed margin
Irregular, ragged borders
Crust formation
Bleeding
Pruritus
Seborrheic keratosis and skin tags
- Seborrheic keratosis
- Most common benign epithelial tumors
- Initially flat, well-demarcated, small, brown pigmented areas
- Over time become raised, darker, with a soft, crumbly surface
- Common in elderly persons
Skin tags (cutaneous papillomas
or fibromas)
- Soft, round, skin color or tan or
brown benign tumors ranging
from 1 mm to 10 mm - These do not warrant medical
treatment - Common in elderly and/or obese
patients - Avoid _______ with manual
therapy/modalities
torsion
Benign: nevi
- Pigmented or non-pigmented lesions that
form from aggregations of melanocytes - Color: brown, black or flesh colored
- Size and thickness varies
- Occur singly or in groups
- Report any changes in size, color, texture
and if bleeding or excessive itching occurs
Pigmented or non-pigmented lesions that
form from aggregations of melanocytes
Benign: nevi
1/3 of cancer in adults is _______ cancer
skin
Most derive from the stratum
______ and stratum _______
* Basal cell carcinoma
* Slow growing tumor
* Does not invade blood or lymph
vessels
* Causes significant local destruction
* Squamous cell carcinoma
* Can be in situ, or invasive
basal
spinosum
Basal cell carcinoma
Basal cell carcinoma
* Presentation:
* Pearly or ivory appearance
* Rolled edges
* Elevated above skin surface slightly
* Usually painless
* Size increase is slow, may ulcerate centrally
* 65% on head and neck, also on trunk (upper back and chest)
* If not detected early, may invade deep tissues
* Once one occurs, more likely to have others
Squamous cell carcinoma
- 2nd most common skin cancer in
Caucasians: sun damaged skin - Affects rim of ear, face, lips, mouth,
dorsum of hand - 80% occur on head or neck
- Presentation: Varies
- Poorly defined margins
- Ulcer, flat red area, indurated plaque or
nodule, may also be crusted - Red – flesh colored, surrounded by
scaly tissue - Don’t usually metastasize but, when
they do… - They metastasize early (to lymph),
begin with inflammation and induration - Systemic symptoms: pain, malaise,
fatigue, weakness, anorexia
Squamous cell carcinoma
Malignant melanoma
- Invasive tumor of melanocytes
- Penetrates the basal lamina and
enter the dermis - Invade the blood and lymphatic
vessels - Easily distributes throughout the
body
Malignant melanoma
Four types:
superficial spreading SSM
nodular
lentigo malignant melanoma LMM
Acral lentiginous melanoma (ALM)
Malignant melanoma
- Superficial spreading (SSM)
- From preexisting mole
- Brown or black, raised patch with
irregular border - Variable pigmentation
- Asymptomatic unless advanced
(itch, bleeding)
Malignant melanoma
2. Nodular
- Presentation :
- Small, suddenly appearing
- Quickly enlarging in both diameter and thickness
- Uniform and dark pigmented papule
- May be grayish
Since the prognosis of melanoma worsens
with the thickness of the lesion, and this
variety of melanoma seems to grow in
thickness faster than diameter, the patients
more often develop metastatic disease with
nodular lesions
Malignant melanoma
3. Lentigo malignant melanoma
(LMM)
- 50-80 years of age
- Less common: 6-10% of
melanomas - Presentation:
- Large, flat freckle
- Irregular border
- Varied pigmentation in single lesion -
brown, blue, black, red, white
Malignant melanoma
4. Acral lentiginous melanoma (ALM)
- 5% of cutaneous melanomas
- Most common form in people with dark skin
- Common in lower pigmented areas, without hair: palms of hands, soles of feet, nail beds, mucous membranes
- Presentation:
- Flat dark brown portions
- Raised bumpy areas that are brown-
black or blue-black
Longitudinal linear lesions:
An irregular nail pigment or history of changing
lesion warrants biopsy as > 50% of melanomas in
black people are found in the nails
Malignant melanoma
* Treatment
- Treatment
- Surgical excision
- Chemotherapy or radiation
- Spreads quickly and insidiously and is life-threatening at early stages.
- Is 100% curable if detected early
- Monthly screenings are suggested
- Use the ABCDE program
ABCDE method to detect melanomas
A Asymmetrical – most early melanomas
are asymmetrical
B Border – most melanomas are uneven
C Color – shades of brown, tan, black can
be first sign of melanoma
D Diameter ≥6 mm, larger than common
moles
E Elevation or evolving – changing in size,
shape, color, bleeding, crusting
Skin assessment components
Describe integrity
Ethnicity
Review sensory status
Moisture
Atrophic changes
Turgor/texture
Observe nail composition/hair quality
Look/feel edema, color and temperature variations
Observe skin folds
Gerontodermatological changes
Inquire about allergies and PMH
Callus
Assess vascular status
Lesions (rashes, scars, bruising, hemosiderin, nevi, etc.)
Skin assessment components
D: describe integrity
* Skin is intact or presents with injury
* Classify
* Describe
E: ethnicity
* Note skin tone and dermatological variants
* Caucasian
* Asian
* African American
* Latino/Hispanic
* Native American
* Pacific Islander
* Other
R: review sensory status
* Intact or altered
* Location
* Specific tests
* Soft tissue status
M: moisture
* Dry or moist to touch
* Dry
* Wet
A: atrophic changes
* Shiny, hairless extremities
* Recommend vascular consult
T: turgor/texture
* Turgor
* Texture
O: observe nail composition and hair quality
* Nails
* Hair
* Both are extensions of the skin
L: look and feel for edema, color and temperature variations
* Edema
* note location and if pitting or non-pitting
* Color
* Tone
* Pigmentation
* Temperature
O: observe skin folds
* Look for breakdown
* Intertrigo
* Yeast/fungal infections
* Foreign objects
G: gerontodermatological changes*
* Normal skin changes with aging
* Risks: skin tears, subsequent bleeding, ulcers
I: inquire about allergies and past medical history
* Are findings exogenous or endogenous in nature
C: callus
* Indicates area(s) of high pressure or repetitive stress/trauma
A: assess vascular status
* Look, listen, feel
* Color changes
* Doppler
* Palpate pulses, capillary refill, ABI
L: lesions (rashes, scars, bruising, hemosideran, nevi, etc.)
* Document location(s), describe presentation, formulate working clinical diagnosis
* Denote anything unusual or suspicious
