Dermatology

1. 1. lentigo maligna melanoma (chronically sun-exposed skin of older individuals)
2. 2. superficial spreading malignant melanoma (two-thirds of all melanomas arising on intermittently sun-exposed skin);
3. 3. nodular malignant melanoma ease.
4. 4. acral-lentiginous mela-nomas (arising on palms, soles, and nail beds);
5. 5. ocular melanoma
6. 6. malignant melanomas on mucous membranes.

Annotations:

• a topography that may be irregular, ie, partly raised and partly flata topography that may be irregular, ie, partly raised and partly flatColor variegation is present, and colors such as pink, blue, gray, white, and black are indications for referral. A useful mnemonic is the ABCD rule: “ABCD = Asymmetry, Border irregularity, Color variegation, and Diameter > 6 mm.” “E” for Evolution can be added. The history of a changing mole (evolution) is the single most important historical reason for close evaluation and possible referral. Bleeding and ulcer-ation are ominous signs. A mole that stands out from the patient’s other moles deserves special scrutiny—the “ugly duckling sign.” A patient with a large number of moles is statistically at increased risk for melanoma and deserves careful and periodic examination, particularly if the lesions are atypical. Referral of suspicious pigmented lesions is always appropriate.

Annotations:

• Sentinel lymph node biopsy using preoperative lymph scintigraphy and intra-operative lymphatic mapping for staging melanoma patients with intermediate risk without clinical adenopathy. Patients with lesions over 1 mm in thickness or with high-risk histologic features. Referral of intermediate-risk and high-risk patients to centers with expertise The long-term use of beta-blockers may reduce the risk of prog

Annotations:

• in most patients. Onset after age 30 is very uncommon.

Annotations:

• dermatitis must include pruritus, typical morphology and distribution (flexural lichenification, hand eczema, nipple eczema, and eyelid eczema in adults), onset in childhood, and chronicity. Also helpful are: (1) a personal or family history of atopic disease (asthma, allergic rhinitis, atopic dermatitis), (2) xerosis-ichthyosis, (3) facial pallor with infraorbital darkening, (4) elevated serum IgE, and (5) repeated skin infections.

Annotations:

• In black patients with severe disease, pigmentation may be lost in lichenified areas. During

1. In chronic cases, the skin is dry, leathery, and lichenified. a
2. Acute flares, widespread redness with weeping, either diffusely or in discrete plaques, is common.

Annotations:

• Soap should be confined to the armpits, groin, scalp, and feet. Washcloths and brushes should not be used. After rinsing, the skin should be patted dry (not rubbed) and thenemollient such as Aquaphor, Eucerin, petrolatum, Vanicream, or a corticoste-roid as needed. Vanicream can be used if contact dermati-tis resulting from additives in medication is suspected.p.99

Annotations:

• Atopic dermatitis must be distinguished from seborrheic dermatitis (less pruritic, frequent scalp and face involve-ment, greasy and scaly lesions, and quick response to therapy). Secondary staphylococcal infections may exacer-bate atopic dermatitis, and should be considered during hyperacute, weepy flares of atopic dermatitis. Fissuring where the earlobe connects to the neck is a cardinal sign of secondary infection. Since virtually all patients with atopic dermatitis have skin disease before age 5, a new diagnosis of atopic dermatitis in an adult over age 30 should be made cautiously and only after consultation.p.99