http://www.doctorslounge.com/dermatology/forums/archive.htm
I just found this amazing discussion forum for doctors on DERMATOLOGY
Dr-Lokku » Your first category » Dr Lokku s forum
Interesting Dermatology Reads for Doctors
(10 posts)-
pinastro
offlineKey MasterPosted 1 year ago # -
Nice Mr.pinastro
regards
Dr-lokkuPosted 1 year ago # -
Melanocytic Nevi (Normal Moles)
In general, a benign mole is a small (< 6 mm), well-circumscribed lesion with a well-defined border and a single shade of pigment from beige or pink to dark brown (see photograph). The physical examination must take precedence over the history, though a reliable history that a lesion has been present without change for decades is obviously a comfort.Moles have a normal natural history. In the patient's first decade of life, moles often appear as flat, small, brown lesions. They are called junctional nevi because the nevus cells are at the junction of the epidermis and dermis. Over the next 2 decades, these moles grow in size and often become raised, reflecting the appearance of a dermal component, giving rise to compound nevi. Moles may darken and grow during pregnancy. As white patients enter their seventh and eighth decades, most moles have lost their junctional component and dark pigmentation and undergo fibrosis or other degenerative changes. Still, at every stage of life, normal moles should be well-demarcated, symmetric, and uniform in contour and color.
Posted 1 year ago # -
Atypical Nevi
The term "atypical nevus" or "atypical mole" has supplanted "dysplastic nevus." The diagnosis of atypical moles is made clinically and not histologically, and moles should be removed only if they are suspected to be melanomas. Clinically, these moles are large ( 6 mm in diameter), with an ill-defined, irregular border and irregularly distributed pigmentation (see photograph). It is estimated that 5–10% of the white population in the United States has one or more atypical nevi. Studies have defined an increased risk of melanoma in the following populations: patients with 50 or more nevi with one or more atypical moles and one mole at least 8 mm or larger, and patients with a few to many definitely atypical moles. These patients deserve education and regular (usually every 6–12 months) follow-up. Kindreds with familial melanoma (numerous atypical nevi and a strong family history) deserve even closer attention, as the risk of developing single or even multiple melanomas in these individuals approaches 50% by age 50.
Posted 1 year ago # -
Congenital Nevi
The management of small congenital nevi—less than a few centimeters in diameter—is controversial. The vast majority will never become malignant, but some experts feel that the risk of melanoma in these lesions may be somewhat increased. Since 1% of whites are born with these lesions, management should be conservative and excision advised only for lesions in cosmetically nonsensitive areas where the patient cannot easily see the lesion and note any suspicious changes. Excision should be considered for congenital nevi whose contour (bumpiness, nodularity) or color (different shades) makes it difficult for examiners to note early signs of malignant change . Giant congenital melanocytic nevi (> 5% body surface area [BSA]) are at greater risk for development of melanoma, and surgical removal in stages is often recommended
Posted 1 year ago # -
Blue Nevi
Blue nevi are small, slightly elevated, and blue-black lesions. They are common in persons of Asian descent, and an individual patient may have several of them. If present without change for many years, they may be considered benign, since malignant blue nevi are rare. However, blue-black papules and nodules that are new or growing must be evaluated to rule out nodular melanoma.Posted 1 year ago # -
Freckles & Lentigines
Freckles (ephelides) and lentigines are flat brown spots . Freckles first appear in young children, darken with ultraviolet exposure, and fade with cessation of sun exposure. In adults, depending on the fairness of the complexion, flat brown spots (lentigines), often with sharp borders, gradually appear in sun-exposed areas, particularly the dorsa of the hands. They do not fade with cessation of sun exposure. They should be evaluated like all pigmented lesions: If the pigmentation is homogeneous and they are symmetric and flat, they are most likely benign. Solar lentigines, also called liver spots, can be treated with topical 0.1% tretinoin, tazarotene 0.1%, 2% 4-hydroxyanisole with tretinoin 0.01% (Solage), laser therapy, and cryotherapy.
Posted 1 year ago # -
Seborrheic Keratoses
Seborrheic keratoses are benign plaques, beige to brown or even black, 3–20 mm in diameter, with a velvety or warty surface . They appear to be stuck or pasted onto the skin. They are common—especially in the elderly—and may be mistaken for melanomas or other types of cutaneous neoplasms. Although they may be frozen with liquid nitrogen or curetted if they itch or are inflamed, no treatment is needed.
Posted 1 year ago # -
Malignant Melanoma
General ConsiderationsMalignant melanoma is the leading cause of death due to skin disease. There were 55,000 cases of melanoma in the United States in 2004, with 7900 deaths. One in four cases of melanoma occur before the age of 40. Overall survival for melanomas in whites has risen from 60% in 1960–1963 to more than 85% currently, primarily due to earlier detection of lesions.
Tumor thickness is the single most important prognostic factor. Ten-year survival rates—related to thickness in millimeters—are as follows: < 1 mm, 95%; 1–2 mm, 80%; 2–4 mm, 55%; and > 4 mm, 30%. With lymph node involvement, the 5-year survival rate is 30%; with distant metastases, it is less than 10%. More accurate prognoses can be made on the basis of site, histologic features, and gender of the patient.
Clinical Findings
Primary malignant melanomas may be classified into various clinicohistologic types, including lentigo maligna melanoma (arising on chronically sun-exposed skin of older individuals); superficial spreading malignant melanoma (two-thirds of all melanomas arising on intermittently sun-exposed skin); nodular malignant melanoma, acral-lentiginous melanomas (arising on palms, soles, and nail beds); malignant melanomas on mucous membranes; and miscellaneous forms such as amelanotic (nonpigmented) melanoma and melanomas arising from blue nevi (rare) and congenital nevi.Essentials of Diagnosis
1)May be flat or raised.
2)Should be suspected in any pigmented skin lesion with recent change in appearance.
3)Examination with good light may show varying colors, including red, white, black, and bluish.
4)Borders typically irregularTreatment
Treatment of melanoma consists of excision. After histologic diagnosis, the area is usually reexcised with margins dictated by the thickness of the tumor. Thin low-risk and intermediate-risk tumors require only conservative margins of 1–3 cm. More specifically, surgical margins of 0.5 cm for melanoma in situ and 1 cm for lesions less than 1 mm in thickness are recommended.
Sentinel lymph node biopsy (selective lymphadenectomy) using preoperative lymphoscintigraphy and intraoperative lymphatic mapping is effective for staging melanoma patients with intermediate risk without clinical adenopathy and is recommended for all patients with lesions over 1 mm in thickness or with high-risk histologic features. -Interferon and vaccine therapy may reduce recurrences in patients with high-risk melanomas. Referral of intermediate-risk and high-risk patients to centers with expertise in melanoma is strongly recommended.
Regards
Dr-LokkuPosted 1 year ago # -
Just a Video about Malignant Melanoma
Attachments
-
66383-004-5A43B15E.jpg (18.2 KB, 0 downloads) 1 year old - ep_0137.jpg (34.9 KB, 0 downloads) 1 year old
Posted 1 year ago # -
Reply
You must log in to post.