Case V

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Senir – Yap Internal Medicine 1 Approach to Patient with Skin Disorder

CC: enlarging nodule over her left infraorbital area HPI • • • (-) pain Nonitchy Some bloody discharge recently 6/14/12 .o.History Female patient. 85 y.

History PMHx • pigmented papule a few years ago which grew slowly in size and became more raised Social Hx ROS 6/14/12 .

• 6/14/12 .Physical Exam: 2 cm firm nodule with central ulceration covered by brownish scab • Appearance: pearly with rolled border & surrounding fine telangiectasia.

3. 4.GUIDE QUESTIONS 1. What are your differential diagnoses? What is your working impression? What salient clinical features support your working impression? How do you compare this disease with the other differential diagnoses? What are the common risk factors for this condition? What is your management plan? What particular treatment would you advise for such an anatomical site & why? 2. 5. 6/14/12 . 6.

SCC 3. Nodulas ulcerative basal cell carcinoma 2. Sweet syndrome 6/14/12 .Differential Diagnosis 1.

translucent nodule with a small central ulceration and few surface telangectasia Rodent ulcer 6/14/12 . asymptomatic. shiny.Nodular ulcerative basal cell carcinoma Single.

epidermis) Nonmelanoma type skin ca Austosomal dominant MC type of skin cancer • 75% of skin cancer is bcc (ACS) Incidence: Men > women ≥40 • < 35 tend to be more aggressive 6/14/12 .BCC Papulonodular skin lesion • Adnexal tumor (pluripotent cells.

BCC Presentation look only slightly different than normal skin may appear as skin bump or growth: • • • Pearly or waxy White or light pink Flesh-colored or brown some cases the skin may be just slightly raised or even flat. 6/14/12 .

rolled. Some are pigmented→ looks like a mole with a pearly border Another type is flat and scaly with a waxy appearance and an indistinct border.  6/14/12 . pearly edge and small visible blood vessels. All BCC types → tendency to bleed with minimal or no trauma.BCC Presentation MC appearance • • • • may have a translucent.

BCC Presentation Other considerations: A skin sore that bleeds easily A sore that does not heal Oozing or crusting spots in a sore Appearance of a scar-like sore without having injured the area Irregular blood vessels in or around the spot 6/14/12 A sore with a sunken area in the .

BCC Pathophysiology starts in epidermis slowly and is painless Regularly exposed on sunlight (UV rays) • • • Rarely spreads if left untreated may grow into surrounding areas and nearby tissues and bone. 6/14/12 .

Risk Factors Chronic sun exposure Repeated sunburns (past or present) A suppressed immune system HIV disease Ionizing radiation used for acne in the 1940's Fair skin freckle or burn rather than tan 6/14/12 .

Diagnostic technique Inspection biopsy 6/14/12 .

Management 6/14/12 .

Treatment Excision Curettage and electrodesiccation Surgery (Mohs surgery) Cryosurgery Radiation Skin creams with the imiquimod or 5-flourouracil 6/14/12 .

Untreated • Spread to surrounding structures – nose. ears 6/14/12 .eyes.

Prevention Sunscreen ≥ 15 spf 6/14/12 .

p 330 Harrison’s Internal medicine 17th ed.nlm.about.References 6/14/12 .

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