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Lesions
Areas of tissue that have been pathologically altered by injury, wound or infection
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Localized lesions
Lesions that affect tissue over an area of a definite size
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Systemic Lesions
Lesions that are widely spread throughout the body
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Primary Skin Lesions
The initial reaction to pathologically altered tissue and may be flat or elevated
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Secondary Skin Lesions
Changes that take place in the primary lesions due to infection, scratching, trauma or various stages of a disease
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Macule
Primary, flat lesion of any size
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Papule
- Primary lesion;
- Solid, elevated
- Less than 1 cm in diameter
- May or may not be pigmented
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Nodule
- Primary lesion;
- Palpable, circumscribed
- Larger and deeper than a papule (0.6-2 cm in diameter);
- Extends into the dermal area
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Tumor
- Primary lesion;
- Solid, elavated
- Larger than 2 cm in diameter
- Extends into the dermal area
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Wheal
- Primary lesion;
- Elevated, firm, rounded
- Localized skin edema (swelling)
- Varies in size, shape and color;
- Paler in the center than its surrounding edges;
- Accompanied by itching
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Vesicle
- Primary lesion;
- Elevated, circumscribed, fluid-filled
- Less than 0.5 cm in diameter
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Pustule
- Primary lesion;
- Small, raised, circumscribed lesion
- Contains pus;
- Usually less than 1 cm in diameter
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Bulla
- Primary lesion;
- A fluid filled vesicle or blister
- Larger than 1 cm in diameter
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Excoriations
- Secondary Lesion;
- Linear scratch marks or traumatized abrasions of the epidermis
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Fissure
- Secondary Lesion;
- Small slit or crack like sore
- Extends into the dermal layer;
- Could be caused by continuous inflammation and drying
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Ulcer
- Secondary Lesion;
- An open sore or lesion
- Extends to the dermis
- Usually heals with scarring
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Depressed Lesions
Secondary leasions caused by loss of skin surface
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Burns - 4 causes
- Thermal
- Chemical
- Electrical
- Radioactive
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First degree burns
Superficial; least serious type of burn; injures only the top layer of skin (epidermis)
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Thermal Burn
First degree burn caused by dry or moist heat
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Sunburn
First degree burn caused by overexposure to the sun
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Erythema
Skin redness; localized affect of a first degree burn
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Hyperesthesia
Acute sensitivity to sensory stimuli (ie Touch, Heat or Cold); localized affect of a first degree burn
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Second-degree burn
Partial-thickness burn; Deep burns that damage both the epidermis and part of the dermis.
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Second degree burn symptoms
Mimic first degree burn symptoms (sensitivity to heat, cold or touch) but may include fluid filled blisters (vesicles or bullae).
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Third Degree Burns
Full thickness burn; Epidermis and dermis are destroyed and some of the underlying connective tissue is damaged, leaving the skin waxy and charred with insensitivity to touch. Underlying bones, muscles and tendons may also be damaged
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Dermatoplasty
Skin grafting; commonly required for third degree burns
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Rule of Nines
- Formula for estimating the percentage of the body surface affected by burns.
- Assigns values of 9% or 18% of surface areas to specific regions.
- Formula is modified for infants and children because of the proportionately larger head size.
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Reason for determining the percentage of body surface affected by burns
IV fluids for hydration are required to replace fluids lost from tissue damage
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Neoplasms
Adnormal growths of new tissue that are classified as benign or malignant
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Benign Neoplasms
Noncancerous growths composed of the same type of cells as the tissue in which they are growing
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Malignant Neoplasms
Composed of cells that are invasive and spread to remote regions of the body.
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Metastasis
Malignant cells from the primary tumor enter the blood and lymph vessels and travel to remote regions of the body to form secondary tumor sites.
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Cancer
The presence of a malignant growth (tumor).
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Abscess
localized collection of pus at the site of an infection.
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Furuncle or boil
a localized abscess that originates in a hair follicle
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Carbuncle
a cluster of furuncles in the subcutaneous tissue with connective channels to the skin surface
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Acne
inflammatory disease of the sebaceous glands and hair follicles of the skin.
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Alopecia
Partial or complete loss of hair resulting from normal aging, an endocrine disorder, a drug interaction, anticancer medication or a skin disease; commonly called baldness.
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Bowen disease
Form of intraepidermal carcinoma (squamous cell) characterized by red-brown scaly or crusted lesions that resemble a patch of psoriasis or dermatitis; als called Bowen precancerous dermatosis.
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Cellulitis
Diffuse (widespread), acute infection of the skin and subcutaneous tissue. Characterized by a light glossy appearance of the skin, localized heat, redness, swelling and occasionally fever, malaise and chills.
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Chloasma
Pigmentary skin discoloration usually occuring in yellowish brown patches or spots.
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Comedo
Typical small skin lesion of acne vulgaris caused by accumulation of keratin, bacteria, and dried sebum plugging an excretory duct of the skin.
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Dermatomycosis
Infection of the skin caused by fungi. A common type of dermatomycosis is called ringworm.
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Ecchymosis
Skin discoloration consisting of a large, irregularly formed hemorrhagic area with colors changing from blue-black to greenish brown or yellow; commonly called a bruise.
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Eczema
Chronic skin inflammation characterized by erytherma, papules, vesicles, pustules, scales, crusts, scabs and possibly itching. Symptoms or exzema may occur alone or in combination.
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Erythema
Redness of the skin caused by swelling of the capillaries. Examples are mild sunburn or nervous blushing.
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Eschar
Damaged tissue following a severe burn.
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Impetigo
Bacterial skin infection characterized by isolated pustules that become crusted and rupture.
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Keratosis
Thickened area of the epidermis or any horny growth on the skin (such as a callus or wart)
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kerat
horny tissue, hard; cornea
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Lentigo
Small brown macules, especially on the face and arms, brought on by sun exposre, usually in a middle-aged or older person. These pigmented lesions are benign.
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Pallor
Unnatural paleness or absense of color in the skin.
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Pediculosis
Infestation with lice, transmitted by personal contact or common use of brushes, combs or headgear.
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Petechia
Minute, pinpoint hemorrhage under the skin. A smaller version of an ecchymosis.
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Pressure Ulcer
Skin ulceration caused by prolonged pressure from lying in one position that prevents blood flow to the tissues, usually in bedridden patients; also known as decubitus ulcer. Most commonly found in skin overlying a bony projection, such as the hip, ankle, heel, shoulder and elbow.
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Psoriasis
Chronic skin disease characterized by circumscribed red patcdhes covered by thick, dry, silvery, adherent scales caused by excessive development of the basal layer of the epidermis. Most commonly found on the scalp, knees, elbows, umbilicus, and genitalia.
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Purpura
Any of several bleeding disorders characterized by hemorrhage into the tissues, particularly beneath the skin or mucous membranes, producing ecchymoses or petechiae.
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Scabies
Contagious skin disease transmitted by the itch mite, commonly through sexual contact. Common areas: the axillae, genitalia, inner aspect of the thighs and areas between the fingers.
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Tinea
Fungal skin infection whose name commonly indicates the body part affeted; also called ringworm.
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Urticaria
Allergic reaction of the skin characterized by the eruption of pale red, elevated patches called wheals or hives.
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Verruca
Epidermal growth caused by a virus; also known as warts. Types include plantar warts, juvenile warts and verereal warts. Can be removed by cryosurgery, electrocautery or acids; may regrow if the virus remains in the skin.
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Vitiligo
Localized loss of skin pigmentation characterized by milk-white patches.
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SKIN TEST - Intradermal
Identifies suspected allergens by subcutaneously injecting small amounts of extracts of the suspected allergens and observing hte skin for a subsequent reaction.
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SKIN TEST - Patch
Skin test that identifies susptected allergens by topical application of the substance to be tested (such as food, pollen and animal fur), usually on the forearm and observing for a subseequent reaction.
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SKIN TEST - Scratch (prick)
Skin test that identifies suspected allergens by placing a small quantity of the suspected allergen on a lightly scratched area of the skin.
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Skin Test
Any test in which a suspected allergen or sensitizer is applied to or injected into the skin to determine the patient's sensitivity to it.
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Biopsy
Representative tissue sample removed from a body site for microscopic examination.
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BIOPSY - Needle
Removal of a small tissue sample for examination using a hollow needle, usually attached to a syringe.
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BIOPSY - Punch
Removal of a small core of tissue using a hollow punch.
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BIOPSY - Shave
Removal of a small slice of tissue by using surgical blade. Used for elevated lesions.
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BIOPSY - Frozen Section (FS)
Ultrathin slice of tissue from a frozen specimen for immediate pathological examination. Commonly used for rapid diagnosis of malignancy after the patient has been anesthetized to determine treatment option.
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Chemical Peel
Chemical removal of the outer layers of the skin to treat acne scarring and general keratoses; also known as chemabrasion. Also used for cosmetic purposes to remove fine wrinkles on the face.
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Debridement
Removal of necrotized tissue from a wound by surgical excision, enzymes or chemical agents. Used to promote healing and prevent infection.
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Dermabrasion
Rubbing (abrasion) using wire brushes or sandpaper to mechanically scrape away (abrade) the epidermis. Commonly used to remove acne scars, tattoos, and scar tissue.
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Fulguration
Tissue destruction by means of high frequency electric current; also called electrodesiccation.
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Cryosurgery
Use of subfreezing temperature (commonly liquid nitrogen) to destroy or eliminate abnormal tissue, such as tumors, warts and unwanted, cancerours or infected tissue.
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Incision and drainage (I&D)
Process of cutting through a lesion such as an abscess and draining its contents.
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Skin Graft
Surgical procedure to transplant healthy tissue by applying it to an injured site. Human, animal or artificial skin can be used to provide a temporary covering or permanent layer of skin over a wound or burn.
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SKIN GRAFT - Allograft
Transplantation of healthy tissue from one person to another person; also called homograft
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SKIN GRAFT - Autograft
Transplantation of healthy tissue from one site to another site in the same individual.
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SKIN GRAFT - Synthetic
Transplantation of artificial skin produced from collagen fibers arranged in a lattice pattern. The recipients body does not reject synthetic skin (produced artificially) and healing skin grows into it as the graft gradually disintegrates.
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SKIN GRAFT - Xenograft
Transplantation (dermis only) from a foreign donor (usually a pig) and transferred to a human; also called heterograft. A xenograft is used as a temporary graft to protect the patient against infection and fluid loss.
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TNM System of Staging
Used to identify the invasiveness of the malignant tumor.
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T (Tumor) number indicates:
Size and invasiveness of the primary tumor.
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N (Node) number indicates:
Indicates the amount of nodal involvement
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M (Matastasis) number indicates:
Indicates the spreading of teh primary tumor to remote regions of the body.
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Basal Cell Carcinoma
- Most common type of skin cancer
- Malignancy of the basal layer of the epidermis or hair follicles
- Commonly caused by overexposure to sunlight
- Locally invasive; rarely matastisize
- Most prevalent in blond, fair-skinned men
- Most common malignant tumor affecting white people
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Squamous Cell Carcinoma
- Skin that undergoes pathological hardening (keratinizing)
- Invasive tumor with potential for metastasis
- Most commonly found in fair-skinned white men over 60
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2 Types of Squamous Cell Carcinoma
- 1. In Situ - comfined to the original site
- 2. Invasive - penetrated surrounding tissue
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Malignant Melanoma
- A neoplasm composed of abnormal melanocytes
- Commonly starts as a darkly pigmented tumor
- Relatively rare but most lethal
- Incidence is growing more quickly than any other type of tumor
- Can matastasize extensively to the liver, lungs or brain
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TUMOR GRADING
Grade 1
- Closely resembles original tissue
- Retains some specialized function
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TUMOR GRADING
Grade 2
- Less resemblance to original tissue
- More variation in shape and size
- Increased mitoses
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TUMOR GRADING
Grade 3
- Only remotely resembles original tissue
- Marked variation in shape and size of tumor
- Greatly increased mitoses
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TUMOR GRADING
Grade 4
- Little or no resemblance to original tissue
- Extreme variation in size and shape of tumor cells
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TNM SYSTEM - T0
No evidence of tumor
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TNM SYSTEM - Tis
- Stage 1
- Tumor is in a defined location and shows no invasion into surrounding tissue
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TNM SYSTEM - T1, T2, T3, T4
Stage 2; T1 small with minimal invasion; T4 large with extensive local invasion into surrounding organs and tissues
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TNM SYSTEM - N0
Regional lymph nodes show no abnormalities
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TNM SYSTEM - N1, N2, N3, N4
Stage 3; Degree of lymph node involvement and spread to regional lymph nodes; N1 is less involvement w/ minimal spreading and N4 is more involvement w/ extensive spreading
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TNM SYSTEM - M0
No evidence of metastasis
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TNM SYSTEM - M1
Stage 4; Indicates metastasis
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