NPTE Integumentary System

Skin is the largest body organ

15-20% of body weight

Skin: Primary functions

Protection, insulation, holding organs together, sensory, fluid balance, temperature control absorbing UV radiation, metabolizing vitamin D, and synthesizing epidermal lipids

Epidermis

Keratinocytes, Melanocytes, Langerhans Cells (immune cells), Basal Cells

Dermis

Has the most important structures, they are protected. Collagen, Reticulum, Fibroblasts, Macrophages, Lymphatic Glands, Blood Vessels, Nerve Fibers

Meissner's Corpuscles

Detect light touch and texture

** Meissner's and Merkel = both have an M : pain/touch

Meissner: Mice(MEISsner) DISCRIMINATIVE TOUCH all your food in the kitchen at night to find a snack.

Merkel Disks

Detect light touch, texture and pressure

** Meissner's and Merkel = both have an M : pain/touch

Merkels discs - in hairless smooth (glabrous) skin - with a high density in the fingertips

Pacinian Corpuscles

Detect deep pressure and vibration

** Pacinian has a P for Pressure

Pacinian: PACinian --> Think of being under PRESSURE when playing the game PACman

Ruffini Endings

Detect warmth, stretch, deformation within joints

Ruffini: A Dog goes Ruff Ruff → RuffRuffRuffini = Dogs breath is HOT and WARM

Ruffini and Pacinian have "IN" spelled in the words, so they are DEEP in the skin --> located in dermis

Free Nerve Endings

Detect pain, temperature, touch, pressure, tickle and itch

Krause End Bulbs

Detect cold temperature

** Think like SANTA KRAUSE - He comes in the winters so COLD sensation.

Golgi Tendon Organs

Sensitive to muscle contraction force.

Golgi Tendon Organ: TENDON- TENSION in the muscles

Herpes Zoster (shingles)

Dermatomes: Herpes zoster has initial symptoms of pain and paresthesia located to the affected dermatome (unilateral)

- If we apply TENS the pads have to follow the dermatome level.

Integumentary:

-- Present as painful rash with clusters of fluid filled vesicles

-- Mostly unilateral

-- Raised to palpation (<2 mm height)

-- Pink with silvery white appearance

Which CN can be affected?

CN 5, 3, 7, 9, 10

Precautions:

Airborne and contact so you need the mask and gloves.

What CN are affected with Herpes Zoster?

3, 5, 7, 9, 10

Precautions for Herpes Zoster?

Airborne and contact so we need mask and globes

Herpes Symplex HSV-1

Herpes labialis "fever blister")

Found on the lip or skin near the mouth. Generally only infects areas ABOVE the waistline and occurs when oral secretions or mucous membranes infected with HSV come in contact with a break in the skin.

Contact precautions

Herpes Symplex HSV - 2

Also known as genital herpes.

Can cause cold sores but usually does not

Contact precautions

Acne Vulgaris

Formation of comedones, papules, pustules, nodules and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their sebaceous gland).

Acne develops on the face and upper trunk, usually in adolescents.

Scleroderma

Scleroderma is an autoimmune condition characterized by inflammation and fibrosis of many parts of the body, including the skin, blood vessels, synovium, skeletal muscle, and certain internal organs such as the kidneys, lungs, heart and GI tract.

- Rare condition that can impact adults and children, with more incidences in Caucasian women.

CREST

Calcinosis: calcium deposits in the skin

Raynaud's phenomenon: spasm of blood vessels in response to cold or stress

Esophageal dysfunction: acid reflux and decrease in motility of esophagus

Sclerodactyly: thickening and tightening of the skin on the fingers and hands

Telangiectasias: dilation of capillaries causing red marks on surface of the skin

CREST

Calcinosis: calcium deposits in the skin

Raynaud's phenomenon: spasm of blood vessels in response to cold or stress

Esophageal dysfunction: acid reflux and decrease in motility of esophagus

Sclerodactyly: thickening and tightening of the skin on the fingers and hands

Telangiectasias: dilation of capillaries causing red marks on surface of the skin

Systemic Lupus Erythematous (SLE)

Autoimmune disease and is an example of a type III hypersensitivity resulting in a chronic condition.

- SLE is the most common form of lupus

Hallmark presentation is malar rash that looks like a red butterfly across the cheeks and nose

- Skin rash can also appear over the extensor surfaces of the arms, forearms, and hands/fingers

- Arthralgia, arthritis, fever, malaise, photosensitivity, dyspnea, cough and peripheral neuropathy.

Epidemiology:

More common in African-American, African-Caribbean, Hispanic-American, American-Indian, and Asian persons > Caucasians

- Women > Men

- 15-40 years old

Fungal Infection: Ringworm

"Tinea Corporis" is marked by the formation of ring-shaped pigmented patches covered with vesicles or scales that often become itchy

- Transmission includes: person to person, animal to person, or from an inanimate object. It will spread without treatment.

Treatment:

Maintaining clean, dry skin

Applying anti fungal powder or topicals as prescribed

- Griseofulvin - may take weeks to months to complete and should be continued throughout the prescribed dosage. Has many side effects including liver.

Fungal Infections: Athlete's foot

Tinea Pedis causes erythema, skin peeling, and pruritus between the toes that may spread

Treatment:

Maintaining clean, dry skin

Applying anti-fungal powder or topicals as prescribed; if needed, intestinal yeast may be required

Clean, dry socks and adequate footwear

Treatments helps to prevent cellulitis (bacterial infection in the leg - red sores, redness, warmth, flaky skin)

Warts

Benign infection caused by human papilloma virus (HPV) seen on the skin especially hands, fingers, pressure points of feet

Psoriasis general

Silvery, scaly patches on the skin. Common in those who have psoriatic arthritis.

Uveitis

commonly found in patients with ankylosing spondylitis

Urethritis

Commonly found in patients who have Reiter syndrome. Occurs after an infection.

Yeast infections

Usually appear as a bright red rash with tiny macules and papules, can also appear scaly

Pediculosis

Lice. Found on the head, body and genital area

Stages of Lipedema

Stage I: skin surface is smooth, subcutaneous fat thickened, fat structure fine-knotted

Stage II: skin surface uneven, fat structure coarsely knotted

Stage III: Tissue additionally coarser and harder, large-lobed deforming fat lobes

Stage IV: Additional severe lipolymphedema

Venous insufficiency

Refers to inadequate drainage of venous blood from a body part, usually resulting in edema and/or skin abnormalities and ulcerations.

- Carry blood to the heart

- Affect blood going to the heart = blood accumulates in the leg = swelling/edema and wet skin

- ELEVATION HELPS SYMPTOMS

Arterial insufficiency

Refers to a lack of adequate blood flow to a region of the body

- Arteries supply blood to the extremities

- Affect blood supply to the limb = less blood to the limbs = pale/dry skin

- ELEVATION WORSENS SYMPTOMS

Intermittent claudication is typically related to arterial insufficiency - specifically peripheral artery disease. Occurs when blocked arteries reduce blood flow to the muscles during activity and cause pain or cramping in the legs. Subsides with rest

Venous insufficiency: clinical presentation

- Proximal to the medial malleolus VENMO Venous = medial malleolus.

- Irregular, shallow appearance

- Flaking, brownish discoloration - hemosiderin staining

- Wet wound

- Mild to moderate pain

- Elevation decrease pain

- Can be bilateral or unilateral. Bilateral cases often due to systemic issues like chronic venous insufficiency, unilateral cases usually due to DVT or trauma.

Arterial insufficiency: clinical presentation

- Lower 1/3 of leg, toe, dorsum of foot, lateral malleolus ALMA = Arterial Lateral Malleolus

- Smooth edges, well defined, tend to be deep

- Thin and shiny, hair loss, yellow nails, dry skin

Severe pain

- Intermittent claudication

- Elevation increases pain

Intermittent Claudication Scale

Grade I: definite discomfort or pain, but only at initial or modest levels

Grade II: moderate discomfort or pain from which the patient's attention can be diverted

Grade III: Intense pain from which the patient's attention cannot be diverted

Grade IV: Excruciating and unbearable pain

* when making an intermittent walking program they will walk and rest. Pain will increase with walking because there isn't enough blood going into the legs.

Ankle Brachial Index (Ankle SBP/Arm SBP)

Measured using three arteries: Brachial artery for upper extremity and either the dorsalis pedis or posterior tibial artery for the ankle.

> 1.2 = falsely elevated, arterial disease, diabetes

1.19-0.95 = normal

0.94-0.75 = mild arterial disease & intermittent claudication

0.74-0.50 = moderate arterial disease and rest pain

< 0.50 = severe arterial disease

Pressure Ulcers stages

Stage 1: intact skin with non-blanchable redness

Stage 2: Partial thickness wound. Superficial in nature with pink/red wound bed (shallow crater)

Stage 3: full thickness wound. Subcutaneous fat tissue visible but no bone, tendon and muscle exposed (deep crater). Slough/eschar present. Undermining and tunneling may occur. FAT three letters, stage 3

Stage 4: Full thickness with exposed bone, tendon or muscle. Slough/eschar present. Undermining and tunneling often occur.

Unstageable: wound bed covered with slough/eschar (unable to identify the depth)

Deep tissue injury: intact skin purple maroon appearance. Something was injured but the skin was intact, like a bruise.

Stage 1: reddened area that doesn't go away

Stage 2: First 2 layers of skin. Superficial in nature

Stage 3: Fat. Down to fascia

Stage 4: bone

Undermining and Tunneling

Undermining: not as deep as tunneling, can be wider and under the wound bed

Tunneling: deeper and with an exit point.

*Once it gets to a stage it's always that stage, it can improve but the classification remains the same. Can only change the name if it gets worse.

Key points to remember: diabetic ulcers, venous insufficiency ulcers, arterial ulcers and pressure ulcers

Diabetic ulcers: generally located on the weight bearing surface of the foot

Venous insufficiency ulcers: frequently are proximal to the medial malleolus. They are edematous.

Arterial ulcers: generally located on the lateral malleolus, distal toes or areas of trauma

Pressure ulcers: the result of unrelieved external pressure on an area

Wound location and size

Measure: length x width x depth using a disposable ruler

A disposable cotton swab can be used to assess the depth

Wound characteristics

Granulation tissue - viable

Necrotic tissue - non viable

Wound edges

thin or thick (indurated), rolled (epibole)

Periwound

the surrounding of the wound; can be infected

There are 6 drainage types

Transudate: clear, thin and watery

Serosanguineous: Clear tinge of red/brown - thin and watery, normal and indicates the wound is healing

Serous: clear/amber, thin and watery

Sanguineous: bloody, right red fluid - indicates inflamed wound

Pus: yellow/brown - moderate to very thick

Infected pus: hues of yellow, blue, green - thick usually indicating infection (may be normal as WBC, macrophage necrotic cells turn them into slough); drainage can be foul and yet the wound may not be infected.

Transudate

clear, thin and watery

Serosanguineous

Clear tinge of red/brown - thin and watery, normal and indicates the wound is healing

Serous

clear/amber, thin and watery

Sanguineous

bloody, right red fluid - indicates inflamed wound

Pus

yellow/brown - moderate to very thick

Infected pus

hues of yellow, blue, green - thick usually indicating infection (may be normal as WBC, macrophage necrotic cells turn them into slough); drainage can be foul and yet the wound may not be infected.

Delayed wound healing: Maceration

If a wound is too moist, the edges and periwound will become macerated

It is identified as white, friable (refers to tissue that is easily irritated - making it more prone to bleeding or tearing), overhydrated, and sometimes wrinkled skin

Cause: inappropriate wound care, uncontrolled wound drainage, perspiration or incontinence

Delayed wound healing: Dessication

If a wound lacks moisture, the wound and periwound will become dessicated

It is identified as cracked, with dry or flaky edges, and the tissue within the wound bed may be hard or crusty

Cause: inappropriate wound care, inadequate moisture, infection, dehydration

Wound care

Wound cleaning : we clean the wound with a cleaning material

Wound debridement : get rid of what we don't need

Wound dressing : cover them so they heal faster

Selective debridement

Removal of only nonviable tissues from a wound "SEA" (sharp, enzymatic, autolytic)

If 50% or more isn't infected then there is hope to save it.

- Sharp debridement: use of scalpel, scissors, forceps

buse of a topical application of enzymes

- Enzymatic debridement: use of a topical application of enzymes

- Autolytic debridement: use of the body's own mechanism to remove nonviable tissue

Nonselective debridement

Removal of both nonviable and viable tissues from a wound, when infected area is > 50% (can use brief intense TENS for pain relief)

- Wet to dry dressings: application of a moistened gauze over area of necrotic tissue to be completely dried and removed

- Wound irrigation: moves necrotic tissue from wound bed using pressurized fluid

- Hydrotherapy: using a whirlpool with agitation directed towards a wound requiring debridement.

Very mild exudate

Transparent films

Minimal Exudate

Hydrogel dressing (infected), hydrocolloid (non infected)

*hydros for minimal

Moderate exudate

foams

Heavy exudate

calcium alginates, hydrofiber (max capacity)

* calcium and fiber are hard/heavy

Heavy exudate usually indicated infection.

Infected wounds

"HAG" hydrofiber, hydrogels, calcium alginates and gauze

Red

Cover the wound, keep it moist and clean, protect it from trauma

Use a transparent dressing (such as Tagadem or OpSite) over a gauze dressing moistened with normal saline solution, or use a hydrogel, foam or hydrocolloid dressing to insulate and protect the wound.

Yellow

Clean the wound and remove the yellow layer

Cover the wound with a moisture-retentive dressing, such as hydrogel or foam dressing or a moist gauze with or without a debriding enzyme

Consider hydrotherapy with whirlpool or pulsatile lavage

Black

Debride the wound as ordered. Use an enzyme product (such as Accuzyme or Panafil), conservative sharp debridement, or hydrotherapy with whirlpool or pulsatile lavage

For wounds with inadequate blood supply and non-infected heel ulcers, don't debride. Keep them clean and dry

Superficial burn

epidermis; dry/red skin without open areas; heals in 5 days without scarring

Superficial partial thickness burn

epidermis/some dermis; mottled red, intact weeping blisters, blanches to pressure with quick capillary refill, extremely painful; heals in 10-14 days with minimal scarring

Deep partial thickness burn

epidermis/dermis; mixed red and waxy white areas, blanches to pressure with slow capillary refill, decreased pinprick sensation, pain on deep pressure; can take up to 3 weeks to heal, large wounds can be managed surgically. Development of hypertrophic and keloid scars is common.

Full thickness burn

epidermis/dermis/some subcutaneous tissue; dry, rigid and leathery eschar, lack of pain, pressure and temperature sensation; requires more than 3 weeks and will requires surgical closure, may have contractures

Subdermal burn

epidermis/dermis/subcutaneous tissue; charred, dry and exposed deep tissue; requires surgical interventions and amputation/paralysis is possible.

Normal scars

flat and similar to skin color

Hypotrophic scars

sunken and often hyperpigmented appearance due to loss of collagen (rare)

Hypertrophic scar

a healed wound with thick fibrous tissue that remains within the original wound border

Keloid

excessive scar tissue grows outside of the original margins of the wound. Hypertrophy but spread out.

Rule of 9's

Head and neck = 9%

Upper Ex = 9% each

Lower Ex = 9% each

Front trunk = 18%

Back trunk = 18%

Child head = 8.5% (front and back)

Child arm = 4.5% (front and back)

Child thorax = 18% (front and back)

Child legs = 6.5% (front and back)

The trunk is the only one where we can divide it into upper and lower.

If they ask about the glutes remember it's with the trunk and not the legs.

Diabetic Foot Care

- Inspect the skin

Look at the foot everyday to check between the toes and bottoms of the feet

Look for blisters, sores, corns, calluses, red spots, swelling, pain, drainage from sores, broken toenails, cracked skin and odor

- Take care of the skin

Wash the feet gently everyday using lukewarm water (85F) and mild soap. Test the temperature with the hand before washing the feet

Dry the feet well, especially between the toes: can use powder

Do NOT walk barefoot: they could get cuts and wounds

- Check the shoes

Alternate the shoes everyday to allow them to dry and check for small things inside the shoe

Shop for shoes in the afternoon when the feet are the largest

See your healthcare provider

- Have regular appointments

Call your healthcare provider immediately if there is a wound on the foot

Dermatitis

Acute- red open sores

Subacute - scales/scabies.

Chronic - pigmentation.

Irritation of the skin, super common. Can be from allergies. Redness, skin irritation, pururitis.

Allergies is because of any

contact with latex, k tape, poison ivy, chemicals like harsh soaps, anything.

Actinic dermatitis: because of photosensitivity, the sun.

Atopic dermatitis: unknown, could be hereditary, allergic, psychologic disorders, stress/anxiety

Precaution: caution - we need to wear gloves!!

Statis Dermatitis

Blood is accumulated in the lower extremity because of venous pooling/insufficiency

Redness of the skin

Especially in lower extremity due to chronic venous insufficiency

Eczema

Dry skin that needs to be kept moist

Impetigo

Superficial bacterial skin infection (staff aurus)

- Small, yellow, pus filled vesicles

- Honey crust appearance

Especially seen around the mouth in children and elderly

CONTACT precautions - we have to wear gloves!

** we remember this with small yellow pus filled vesicles. Like honey.

Initially starts as small vesicles that are filled with pus, once it dries out it looks like a honey crust appearance.

- Usually seen with children and elderly population because they are immunocompromised and can get a bacterial infection easier.

Cellulitis

Bacterial skin infection but now it's deep

- Staff/strep aurus has gone deep inside the connective tissue.

- HOT RED EDEMATOUS !!

- Can lead to sepsis. First thing is antibiotics and getting rid of the infection. - Can cause lymphangitis, gangrene etc. Advanced lymphedema + bacteria can cause this. Can have a fever as well because it's an infection. Fever/chills

- Can be unilateral or bilateral

Abcess

Cavity filled with pus

Local bacterial infection

Pull of hair

Antibiotics and needs to be drained.

Very painful

Herpes Simplex HSV 1

Cold sores

Occurs on the face and around the mouth

Sore and itchy

CONTACT precaution

** we have to remember the three types of herpes

Vesicular eruptions. Small vesicles erupt around the mouth. "Fever blister" Very sore and itchy. Spreads through contact so we use gloves. These same vesicular eruptions happen in HSV 2 but these mainly happen in the genital area/below the waist.

Herpes simplex HSV 2

Occurs below waist - over genitals

CONTACT precaution / Sexually transmitted

Can happen in newborns and can cause meningoencephalitis which can be fatal

Herpes zoster

The virus is varicella

- Same virus that causes shingles/chicken pox.

- Dorsal root ganglion - it's dormant and then it gets reactivated

- Follows dermatomal pattern

- Spinal nerves and cranial nerves can be affected / dermatomal pattern.

- Unilateral - over trunk/thoracic region

- Very painful

- Airborne and CONTACT precaution

Can affect CN 3: ocular complications. And CN 5: trigeminal neuralgia, sharp shooting pains.

- Postherpetic neuralgia = after the virus has attacked we still have nerve pain that's constant. This can stay for weeks, months or even years after the herpes is done.

Shingles vaccine is recommended in 50+.

When we treat these patients and they have a lot of pain over these regions. Don't give heat to pacify the pain, no hot packs, no diathermy. We can give cryotherapy or TENS conventional mode.

Antiviral medications sometimes corticosteroids.

Which organisms require water to wash off?

C diff and bascilis anthrax - they cannot be killed with sanitizer.

Otherwise only use soap and water if hands are visibly soiled

Wart

Benign infection HPV on the hands, fingers, plantar warts on feet.

- Contact precautions

- We can use ice. Over the counter medications.

What causes fungal infections?

Poor hygiene, sweating, moisture, direct contact

Tinea corpis/ring worm

Little vesicles or scales that form in a ring like pattern. The cure is antifungal creams, making sure there isn't too much moisture or sweat around that area. Exposure to sunlight is good.

CONTACT precautions

Tinea pedis/athletes foot

Fungal infections between the toes. Redness, swelling, erythmea. Exposure to sunlight is good. Keep it dry. Use antifungal creams and ointments

Candidiasis - yeast infection

Can be in the tongue/oral

Foul breath, pain

Genital area

Treat with antifungal creams and ointments

Parasite infections

They require a host body to survive

Pediculosis: head lice

Scabies

Lymes disease

Deer tick

Stage 1: localized stage, early. Redness, fever, chills, headache 5-7 days after the tick bite. Headache, lethargy, myalgias, arthralgias.

Stage 2: Months after the infection infection is disseminated. It's spreading so we have small rashes in the skin. Bulls eye rash/erythema migrans. Now it's not only limited to the muscle ache. Now we can have neurological complications - meningitis, stiff neck, nerve issues, bells palsy. CN issues. Radiculopathies. Can affect the heart - lymes carditis. It is spreading everywhere.

Stage 3: years after the infection. Late persistent. Even though years have passed we still may have joint swelling, achiness, myalgias, arthralgias

Psoriasis (LSP)

Autoimmune

Silvery scales

CONTACT precaution

Common areas to see the scales:

- Elbow

- Knee

- Foldable joints

- SCALP is very common

- Behind the ears

- Even in the genital region

Most patients can get affected with psoriatic arthritis. Usually in the small joints (DIP, PIP, nail changes - yellow nails).

May affect unilaterally, can progress bilaterally. Can have exacerbations and remissions

Cold weather, anxiety, smoking, stress can trigger it

Only management for all autoimmune conditions is corticosteroid medications and stress reduction.

Discoid Lupus Erythematous DLE

Umbrella term

Discoid only affects the skin and it can get worse with sun exposures. Can cause scars. It's not systemic. Just a condition affecting the skin. May have flareups due to sun. Can leave hypo or hyper pigmentation marks. Just know it if it's in an option

Systemic Lupus Erythematous SLE

Characteristic butterfly rash/malar

Chronic autoimmune condition that affects the skin/ can affect all the organs because it's inflammatory. Kidneys, heart, nervous system, GI system etc. can affect anywhere can have myalgia, arthralgia, joint pain. And RAYNAUDS PHENOMENON. They can also have photosensitivity - this will get worse when exposed to sunlight.

Medical management = corticosteroids (always!)

More present under the age of 50 for all of these conditions.

If we are seeing a patient with this condition, in a flare up phase and on long term corticosteroids we need to make sure were aware of osteoporosis. Ask about fractures. Cushing like features. 3-6 months is considered long term steroid use.

Scleroderma: FIBROSIS of the skin

CONTACT precaution

CREST syndrome

- Calcinosis: calcific depositions

- Raynaud's phenomenon: spasms of the small capillaries because of exposure to cold, stress, caffeine

- Esophageal dysmotility: poor mobility of esophagus = leads to GERD

- Sclerodactyly: stiffening and thickening, tightening of skin in fingers and hands. Skin will be very taut and firm. Firmly adhered to the subcutaneous tissue. You can't lift it up. Affects more distally.

- Telangiectasis: spider veins, dilated blood vessels that look like spider veins.

Hands are stiff so we are going to be SLOW prolonged stretching. Functional mobility. We don't want to do aggressive stretching. Splinting is okay. It is symmetrical distal involvement. Low load stretching, functional activities, holding things, combing hair, eating, etc. Work on improving the hand mobility.

Polymyositis

Multiple muscles are inflamed

P for poly P for proximal

The proximal muscles are getting inflamed. This is symmetrical. ((scleroderma was DISTAL and symmetrical))

- All autoimmune conditions have flareups and remissions

- They will have issues with any activity with overhead activities, ADLS because of inflammation and degeneration of the muscles. Swallowing, speaking will be difficult. Can affect respiratory muscles.

If muscles are already inflamed and degenerated we don't want to work them out a lot. Light mobility exercises, no aggressive stretching or strengthening. Lots of interval training and breaks. Muscle fibers are already damaged. Don't make it work more. Interval training, no resistance, no stretching, no strengthening. Autoimmune.

** We don't know how severe it can be due to the flareups.

A patient has this and starts getting skin inflammation over the knuckles and the skin. This is called DERMATOMYOSITIS

Muscle inflammation + skin issue "dermato"

If we exercise them at heavy intensity: rhabdomyolysis can happen. Muscle breakdown. This is a 911 situation

Squamous cell carcinoma

Fast growing

Flat

Metastases fast. This is the problematic one. Can spread to the surrounding tissues, mucosa.

Skin cancers.

Basal cell carcinoma

Slow growing

Raised

Metastases rarely. If it's not immediately diagnosed it's okay

Malignant melanoma

VERY IMPORTANT for exam.

Nevus - a term to describe a mole.

Nevi - many small moles

If someone comes to us with a nevus that's benign, we don't do anything. Just assess it. Make sure that it hasn't undergone changes. If it has then it's a malignant melanoma.

ABCDE

- Asymmetry: it's not symmetrical, can have raised areas and flat areas

- Border irregularity : borders aren't round. They are irregular.

- Color : Color may be black, blue or red. not like a nice brown

- Diameter : greater than 6mm

- Evolution : flat moles will change in color, elevation, etc. have increased in size.

Initially they may look like harmless moles. It takes skill to assess these lesions.

We need to refer them out. Finish the eval and then tell them to make an appt with their dermatologist.

Kaposi's sarcoma

AIDS

Kaposi's sarcoma is caused by the human herpesvirus-8 (HHV-8), also known as Kaposi sarcoma herpesvirus (KSHV).

Most people with HHV-8 don't develop Kaposi's sarcoma.

Kaposi's sarcoma is more likely to develop in people with weakened immune systems (AIDS)

Painful

Seborrheic keratosis

Proliferation of basal cell

Raised lesion

Irritation

Pain

Don't really need to know. But a raised lesion. Not cancerous.

Exposure to the sun