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    Review This Flashcard For UV Safety Awareness Month

    July is UV Safety Awareness Month, the best time to educate your patients about UV safety and skin health. See if you can answer this Internal Medicine Core Scripts Flashcard for UV Safety Awareness Month! Then, read up on a mnemonic to help you evaluate the condition. 

    Diagnose This Patient 

    Middle-aged Caucasian woman presents with:

    • Skin lesion on her thigh
    • History of extensive sun exposure as a child with repeated sunburns
    • Flat, asymmetric, pigmented lesion that lacks uniform color and is ~ 8 mm
    • Enlargement of the lesion over the past few months

    What is the diagnosis?

    Did You Diagnose Correctly? 

    Did you diagnose this patient with melanoma? You are correct!

    Melanoma tends to occur more commonly in fair-skinned, light-haired, and freckled people with sunlight exposure, especially those who had severe sunburns in childhood. There has been a 300% increase in incidence of melanoma in the past 40 years. Other risk factors are numerous dysplastic nevi, a family history of melanoma, a high number of ordinary nevi, a congenital nevus, previous personal history, and immunosuppression.

    Melanoma is more common in women < 50 years of age and in men > 50. It commonly presents on the lower legs of women and the backs of men.

    There are 4 types of melanoma: superficial spreading, lentigo maligna, acral lentiginous (palms, soles, nails, and mucosa), and nodular. Nodular is the only 1 of the 4 types that does not exhibit radial growth; instead, it grows deeply vertical, with an increased incidence of early metastasis.

    Use This Mnemonic To Evaluate Melanoma 

    abcde rule for evaluating melanoma

    Remember the ABCDE features of melanoma: asymmetry, border irregularities, color variation, diameter > 6 mm, evolution or enlargement of color change, shape, or symptoms.

    abcde rule for evaluating melanoma

    General prognostic factors include age and sex of the patient (better prognosis in younger men and older women), location of the lesion (extremities have better outcomes than on the trunk). Superficial and nodular types have a poorer prognosis. Specific prognosis factors are depth of the lesion (deeper lesions have a poorer outcome), mitotic index, ulceration, number of regional lymph nodes, and systemic metastases.

    Staging at diagnosis predicts survival. Rates from 2015 are 99% for localized, 65% for regional, and 25% for distant.

    Dx: Excisional skin biopsy
    Tx: Based on staging; surgical excision with wide margins + subdermal fat on the bottom ± sentinel lymph node biopsy

     

    Sharpen your diagnostic skills with a free trial of our Core Scripts Flashcards Premium. You'll be able to answer 36 questions from the Pulmonary Medicine Section of our Flashcards.

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