CONDITIONS OF THE INTEGUMENTARY SYSTEM

SKIN CANCER
- Benign Tumors
- Precancerous conditions
- MAlignant tumors

1. Seborrheic Keratosis (Benign)

- Hereditary benign proliferation of basal cells occurring most frequently after
middle age
- present as multiple lesions on the chest, back, and face
CHARACTERISTICS:
aPPERANCE: Waxy, smooth, or raised lesions
COLOR: varies from yellow to flesh tones to dark brown or black
SIZE: varies from barely palpable to large verrucous (WART-LIKE) plaques
- These tumors are usually left and untreated unless they each or cause pain
- chiro therapy with liquid nitrogen is an effective treatment

2. Actinic Keratosis (Precancerous)

- Skin disease resulting from many years of exposure to the sun's uv rays
- appears on chronically sun-exposed areas of the body examples are the face,
ears, lower lip, bald scalp, dorsal of hands
CHARACTERISTICS:
Appearance: A well-defined, crusty, or sandpaper lite patch or bump
Color: maybe light or dark, Tan, pink, red, or a combination of these, or it may be the same
color as the skin
Texture: the scale or crust is horny, dry, and rough, it is often recognized by touch rather than
sight

Epidemiology: Affects nearly 100% of the older white population. it is most common in fair
complexioned, blue or green eyed, middle-aged men with a history of sun exposure (solar
radiation).
- There is a known risk of malignant degeneration and subsequent metastatic potential in
neglected lesions
- almost half of the estimated 5 million current cases of skin cancer began as actinic
keratosis lesions

TREATMENT:
● 5-Fluorouracil (Efudex)- A topical antimetabolite that inhibits cell division comma or
masoprocol cream
● Cyrosurgery Using liquid nitrogen
● Curettage by electro desiccation( superficial tissue destruction through the use of bursts
of electrical current)
● sun protection factor (SPF)- spf 15 sunscreen 30 to 60 minutes before going outside
- spf 30 is recommended for people of fair complexion
 -sunscreens are not recommended for infants under 6 months of age
-infants should be kept out of the sun or shaded from it comma fabric with a tight
weave , such as cotton , is suggested
3. Bowen Disease (PRecancerous)
- Can occur anywhere on the skin ( exposed and unexposed areas) or mucous
membranes ( especially the glans penis in uncircumcised males)
ERYTHROPLASIA OF QUEYRAT
- it presents as a persistent , brown to reddish brown , scaly plaque with
well-defined margins
- often the person has a history of arsenic exposure in youth
- Multiple lesions have been associated with an increased number of internal
malignancies and therefore require close follow-up
- treatment is with surgical excision and topical 5-fluorouracil

4. Basal Cell Carcinoma

RISK FACTORS
● Prolonged sun exposure and intermittent sun exposure- the most common
causes
● Immunosuppression
- Organ transplant recipients- squamous cell carcinoma
- hiv-positive patients- basal cell carcinoma
● genetic predisposition- with defects in dna replication and repair ( xeroderma
pigmentosum)
● site of vaccination- rarely
● immunosuppressed organ transplant recipients are more likely to develop squamous
cell carcinoma whereas hiv-infected adults are far more likely to have basal cell
carcinoma
CHARACTERISTICS
● Typically has a pearl a or ivory appearance , has rolled edges , and is slightly elevated
above the skin surface , with small blood vessel on the surface- telangiectasia
● usually painless and slowly increases in size and may also rate centrally
● more than 65% of basal cell carcinomas are found on the head and neck. other
locations are the trunk especially the upper back and chest
TREATMENT
a) Mohs Micrographic Surgery- Gold standard treatment , in which the specimen is excised
, frozen section , and examined for positive margin
b) Irradiation- Used if the tumor location requires it in order or debilitated people who
cannot tolerate surgery
- generally contraindicated in person less than 50 years of age because of the risk
of recurrence and the development of secondary radiation induced tumor of the
skin
c) Cytokine therapy- including interferon and interleukin , is a type of systemic
immunotherapy used to treat skin cancer
5. SQUAMOUS CELL CARCINOMA
- Second most common skin cancer in white individuals , usually arising in sun damaged
skin , such as the rim of the ear , the face , the lips and mouth and , the dorsum of the
hands
- it is a tumor of the epidermal keratinocytes and rarely occurs in dark skinned people
- TWO TYPES:
a) In situ- Is usually confined to the epidermis but may extend into the dermis
- common premalignant skin lesions associated with in situ carcinoma are
actinic keratosis and bowen's disease
b) Invasive - infiltrate surrounding tissue
- Can arise from premalignant lesions of the skin including sun-damaged
skin , actinic dermatitis , scars , whitish discolored areas (leukoplakia),
radiation-induced keratosis , tar and oil keratosis , and chronic ulcers and
sinuses
RISK FACTORS
● Cumulative overexposure to uv radiation (eg. outdoor employment or residence in a
warm , sunny climate)
● Burns
● presence of premalignant lesions- actinic keratosis or bowen's disease
● radiation therapy
● ingestion of herbicides containing arsenic
● chronic skin irritation and inflammation , exposure to local or carcinogens (tar)
● hereditary diseases such as xeroderma pigmentosum and albinism
● organ transplant recipients
● warily , on site of a smallpox vaccination
● More difficult to characterize than basal cell tumors
● the squamous cell tumor has poorly defined margins , because the edge blends into the
surrounding sun-damaged skin
● please type of carcinoma can present as an ulcer , a flat red area , a cutaneous horn ,
an indurated plaque , or a nodule
● It may be read to flash colored and surrounded by scaly tissue
● more than 80% office , cell carcinomas occur in the head in the neck region

MARJOLIN ULCER
- Dr.Jean Nicholas MArjolin first describe the occurrence of ulcerative lesions within the
scar tissue in 1828
- Term given to aggressive epidermoid tumors that arise from areas of chronic injury and
for me squamous cell carcinomas
- shield burns wounds are common sites , but any chronic wound can transform into
malignancy

6. MALIGNANT MELANOMA
- Serious form of skin cancer
- the melanomas occur most frequency frequently in the skin but can also be found in the
oral cavity , esophagus , anal canal , vagina , or meninges or within the eye
- associated with intensity > duration of sunlight exposure
- levy that are changing or a typical , especially if greater than 50
- can cause pain , swelling , bleeding or sensation of itching , burning

1. Superficial spreading melanoma

- most common type of melanoma and accounts for 70% of cutaneous
melanomas, most commonly diagnosed between 20 and 60 years of age
- usually arises in a pre-existing mole and present as a brown or black , rice patch
with an irregular border and variable pigmentation ( red , white , and blue ,
brown- black and black-blue)
- usually asymptomatic , but in advanced lesions , itching and bleeding may occur

2. Nodular Melanoma
- most aggressive form in can be found on any part of the body with no specific
site preference: men 60 years of age and older affected more often than women
- it is often described as a small , suddenly appearing but quickly and lodging ,
uniformly and darkly pigmented papule (may be grayish)
- Accounts for approximately 15% of the cutaneous melanomas
- Please type in which the dermis and metastasizes early

3. Lentigo maligna melanoma

- Is a less common type of lesion occurring predominantly in the 52 18 years old of
age group , accounting for 10% of cutaneous melanomas
- looks like a large (3 to 6 cm), lat freckle with an irregular border containing
buried pigmentation of black , brown , blue- black , red , and white found in a
single lesion
- these lesions in large and became progressively irregular pigmented overtime .
approximately one-third develop into malignant melanoma and therefore bear
careful watching

4. Acral lentiginous melanoma

- Relative uncommon form accounting for 5% of all cutaneous melanomas but
most common form of melanoma and dark skin people such as africans and
asians
- these lesions usually have flat , dark brown portions with rays bumpy areas that
are predominantly brown- black or blue- black
- most common areas include low- pigment sites were hair is absent , such as the
palms of the hands , soles of the feet , nail beds of fingers and toes , and mucous
membranes
RISK FACTORS
- All who have blonde or red hair , fair skin , and blue eyes are prone to sunburn , and are
off celtic or scandinavian ancestry
- more prevalent among whites of high socioeconomic status who work indoors and tend
to take short vacations with intense sun exposure than in people who are at risk of
chronic sun exposure
- excessive exposure to uv radiation through sunlight or tanning devices, specially
intense intermittent exposure , and immune suppression from chemotherapy
- there are some reports that airline pilots and flight crews exposed to ionizing
radiation of cosmic origin have increased rates of malignant melanoma
- increased cancer risk among off light personal has been previously noted ,
including breast cancer among flight attendants and acute myeloid leukemia among
pilots

PREVENTION OF SKIN CANCER

SUNAWARE GUIDELINES FOR PREVENTION OF SKIN CANCER
A- Avoid unprotected exposure to sunlight: avoid peak hours of sunlight (10 AM-4PM: sick
shade: never use tanning deviceS
W- We're close-WOVEN protective clothing , including long sleeves shirt , pANTS ,
wide-brimmed hat and approve protection glasses every day of the year
A- apply sunscreen of spf 15 or 30 or greater when there are risk factors or a previous history
of a skin cancer) 20 minutes before going outdoors to all exposed skin; reapply every 2 hours ,
especially if exposed to wind , water or perspiration
R- Routinely examine your skin and have a healthcare provider evaluate any skin changes
E- educate family and community children about this guidelines: protect education yeah

1. ATOPIC DERMATITIS
- Chronic inflammatory skin disease. It is the most common type of frequently
already present during first year of life affecting more than 10% of children
- Often associated with increased levels of serum immunoglobulin E
- AD is considered as early manifestation of atopy that appears before the
development of allergic rhinitis or asthma
- ( the word at to pick from the atopy refers to the group of three associated
allergic disorders- asthma allergic rhinitis or hay fever- in atopic dermatitis)
-( Where is usually a personal or family history of allergic disorders present , and
atopic dermatitis is often associated with food allergies as well
- AD Begins in a form of a red , aging , cresting rush classified as acute dermatitis. as the
child grows , the chronic form of dermatitis result in skin that is dry, t thickened, and
brownish gray in color (lichenified)
- Xerosis and pruritus are the major symptoms of atopic dermatitis and cause the greatest
morbidity with severly excoriated asians , infection , and scarring
 _ viral , bacterial , and fungal secondary skin infection may cause further
changes in the skin
_ is staphylococcus aureus is the most common bacterial infection
- Daily care( hydration and lubrication) Off the skin is important, and application
(2-3x daily) of emollient to prevent Evaporation and retain moisture should be
recommended
- Dreams or ointments containing petrolatum maybe , and those that contain urea
or lactic acid improve the bonding of water in the skin and prevent evaporation
-

STAGES OF DERMATITS
1. Acute- read , using , cresting rush , extensive erosion , exudate , pruritic vesicles
2. Subacute- Erythematous skin , scaling , scattered plaques
3. Chronic- Chicken skin , increased skin marking secondary to scratching ,
post-inflammatory pigmentation change

2. CONTACT DERMATITIS
- Can be an acute or chronic skin inflammation caused by exposure to a chemical ,
mechanical , physical , or biological agent
- it is one of the most common environmental skin diseases occurring at any age
- as people age , they may develop delayed cell mediated hypersensitivity to a variety of
substances that come in contact with the skin
Common sensitizers include:
- Nickel ( Found in jewelry and many common foods)
- Chromates ( used in tanning leathers)
- Wool fats ( particularly lanolin found in moisturizers and skin cream)
- Rubber additives (latex
- Topical Antibiotics (typically neomycin and bacitracin)
- Topical anesthetics, such as benzocaine or lidocaine
- Silicone
a) Therapies is most likely to see this reaction in a sensitized person with an
amputation using a silicon type of interface in a prosthetic device ( designed to
reduce shear, decrease a repetitive stress, and absorb shock
b) silicone sheets used for scar reduction in the post-burn population may also
result in an episode of contact dermatitis
- Intense pruritus ( itching), erythema ( redness), and oedema of the skin to two days
after exposure in previously sensitized persons
- clinical manifestations begins at the site of exposure but then extend to more distant
sites
- this condition may progressed to vesiculation , using or watery discharges , crusting ,
and scaling
- primary treatment is removal of the offending agents: treatment of the skin is secondary
3. STATIC DERMATITIS
- The development of areas of very dry , thin skin and sometimes shallow ulcers of the
lower legs primarily as a result of venous insufficiency
- the client commonly has a history of varicose veins or DVT
- The process of stasis dermatitis begins with:
● Edema of the leg as a result of his load venous return
● as the venous insufficiency is continuous , the tissue becomes hypoxic from
inadequate blood supply
● this poorly nourished tissue begins to necrose
● the lesion are very slow to heal because of a lack of oxygenated blood
● gait training is an important part of compression , the gold standard , in the
treatment of stasis dermatitis
● gradient compression erupts and stockings work well in the recumbent position,
but ambulation with the muscular contract relax cycle pushes the venous return
within the compressive field

4. INCONTINENCE-ASSOCIATED DERMATITIS
- Formerly known as a diaper rash: describe skin damage resulting from urine or feces
exposure
- some health care providers refers to this condition as “peri-rash” ( affecting the
perineum between the anus and external genitalia), but the term IAD is recommended
because usually a larger area than the perineum is affected
- IAD is clinically and pathologically distinct from pressure ulcers and intelligence
dermatitis or dermatitis of the skin folds
- ad is characterized by redness with or without blistering , erosion , or loss of skin barrier
function as a result of chronic or repeated exposure to urine or fecal matter

5. ROSACEA
- A common chronic facial disorder of middle-aged and older people affecting
approximately 10% of the general population
- Erythema, flushing, telangiectasia, papules, and pustules affecting the cheeks and ose
of the face
- Enlarged nose is often present
- Early mistaken for SLE (butterfly Rash)
- Has often been linked with gastrointestinal disturbance, in a causal relationship between
helicobacter pylori (bacterium that causes gastritis.
- the affected person reports burning or staining with episodes of flashing that come and
go , but the condition may worsen over time , causing lasting readiness , pimples ,
telangiectasis, or nasal hypertrophy (rhinophyma)
6. XANTHOMAS
- Benign fatty fibrous Yellow plaques , nodules or tumors that develop in the subcutaneous
layer of the skin
- most often associated with disorders of the lipid metabolism , primarily biliary cirrhosis ,
and uncontrolled diabetes
 - may have no pathologic significance but can occur in association with malignancies
such as leukemia , lymphoma , myeloma
-

BACTERIAL INFECTIONS
1. Impetigo
- A superficial skin infection commonly caused by staphylococcus or a streptococci
- most commonly found in infants , young children to 25 years of age , older
people
- occurs most often during hot , humid weather
- predisposing factors include:
● close contact in schools , overcrowded living quarters
● poor skin hygiene
● anemia , malnutrition
● miner skin trauma
Contagouis through: AUTOINOCULATION
- Small macules ( flat spots) rapidly develop into vesicles or small blisters that became
pustular (pussed filled). When did vesicle breaks , ezekiel o crest forms from the exu
date
- Neither fever nor pain is typically a component of impetigo and if present suggest
another diagnosis. if the infection is extensive , then malaise , fever , and
lymphadenopathy may be present

2. Cellulitis
- A rapid spreading acute information with infection of the skin and subcutaneous
tissue that spread widely through tissue spaces
- streptococcus pyogenes or staphylococcus is the usual cause of this infection in
adults
- haemophilus influenzae type b in in children , although other pathogens may be
responsible
RISK FACTOR
● Post-operatively
● elderly with tm or diabetes mellitus
● open wounds
● Malnutrition
3. Abscess
- Cavity containing pause and surrounded by inflamed tissue
- result of localized infection
- commonly a staphylococcal infection

4. Syphilis
- Highly contagious, spread from person to person by direct contact
 - source occur at the site of infection, mainly on the external genitals, vagina, and,
anus, or rectum
- transmission occurred during vaginal , anal , oral sex
- CAUSATIVE AGENT: Treponema Pallidum
● First stage: Syphilis Chancre (painless sores) with lymphadenopathy
● Secondary- Nerurologic s/sx- Dorsal column medial leminiscal pathway (tabes Dorsals)
- Abnormal gait, numbness, tremor
- Rash that can appear all over the body , most often on palms and soles
- the appearance of the skin lesions occur after the primary chancre disappears

5. Lyme’s Disease
- Is transmitted to humans through the bite of infected blacklegged ticks
- typical symptoms include fever , headache , fatigue , at ritus , and a
characteristic skin rash called erythema chronicum migrans
- CAUSA TIVE AGENTS: Borrelia burgdorferi- most common
- - Borrelia Mayonii- rarely

VIRAL INFECTIONS
1. Herpes 1 ( herpes simplex)
- itching in turn is followed by vesicular eruption on the face or mouth
- AKA cold sore, recurrent herpes labialis, fever blister
2. Herpes 2
- Common cause of vesicular genital eruption
- spread by sexual contact
- AKA genital Herpes
● S/SSx
- Flu like symptoms , like fever , chills , fatigue and body aches
- genital itching , burning or irritation
- painful genital blister or source that break open
- Headaches
- painful urination or dysuria
- swollen lymph nodes
3. Herpetic Whitlow
- Simple infection of the terminal phalanx caused by herpes simplex 1 and 2
- tingling pain or tenderness of the affected digit followed by throbbing pain ,
swelling and redness
4. Herpes Zoster (shingles)
- Cause varicella-zoster virus ( chicken pox)
- pain and tingling affecting the spinal or cranial nerve dermatome
- red papules progressing to vesicles
- accompanied by fever , chills , malaise gastrointestinal disturbance
- (+) Post Herpetic Neuralgic pain
5. Warts
- Benign infection by human papilloma virus (HPV)
 - Transmission: direct contact in autoinoculation
- Location: hands and fingers
- plantar wart: on pressure points of the feet
TREATMENT
● Cryotherapy
● Electrodissection
● Curettage
● Salicylic acid

1. Ringworm (Tinea Corporis)

- For ring-shaped patches with vesicles or scales
- Transmission is direct contact
- Treatment: topical or antifungal drugs
2. Athlete’s foot (Tinea Pedis)
- Erythema, Inflammation, priritis, itching, pain
- Can progress to cellulitis if untreated
- Treatment: Antifungal creams
3. Candidiasis (yeast)
- Also is frequently a complication of moisture associated skin damage (MASD)
due to chronic wetness from wound exudate, urine, stool, and or perspiration
- it can be found very wound comma peristomal , in skin folds , and with IAD
- usually appearing as a bright red rash with tiny macules and papules , it also
can appear scaly