A closed pocket containing pus
A blister greater than 0.5 cm in diameter
Bulla (plural: bullae)
A closed, saclike, membranous capsule containing a liquid or semisolid material
A discoloration on the skin that is neither raised nor depressed
Macule (large: patch)
A small mass of rounded or irregular shape that is greater than 1.0 cm
A small, circumscribed elevated lesion of the skin that is less than 1.0 cm
A plateaulike, raised, solid area on the skin that covers a large surface area in relation to its height above the skin
A lesion through the skin or mucous membrane resulting from loss of tissue
A small blister less than 0.5 cm in diameter
The single most important risk factor for the development of skin cancer is...
exposure to UV radiation
What are the 4 basic types of melanoma?
- Superficial Spreading Melanoma
- Lentigo Maligna
- Acral Lentiginous Melanoma
- Nodular Melanoma
The most common type of melanoma is...
Superficial Spreading Melanoma
Spreads superficially before penetrating (radial growth phase is slower than the vertical phase)
Common clinical features: raised borders and brown lesion with pink, whites, grays, or blues
Least common type of melanoma
Often found in the elderly (commonly diagnosed in the seventh decade of life)
*Most common form of melanoma found in Hawaii
Clinicaly characterized as tan to brown lesions with very irregular borders (found on sun-damaged skin such as the face, ears, arms, and upper trunk)
Most common melanoma found in African Americans and Asians
Acral Lentiginous Melanoma (think the one that starts with an "A")
Usually found under the nails, on the soles of feet, and on the palms of the hands. Common clinical features include: flat, irregular, dark brown to black lesions
Most aggressive form of melanoma
Usually invasive at the time of diagnosis. Clinically characterized as brown to black lesions that arise from nevi or normal skin
ABCDE of Melanoma
Diameter (>6 mm)
What is the next step for any new pigmented lesion that exhibits any of the ABCDE signs or any preexisting nevus that has changed?
Excision with 2-3 mm margin
*If pathology indicates a malignancy, the lesion should then be completely excised with 5 mm margins
The single most important piece of information for prognosis in melanoma is...
thickness of the tumor (Breslow measurement)
Melanomas less than 1 mm thick have a low rate of metastasis and a high cure rate with excision
Nevus in a patient with a history of actinic keratoses and HPV raises the risk of...
Squamous cell carcinomas
Have a higher rate of metastasis than BCC, but the risk is still low
Most common skin cancer
Basal cell carcinoma
Typically appear as pearly papules, often with a central ulceration or with multiple telangiectasias (bleeds and itches)
Which studies image the upper urinary tract?
i.e., the kidneys and ureters
Intravenous pyelogram (IVP)
What study images the lower urinary tract?
i.e., the urinary bladder and urethra
The incidence of cancer presenting as asymptomatic microscopic hematuria is...
Define microscopic hematuria
The presence of three or more RBCs per HPF on two or more properly collected urinalyses
Urine samples showing significant proteinuria, erythrocyte casts, and dysmorphic RBCs
Likely glomerular hematuria
*Renal hematuria is also associated with proteinuria, but not with erythrocyte casts or dysmorphic RBCs
*Urologic hematuria is not associated with any of the three mentioned above
Routine screening for hematuria is
The initial finding of hematuria by the dipstick method should be...
confirmed by microscopic evaluation of urinary sediment.
*the dipstick has limited specificity because it lacks the ability to distinguish RBCs from myoglobin or hemoglobin
How do you distinguish glomerular disease from interstitial nephritis?
RBC casts + dysmorphic RBCs = renal glomerular
Eosinophils = interstitial nephritis (often caused by analgesics or other drugs)
What medications can be given to reduce the risk of contrast nephropathy during an IVP or CT urography?
N-acetylcysteine or IV sodium bicarbonate
*Remember to take a CT scan without contrast first to detect calculi
What study can you give a patient with renal insufficiency to evaluate their upper urinary tract?
Retrograde pyelography combined with a renal ultrasound