Integumentary Diseases, Disorders, and Conditions Part II of II

1. Integumentary Diseases, Disorders, and Conditions Part II of II H. Biology II Presented November 2014

2. Burns • Heat, electricity, radiation, certain chemicals  Burn (tissue damage, denatured protein, cell death) • Immediate threat: • Dehydration and electrolyte imbalance, leading to renal shutdown and circulatory shock

3. Rule of Nines • Used to estimate the volume of fluid loss from burns

4. Totals 1 4 / % 2 Anterior and posterior head and neck, 9% Anterior and posterior upper limbs, 18% Anterior trunk, 18% 1 1 Anterior and posterior trunk, 36% 4 / % 4 / % 2 2 9% 9% (Perineum, 1%) Anterior and posterior lower limbs, 36% 100% Figure 5.9

5. Severity of Burns • Critical if: • >25% of the body has second-degree burns • >10% of the body has third-degree burns • Face, hands, or feet bear third-degree burns

6. Burns • Burns are categorized by severity as first, second, or third degree. • First degree burns are similar to a painful sunburn, causing redness and swelling to the tissues. • The damage is more severe with second degreeburns, leading to blistering and more intense pain. Damage is found in deeper tissues. • The skin turns white and loses sensation with third degree burns. The entire depth of tissue is affected. Scarring is permanent, and depending on the extent of the burning, may be fatal. • Burn treatment depends upon the location, total burn area, and intensity of the burn.

8. 1st Degree Burn

9. 2nd Degree Burn

10. Full-Thickness Burns • Third degree • Entire thickness of skin damaged • Gray-white, cherry red, or black • No initial edema or pain (nerve endings destroyed) • Skin grafting usually necessary

11. 3rd Degree Burn Skin bearing full thickness burn (3rd degree burn)

12. Skin Grafting In its most basic sense, skin grafting is the transplanting of skin and, occasionally, other underlying tissue types to another location of the body.

13. Pre-Cancerous and Other Growths • Benign Growths • Pre-Maligant Growths

14. Benign Growths 3: Nevi Junctional Nevus nests of melanocytes occupy the junction of the epidermis and dermis Compound Nevus nests of melanocytes occupy not only the junction of the epidermis and dermis, but are also solidly in the dermis. Dermal Nevus nests of melanocytes are all in the dermis.

15. (Dysplastic nevi are pre-melanomas) Premalignant Growths 1: Dysplastic Nevi nevi are dysplastic. They are larger than most common nevi and show a slight (minimal) variation in color and border.

16. (Aks are pre-squamous cell carcinoma) Premalignant Growths 2: Actinic Keratosis Actinic keratoses are single (<6 mm) or multiple discrete, dry, rough, adherent scaly lesions which occur on the sun-exposed skin of adults. Prolonged or repeated sun exposure leads to cumulative UVB-damage to keratinocytes. Skin lesions have adherent, disorganized, hyperkeratotic scale which is not easily removed. Lesions are often easier to feel (they fill like sandpaper) than to see. They are typically distributed on the face, ears, neck, forearms and dorsa of hands. maturation disarray in the epidermis and the cells appear lsightly atypical

17. Skin Cancer • Skin cancer is the most common form of cancer in the United States. • More than one million skin cancers are diagnosed annually.Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. • One in five Americans will develop skin cancer in the course of a lifetime. • Basal cell carcinoma (BCC) is the most common form of skin cancer; about one million of the cases diagnosed annually are basal cell carcinomas. basal cell carcinomas are rarely fatal, but can be highly disfiguring • Squamous cell carcinoma (SCC) is the second most common form of skin cancer. More than 250,000 cases are diagnosed each year, resulting in approximately 2,500 deaths. • Basal cell carcinoma and squamous cell carcinoma are the two major forms of non-melanoma skin cancer. Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once. • About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun. • Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.

18. Skin Cancer Cont. • Most skin tumors are benign (do not metastasize) • Risk factors • Overexposure to UV radiation • Frequent irritation of the skin • Some skin lotions contain enzymes in liposomes that can fix damaged DNA

19. Basal Cell Carcinoma • Basal cell cancer most often appears on sun-exposed areas such as the face, scalp, ears, chest, back, and legs. • The most common appearance of basal cell cancer is that of a small dome-shaped bump that has a pearly white color. • Blood vessels may be seen on the surface. • Basal cell cancer can also appear as a pimple-like growth that heals, only to come back again and again. • A very common sign of basal cell cancer is a sore that bleeds, heals up, only to recur again. • Stratum basale cells proliferate and slowly invade dermis and hypodermis • Cured by surgical excision in 99% of cases

20. Malignant Growths 1: Basal Cell Carcinoma Nodular bcc Basal cell carcinomas typically contain nests of basophilic cells arising from the basilar portion of the epidermis and extending into the dermis. The nests of basal cells show a distinct perpindicular arrangement of the cells at the periphery of the nests called palisading. The nests are also surrounded by a fibrous stroma and retraction artefact is often observed at the edges of many nest. Superficial bcc Nodular bcc Pigmented bcc

21. Figure 5.8a

25. Squamous Cell Carcinoma • A firm, red nodule on your face, lower lip, ears, neck, hands or arms. • A flat lesion with a scaly crust on your face, ears, neck, hands or arms. • A new ulceration or raised area on a pre-existing scar or ulcer. • An ulcer or flat, white patch inside your mouth. • A red, raised patch or ulcerated sore in the anus or on your genitals. • Involves keratinocytes of stratum spinosum • Most common on scalp, ears, lower lip, and hands • Good prognosis if treated by radiation therapy or removed surgically

26. Malignant Growths 2: Squamous Cell Carcinoma tumor islands have irregularly invaded the dermis. There are many atypical cells

27. Figure 5.8b

31. Melanoma • A highly malignant type of skin cancer that arises in melanocytes, the cells that produce pigment. Highly metastatic and resistant to chemotherapy • Treated by wide surgical excision accompanied by immunotherapy • Melanoma usually begins in a mole.

32. Melanoma • A popular method for remembering the signs and symptoms of melanoma is the mnemonic/rule "ABCD": • Asymmetrical skin lesion.(the two sides of the pigmented area do not match) • Border of the lesion is irregular. (exhibits indentations) • Color: melanomas usually have multiple colors. (black, brown, tan, and sometimes red or blue) • Diameter: moles greater than 6mm are more likely to be melanomas than smaller moles.(size of a pencil eraser)

33. Melanomas are recognizable by their irregular and indistinct boarders, multiple colors, asymmetry, and varigate contours (raised and flat arease within the same lesion). Particularly worrisome colors are black, red, gray or blue Malignant Growths 3: Melanoma Large islands of atypical pigment-containing cells invade the dermis irregularly Melanoma arising from nevi

34. Figure 5.8c

38. Other Skin Disorders/Diseases of Interest

39. Rosacea • Rosacea (roz-ay-sha) is a very common benign skin disorder that affects many people worldwide. • As of 2008, it is estimated to affect at least 14 million people in the United States alone. • The main symptoms of this facial condition include red or pink patches, visible brokenblood vessels, small red bumps, red cysts, and pink or irritated eyes. • Many patients may just assume they blush easily or have gotten sunburned.

43. Impetigo • Impetigo is a skin infection that can spread from one person to another. • Impetigo causes one or more "sores" on the skin that are often covered by a thick dry honey-coloredcrust. The sores don't hurt, but may be tender if touched. They may also be itchy. • Any skin area can be affected, but sores are usually on arms or legs, the face (mainly around the mouth, nose, or ears), and sometimes on the scalp. Anyone can get impetigo, but it most often occurs in children 2 to 6 years old. • The disease is most common during summer and fall, but can occur anytime.

47. Ringworm • Ringworm is not, as its name suggests, caused by a worm. • Characterized by round lesions (rings) and early belief that the infection was caused by a parasite (worm), the term ringworm was born. Further confusion comes from the medical term for ringworm, tinea, which is Latin for 'growing worm.' • While the condition is actually the result of a fungal infection, the name 'ringworm' has stuck.