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Malignant melanoma is a serious skin cancer affecting the melanocytes. Melanocytes are cells located at the base of the epidermis (see the skin). They are responsible for producing Melanin which is a protein that gives color to the skin, eyes and hair. In the skin melanin pigment acts as an umbrella that absorbs and protects the skin from the effect of ultraviolet radiation. The more melanin produced by melanocyes, the darker the skin.

Malignant melanoma known also as melanoma happens when melanocytes begin to grow in an uncontrollable way. It can happen at all ages but it’s more common in young adults and the risk increases with age. Although anyone can be affected, there are certain risk factors that increase the risk of having malignant melanoma and these risk factors include:

  • Fair colored skin.
  • Excessive sunlight exposure.
  • History of sunburn.
  • Previous history of melanoma or other skin cancer squamous or basal cell carcinoma.
  • Family history of melanoma.
  • Presence of large number of moles (more than 50).
  • Presence of abnormal moles (called a typical or dysplastic mole).
  • People with low immune system such as those with Aids or having organ transplantation.
  • People with Xeroderma pigmentosa witch is a genetic disorder.

Signs and symptoms:

Malignant melanoma can appear in normal looking skin or can be appear in a previously present mole or freckle. Warning Changes in a mole or a freckle include:

The ABCDE guide:

  • A for asymmetry in shape where one half is different from the other half.
  • B for border, change in border may include notched or poorly defined border.
  • C for color, uneven distribution of color or more than one color in a lesion is a warning sign.
  • D for diameter, lesions with a diameter greater than 6 millimeter is a warning sign.
  • E for evolving (changing, enlarging).

Other warning changes may include:

  • Itching.
  • Change in consistency eg, become hard.
  • Change in sensation.
  • Bleeding.
  • Oozing.
  • Pigment spread to the surrounding skin.

Malignant melanoma can appear anywhere in the body where melanocytes are present, some appear on sun exposed areas such as the face and hands while others can appear in places such as under the nail (subungual), between the toes, palms and soles, the eye, genitals and mouth. Primary tumors are more common on the back in men and on the lower extremity in women.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Also called Skin cancer-basal cell, Rodent ulcer
It is the most common type of skin cancer. It originates from the basal cells of the epidermis (see the skin). It occurs more often in men than women and used to be more common after the age of 40 but it is more and more being seen in younger people. Ultraviolet light exposure from sun or other source is the main predisposing factor for developing BCC and that is why the majority occur on sun exposed areas such as face, neck and ear but they can also occur in areas which are not exposed to sunlight.

Certain risk factors increase the risk of basal cell carcinoma which may include:

  • People with chronic exposure to sunlight.
  • People with fair skin.
  • People with red, blond or light brown hair.
  • People with blue or green eyes.
  • People with suppressed or low immunity.
  • People who have been exposed to x-ray or other radiation forms for prolonged time.
  • Arsenic exposure.

clinical features:

There is more than one type of BCC and the appearances vary depending on the type of BCC, it may appear as:

  • A bump or a pearly nodule, it may appear as a light pink, brown or flesh colored.
  • An easy bleeding sore or a sore that doesn’t heal.
  • A well defined red and scaly patch.
  • A scar like lesion.

Diagnosis:

Diagnosis is made by taking a history, examining the lesion and confirming the diagnosis by taking a skin biopsy. There are many types of biopsies and the patient is given local anesthesia before taking the biopsy to numb the skin.

Treatment:

Treatment depends on the type, extent and the location of BCC. Treatment includes:

  • Surgical excision of the tumor after using local anesthesia followed by closing the wound with stitches.
  • Curettage and electrodessication in which the cancer cells are scrapped away with a curette and the remaining is destroyed with an electrical current that generates heat.
  • Mohs surgery in which the surgeon after removing each piece of skin, examines it under a microscope to check if there is any cancer cells left behind, if tumor cells are still present another piece is removed until the skin sample is free from cancer cells. Among other methods, this method provides the highest cure rate.
  • Cryotherapy: this method freezes the tumor cells using liquid nitrogen leading to their destruction.
  • Radiation therapy: this method may be use when cancer has spread to lymph nodes or other organs or for patients who can’t withstand surgery.
  • Topical creams such as imiguimod used for treatment of superficial BCC.

Prevention:

  • Protecting the skin from the effect of sunlight by wearing protective clothes which include hats, clothes with long sleeves and UV protective glasses.
  • Avoid exposure to sunlight in peak hours from 10am-4pm.
  • Sunlight protection by using a broad spectrum sunscreen with a sun protective factor of at least 15 or higher. Apply the sunscreen to all areas of the body 30 minutes before sun exposure. Reapply it frequently.
  • Examining the skin regularly for any lesion that recently appeared, changes in an existing lesion that may be suspicious include: growing, any change in appearance, bleeding, pain, itching, inflammation or a lesion that never heals completely
  • Full skin examination by a qualified physician once a year.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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The skin like other organs in the body can be affected by cancer. Skin cancer is an abnormal and uncontrolled growth of skin cells that can be divided into three types:

  • Squamous cell carcinoma.
  • Basal cell carcinoma.
  • Malignant melanoma.

Squamous cell carcinoma:

This type of cancer originates from the squamous cells present in the epidermis which is the outer most layer of the skin (see the skin). Too much exposure to ultraviolet light of sun is the most common cause and that’s why it is more common on areas that are exposed to sun light.

Certain factors increase the risk of squamous skin cancer which may include:

  • Sunlight exposure for a long time.
  • People with fair skin are more affected than people with dark skin because they have less melanin pigment which protects the skin from sunlight.
  • People who have been exposed to x-rays for a prolonged time.
  • Burns, ulcers and old scars on the skin.
  • Exposure to chemical substances such as arsenic.
  • Old age people.
  • Genetic disorders eg, Xeroderma pigmentosum.
  • People with suppressed or low immunity.

Squamous cell carcinoma can appear on any area of the body but it mostly appear on sun exposed areas such as the head and neck including the ears and lips, back of the hands.

Symptoms and signs:

  • In early stages the skin change may include a skin bump that may be pink or red in color with a rough or scaly surface.
  • A change in a pre existing lesion is a warning sign.
  • Actinic Keratosis is a precancerous skin lesion that may change to squamous cell cancer, changes in Actinic Keratosis may be a warning sign for developing squamous cell carcinoma, and these changes may include: increase in size, increase in redness, bleeding, thickening or pain.
  • This type of cancer has the ability to spread to the deeper layers of the skin and may also spread to other areas of the body as well.

Diagnosis:

Diagnosis is usually made by examining the lesion and confirmed by taking a skin biopsy, there are many types of biopsies and the patient is given local anesthesia before taking the biopsy to numb the skin.

Treatment:

The earlier the diagnosis is, the better is the cure rate. Factors that determine the treatment options are: tumor size, the location of tumor and whether or not the tumor has spread.

  • Cutting the tumor out (excision) after giving local anesthesia and then the wound is closed with stitches.
  • Curettage and electrodessication in which the cancer cells are scrapped away with a curette and the remaining is destroyed with an electrical current that generates heat. This type of treatment is used for small squamous cell carcinoma.
  • Cryotherapy: this method freezes the tumor cells using liquid nitrogen leading to their destruction.
  • Advanced surgery called Mohs surgery in which the surgeon after removing each piece of skin, examines it under a microscope to check if there is any cancer cells left behind, if tumor cells are still present another piece is removed until the skin sample is free from cancer cells. This type of surgery is mostly used for tumors on the face such as the ears or for difficult or recurring tumors.
  • Actinic keratosis and some cases of Bowen’s disease which is the earliest form of squamous cell cancer can be treated with 5-fluorouracil containing lotion or imiquimod.
  • Radiotherapy: this method may be used when the tumor is large, in places where it is difficult to remove or to relieve symptoms when the tumor has spread to other parts of the body. Radiotherapy maybe used alone or in combination with surgery.
  • Chemotherapy: this method is used in cases where there is spread of the tumor to other body parts. In advanced cases, chemotherapy is added to surgery or radiation.
  • Photodynamic laser therapy: may be used in Bowen’s disease.

Prevention:

  • As sun exposure is the most important factor, protecting the skin by wearing protective clothes which include hats, long sleeve clothes and UV protective glasses and try to stay out of the sun during peak sunny hours from 10am-4pm.
  • Using sunscreens with a sun protective factor (SPF) of at least 15. For children and persons with fair skin use sun protective factor of 30.
  • Regular checking of the skin for any lesion that recently appeared, changes in an existing lesion that may be suspicious include: growing, any change in appearance, bleeding, pain, itching, inflammation or a lesion that never heals completely.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Hydrotherapy is the external use of water in the medical treatment of certain diseases. Most burn units in hospitals have hydrotherapy rooms. Hydrotherapy softens and removes dead tissue enabling new healthy tissue to form and promote healing.

Hydrotherapy can have other effects in addition to removing dead and damaged tissue, it can:

  • prevent the fluid loss through the burned skinwhich may result in fliuid deplesion and dehydration.
  • Remove debris and clean the wound surface.
  • Provide a good environment for wound healing.
  • Decrease the risk of infection.
  • Decrease the risk of scar tissue formation.
  • The wound has microbial flora, hydrotherapy help adjust them.
  • Help facilitate physical therapy.
  • Promote healing and the formation of healthy tissue.
  • Help provide comfort for the patient.

Hydrotherapy for burns can start within a few days of the trauma once patients have recovered from the initial shock and their condition has stabilized. Burn patients often receive daily hydrotherapy throughout their hospitalization. As the burn begins to heal, hydrotherapy may be reduced to three times per week on an outpatient basis. Hydrotherapy is administrated by nurses and specialized technicians. Sometimes physicians or physical therapists are also involved in the hydrotherapy sessions.

Immersion hydrotherapy:
Many burn units use immersion hydrotherapy on all patients, regardless of the extent of the affected body surface. Immersion hydrotherapy is performed in tubs called hydrotanks, or burn tanks; these may be equipped with lifts to ease the patient in and out. Hydrotherapy tubs must be carefully disinfected after each use, since infection of the damaged tissue is one of the most serious side effects of burns. Disposable liners are used in some burn tubs, and the water is sterilized. Hydrotherapy for burns should never be performed in a public tub because of the risk of infection.

Shower hydrotherapy:
Many burn units are replacing immersion hydrotherapy with shower hydrotherapy, because of the risk of infection from hydrotubs and because showering immediately rinses away dead skin and bacteria. Showering removes dead tissue as effectively as immersion hydrotherapy. A shower trolley or stretcher is draped with a sterilized disposable plastic sheet to reduce the risk of contamination that can cause infection. The patient lies on the sheet and receives hydrotherapy through a showerhead. Patients with less severe burns can be showered while sitting in a chair. Shower hydrotherapy utilizes tap water, but a chlorine solution is run through the showerhead to disinfect it. Handheld showerheads are recommended when performing hydrotherapy at home, since strong hospital-grade disinfectants require special handling.

The duration of hydrotherapy treatments varies greatly. Hydrotherapy for burns is often performed for just a few minutes at a time because it can be intensely painful. Pain medication is often administrated before hydrotherapy, and general anesthesia may be required before performing hydrotherapy on the most severe burn victims. In some centers water friendly virtual reality have been used during burn treatment in hydrotherapy tubs. This diverts the patient’s attention away from the pain signals.

Burn patients often undergo physical therapy during hydrotherapy. The physical therapist encourages the patient to perform movements and participate in the bathing when possible.

Hydrotherapy and chemical burns:
When hydrotherapy is administrated for chemical burns, either acid or alkali, within one minute, there is far less damage to skin than if treatment is delayed for even three minute. A delay in hydrotherapy can lead to irreversible damage. Prolonged gentle rinsing of the burn with a large volume of water under low pressure dilutes the chemical, washes it out of the skin and normalizes the PH of the skin.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Tissue expansion is a procedure that allows the body to grow extra skin. It is done by inserting a silicone balloon expander under the skin near the area to be repaired (such as scars happening after burns) and then gradually filling the balloon with salt water over time causing the skin to stretch and grow (keeping the skin under tension causes new cells to form).

Tissue expansion is used in conditions such as breast reconstruction surgery, repairing burns, scars, large birth marks, hairy areas such as the scalp (the extra skin is still able to grow hair).

After the skin stretches the scaring is surgically removed and the expanded skin is extended to meet healthy un-scarred skin.

The advantage of this procedure is that it provides a good match of color, texture and hair bearing quality. The expanded skin has a smaller risk of dying because the skin remains attached to the donor’s area blood and nerve supply. Scars are often less apparent because the skin is not removed from one area and transferred to another.

The main disadvantage of the procedure is related to the length of time needed to grow/stretch the skin which may be as long as three to four months. The expander during the expansion process appears as a bulge. Frequent visits to the surgeon are required for salt water injection to expand the balloon. There are risks related to the anesthesia and the surgery such as infection and bleeding.

The silicone balloon expander is inserted by a plastic surgeon under the skin in an initial surgery followed by salt water injection through a period of time than the expander is removed and the new tissue is put in place. During this process most patients feel temporary discomfort which can be controlled by medication prescribed to you by your physician.

You should contact your physician if you see any indication of wound infection. You have to avoid applying any undue pressure to the area around the tissue expander such as poking it or wearing tight clothes over the area.

Tissue expansion can be an effective method to make scars that result from burns less noticeable; it is not a replacement for skin graft. Skin grafts are usually done when the tissue is destroyed in severe burns.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Gastritis refers to inflammation of the lining (mucosa) of the stomach which may progress to form an ulcer.

Risk factors:

  1. Patients on mechanical ventilators or who are intubated for more than 24 hours.
  2. Smoke inhalation.
  3. Severe burns such as third degree burns.
  4. Trauma.
  5. Severe illness.
  6. Shock such as septic shock, hemorrhagic shock, etc.
  7. Patients with multiple organ failure.

The risk of developing stress ulcer in severe burns has decreased with the improvements of critical care and the use of medications.

Signs and symptoms:

  1. Can be a symptomatic in early stages.
  2. Burning pain.
  3. Blood mixed with vomitus that will have the color of coffee.
  4. Melena which is the passage of blood in stool.
  5. Hematemesis in severe cases which is the vomiting of pure blood.

Preventive measures in burned patients are the use of medications such as antacids and other medications which decrease the effect of gastric acid on the mucosa. Adequate fluid replacement after a burn injury will decrease the risk of developing stress gastritis as decreased blood supply to the stomach (ischemia) that results from fluid loss in burned patients plays a role in the development of the disease. Early feeding is also one of the important preventive measures.

If a stress ulcer develops, the treating physician will determine the type of treatment needed. In certain conditions surgical intervention may be needed.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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One of the most common causes of hospital admission of pediatric patients is burns. Most pediatric burns occur at home. The most common cause of burns in young children is exposure to hot liquids (scald injury) such as hot water. Contact with hot objects is the second most common cause of burn in young children. Pediatric burns differ from adult burns in many aspects.

Their skin is more sensitive and less resistant to heat and because it is harder for them to escape from the burning object, this may lead to longer exposure which may increase the burn severity.

Pediatrics have a smaller body size than adults with a greater body surface area in relation to their weight. Fluid loss is proportionally greater in young children when compared to the same percentage of burn in adults because of their smaller circulating volume and different distribution of body fluids leading to more rapid onset of fluid and electrolyte disturbance and imbalance. Therefore pediatrics especially infants develop hypovolemic shock faster and fluid replacement should be started as soon as possible which is calculated according to certain formulas.

Small children are at a greater risk to have a decrease in body temperature (hypothermia) due to the insufficiency of their thermoregulatory system, they are less tolerant to changes in temperature (see regulation of body temperature).

In case there is a burn to the genital area and the child is still wearing diapers, special attention should be taken as the burned area may be contaminated easily making it more susceptible for infection.

Pediatric patients with burns are harder to cannulate (insert a cannula) than adults and the smaller the child is the harder it is. Airway intubation is also harder in pediatrics than adults and the smaller the child is, the harder it is to intubate especially after burns that affect the airways. That is why trachiostomy is sometimes needed.

One of the things that differentiate small children from adults is the inability of small children to speak and express what they feel. The parents play a major role in this case because they know their child better than anyone else and know when there is something wrong with him/her. Therefore when your child is to be discharged you have to make sure that your child is feeling well.

Prevention of scald burns:

  • Water heater thermostat should not be set higher than 120 degrees.
  • Bathtub water should be checked before putting the child in the tub.
  • Never leave the child in the bathtub alone as he/she might turn on the facet or the water may become too hot and lead to scaled injury.
  • Keep hot liquids out of the reach of children like turning pot handles on the stove out of the reach of children.
  • Avoid carrying hot object while carrying the child.

According to the Consumer Product Safety Commission a child exposed to hot tap water of 140 degree for three seconds develops a third degree burn.

According to the National Center for Health Statistics between 2001 and 2005, each year approximately 116,600 children are treated for fire/burn injuries. Fires and burns are the third leading cause of unintentional death among children aged 1-14 years in 2004.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Burn injury may be severe and may involve any part of the body including the face. Facial scars are considered in general as a cosmetic problem, whether or not they are hypertrophic. There are several ways to reduce the appearance of facial scars. Often the scar is simply cut out and closed with tiny stitches, leaving a thinner less noticeable scar.

If the scar lies across the natural skin creases (or lines of relaxation) the surgeon may be able to re-position the scar using Z- Plasty to run parallel to these lines, where it will be less conspicuous.

Some facial scars can be softened using a technique called dermabration, a controlled scraping of the skin using a hand held high speed rotary wheel. Dermabration leaves a smoother surface to the skin but it won’t completely erase the scar.

After scar revision:

With any kind of scar revision it’s very important to follow your surgeon’s instructions to make sure the wound heals properly. Although you may be up and about very quickly, your surgeon will advise you on gradually resuming your normal activities.

As you heal, keep in mind that no scar can be removed completely; the degree of improvement depends on:

  • The size of the scar
  • The direction of the scar
  • The nature and quality of your skin
  • How well you take care of the wound after the operation.

If your scar looks worse at first, don’t panic because the final result of your surgery may not be apparent for a year or more.

As there are different methods of facial scar removal and each has its benefits and risks, you will want to schedule an appointment with a practitioner that specializes in facial scar removal before having the procedure completed because they will explain all these risks and benefits. You might also want to do your research on the practitioner that you choose because some are more experienced than others and you will want to choose the one that will provide you with the best results.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Nosocomial infection also known as Hospital acquired infection (HAI) is an infection that the patient acquires when he/she is admitted to a hospital or a health care facility for any reason other than that infection. The infection should have not been present or incubating prior to the patient’s being admitted to the hospital.

Certain factors may affect the susceptibility of the patient to get nosocomial:

  1. The age of the patient: elderly and infants are more susceptible for infection.
  2. The presence of pre-existing diseases (co-morbidity): chronic diseases such as chronic kidney disease, chronic liver disease and diabetes can increase the patient’s risk for contracting a nosocomial infection as all these diseases may interfere with the immunity of the patient making him/her more susceptible for infection.
  3. Low or compromised immune system: any condition that suppresses the immune system can increase the susceptibility of the patient for a nosocomial infection.
  4. Malignancy, chemotherapy and radiotherapy: as all may suppress the immune system.
  5. Treatment with Antibiotics: this can cause the growth of antibiotic resistant micro-organisms that can cause nosocomial infection.
  6. Procedures and surgeries: therapeutic and/or diagnostic procedures and surgeries may increase the susceptibility of the patient for a nosocomial infection.

Measures taken by the healthcare staff to prevent and/or control nosocomial infection:

  • Proper hand washing and/or cleansing.
  • Wearing gloves, masks and gowns.
  • Aseptic technique and procedure practice.
  • Isolating patients with communicable diseases.
  • Proper disinfection and sterilization of reusable equipment.
  • Immunization patients at risk.
  • Proper disposal of waste product.
  • Prophylaxis
  • Educating patients and public about the causes, methodS of transmission, treatment and prevention of infection

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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Nosocomial infection also known as Hospital acquired infection (HAI) is an infection that the patient acquires when he/she is admitted to a hospital or a health care facility for any reason other than that infection. The infection should have not been present or incubating prior to the patient’s being admitted to the hospital.

Origin of Nosocomial infection:

Nasocomial infection can be external (from out side the body) or internal (from the inside of the body).

External (Exogenous) infection: examples of external sources of infection may include

  1. Catheters such as the urine catheter (Foley Catheter)
  2. Instruments such as speculum, scissor, forceps.
  3. Hands if they are not properly sterilized.
  4. Blood product transfusion which can transmit Hepatitis B and HIV.
  5. IV lines like Central and Picc lines.
  6. Respiratory equipment such as ventilators.
  7. Airborne infection: such as Tuberculosis (TB).
  8. Linen that are contaminated.

Internal (Endogenous) infections: Internal sources of infection may include

  1. Skin: Certain bacteria live on the skin of many healthy individuals without causing any infection. However, these bacteria can cause skin infections if they enter the body through a break in the skin as in burns, open wounds and cuts. Staphylococcus aureus (Staph) is a bacteria that can be found living on the skin and in the nose of many healthy people without causing any infections. This bacteria can cause skin infections such as boils when the circumstances are appropriate.
  2. Oropharynx.
  3. Respiratory System.
  4. Gastrointestinal tract.
  • Pathogens that cause nosocomial infections can be Bacteria, Fungi, Viruses and Protozoa.
  • Pathogens vary in their virulence (the ability of a microorganism to cause disease); the more virulent the organism is, the less the number needed to produce the disease.
  • The sicker the patient is, the higher the risk of contracting a nasoconial infection.
  • The lower the patient’s immunity is, the higher the risk of getting a nasocomial infection.
  • Certain circumstances may favor the growth and survival of the microorganism such as wet versus dry objects. Contamination is heavier in wet objects than dry objects.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.