Six Signs of Malignant Melanoma

Skin, Hair, and Nails

Six Signs of Malignant Melanoma

• Asymmetry (A): One-half of the mole or lesion does not match the other half in shape, indicating a warning sign of melanoma.
• Border (B): Irregular, scalloped, or poorly defined edges of the mole or lesion, which may indicate malignancy.
• Color (C): A mottled appearance with multiple colors, including shades of brown, black, gray, red, and white, which is a sign of melanoma.
• Diameter (D): A mole or lesion that is larger than 6.0mm in diameter, increasing the suspicion of malignancy.
• Evolving (E): Changes in the mole or lesion's size, shape, color, or symptoms, such as bleeding, itching, or tenderness, which is a warning sign of melanoma.
• Elevation (E): A raised mole or lesion with an uneven surface, which can be indicative of melanoma.

Abnormalities: Wide Spread Color Changes

Pallor

• Definition: Unusual lightness of the skin or mucous membranes, indicating an underlying condition.
• Causes: Anemia, shock, arterial insufficiency, high-stress states.
• Observation sites: Mucous membranes, lips, nail beds, and palpebral conjunctiva.

Erythema

• Definition: Intense redness of the skin, caused by excess blood in the dilated superficial capillaries.
• Causes: Fever, localized infection, emotional responses, increased skin temperature.
• Other conditions: Carbon monoxide poisoning, venous stasis, polycythemia, bruises.

Cyanosis

• Definition: Bluish mottled coloration of the skin and mucous membranes, indicating decreased perfusion of tissues with oxygenated blood.
• Observation sites: Lips, nose, cheeks, ears, and oral mucous membranes.
• Challenges: More difficult to detect in darker skin tones; look for other signs and symptoms.
• Associated conditions: Shock, heart failure, chronic bronchitis, congenital heart disease, cardiac arrest, and severe COVID-19 infection.

Jaundice

• Definition: Yellow coloration of the skin and mucous membranes, indicating elevated levels of bilirubin in the blood.
• Detection: Best assessed in natural daylight; initially noticeable in the junction of the hard and soft palate or in the sclera (white part of the eyes).
• Associated symptoms: Clay-colored stool, dark golden urine.

Increased Pigmentation: Acanthosis Nigricans

• Definition: Areas of dark, velvety discoloration, often found in body folds and creases.
• Characteristics: Skin texture becomes thickened.
• Associated conditions: Obesity, diabetes, particularly type 2 diabetes.

Color - Developmental Considerations

Skin Conditions Overview

• Congenital Dermal Melanocytosis (Mongolian spots): Blue-gray spots on the skin, usually on the lower back and buttocks.
• Café au Lait Spot: Light brown, flat skin patches.
• Acrocyanosis: Bluish discoloration of the hands and feet.
• Cutis Marmorata: Red and blue mottling of the skin.
• Acne: Comedonal, pustular, and other types.
• Seborrheic Keratosis: Noncancerous, wart-like growths.
• Senile Lentigines: Flat, brown spots, also known as age spots or liver spots.
• Xerosis: Abnormally dry skin, often caused by environmental factors, medical conditions, or age.

Abnormalities - Edema

• Definition: Abnormal accumulation of fluid in the interstitial spaces, leading to swelling.
• Causes: Chronic venous insufficiency, lymphedema, orthostatic edema, congestive heart failure, and deep venous thrombosis.
• Grading: Scale used to assess the severity of edema, from mild to severe.

Wound Assessment

• Key elements: Type of wound, appearance, dressing, and drainage.
• Types of wounds: Incision, laceration, skin tear, rash, excoriation, and decubitus ulcer.

Primary Skin Lesions

• Macule: Small, flat spot.
• Papule: Small, solid elevation.
• Nodule: Larger, solid elevation that extends deeper into the skin.
• Patch: Larger, flat area of discoloration.
• Plaque: Raised, flat-topped area.
• Vesicle: Small, fluid-filled blister.
• Bulla: Larger, fluid-filled blister.
• Pustule: Pus-filled blister.
• Tumor: Solid, elevated mass, which can be benign or malignant.

Secondary Skin Lesions

• Crust: Dried serum, blood, or pus on the skin surface.
• Scale: Flakes or plates of dead epithelial cells.
• Scar: Fibrous tissue that replaces normal skin after injury or surgical incision.
• Ulcer: A deep loss of skin that may extend into the dermis or subcutaneous tissue.
• Excoriation: Linear or punctate erosions caused by scratching or picking at the skin.

Note: This is not an exhaustive summary of the provided text. It highlights the key points and concepts, focusing on the main topics and subtopics.### Skin Lesions

• Skin lesions are characterized by linear or punctate marks on the skin surface and can lead to further complications such as infection if not properly managed.

Atrophy

• Atrophy refers to thinning of the skin, which often appears shiny and translucent.
• The skin may become dry and fragile, making it prone to easy bleeding or tearing.
• Examples of atrophy include striae (stretch marks), senile skin (skin changes associated with aging), and arterial insufficiency (reduced blood flow to the skin).
• Management involves protecting the skin from injury, maintaining skin hydration, and addressing underlying health conditions contributing to skin changes.

Lichenification

• Lichenification refers to the thickening and roughening of the skin, typically occurring as a result of chronic, intense scratching or rubbing of the skin.
• It results from a tightly packed set of papules and causes increased visibility of superficial skin markings.
• Examples include long-standing eczema (atopic dermatitis) or other chronic dermatological conditions.
• Management involves addressing the underlying cause, managing itching, and providing appropriate skin care to reduce further damage and promote healing.

Ulcer

• An ulcer is a lesion that affects the skin or mucous membrane, characterized by loss of tissue and often exposing underlying layers.
• Ulcers may contain necrotic tissue (dead tissue) or slough (shedding of dead tissue).
• They can involve the epidermis, dermis, or even extend into the subcutaneous tissue.
• Examples include pressure ulcers (bedsores) caused by prolonged pressure on the skin, or a chancre, which is a primary sore in syphilis.
• Treatment involves addressing the underlying cause, relieving pressure if applicable, and promoting wound healing through appropriate wound care and management.

Pressure Ulcer

• Factors contributing to the risk of pressure ulcers include:
• Immobility and excessive pressure
• Sensory loss
• Friction and shear injury
• Nutritional and fluid status
• Moisture, heat, and incontinence
• Co-morbid conditions
• Developmental considerations for the older adult include:
• Aging skin: thinner, less elastic skin that repairs itself more slowly
• Delayed wound healing: wound healing in older adults can be up to four times slower than in younger individuals

Vascular Lesions

• Petechiae are pinpoint-sized macules (flat, discolored spots) that appear red or purple, typically smaller than 3 mm in diameter.
• Petechiae are important clinical signs that can indicate serious underlying conditions, particularly when they appear suddenly or in large numbers.

Purpura

• Purpura refers to purple-colored macules (flat, discolored spots) and patches that occur on the skin and mucous membranes.
• Purpura can result from medication interactions, certain vitamin deficiencies, infections, autoimmune disorders, or underlying systemic conditions affecting blood vessels.

Skin Cancer

• Actinic keratosis (AK) refers to keratotic (rough, scaly) lesions on the skin, typically caused by prolonged exposure to ultraviolet (UV) radiation.
• AK is considered a precancerous lesion and requires medical evaluation and treatment to prevent progression to skin cancer.

Basal Cell Carcinoma

• Basal cell carcinoma (BCC) is the most common type of skin cancer, primarily caused by cumulative exposure to UV radiation.
• BCC is locally invasive and destructive to surrounding tissues but typically grows slowly and rarely metastasizes.
• Treatment options include surgical removal, topical therapies, cryotherapy, or other dermatological procedures.

Squamous Cell Carcinoma

• Squamous cell carcinoma (SCC) is an invasive malignancy of the skin, potentially life-threatening if left untreated.
• Risk factors include excessive sun exposure, fair skin, and may develop from scar tissue or chronic wounds.
• Early detection and treatment are crucial to prevent metastasis and potential complications.

Melanoma

• Melanoma is the most aggressive type of skin cancer, with increased risk associated with exposure to UV light, fair skin tone, genetic predisposition, and a history of severe sunburns.
• Melanomas often present as multicolored lesions with irregular borders, and may have asymmetry, uneven color distribution, and a diameter larger than 6 mm.
• Treatment options include surgical excision, lymph node biopsy, immunotherapy, targeted therapy, or chemotherapy depending on the stage and extent of the melanoma.