Harrison's Internal Medicine Chapter 83. Cancer of the Skin
Melanoma Pigmented lesions are among the most common findings on skin examination. The challenge is to distinguish cutaneous melanomas, which may be lethal, from the remainder, which with rare exceptions are benign. Examples of malignant and benign pigmented lesions are shown in Fig. 83-1.
Atypical and malignant pigmented lesions. The most common melanoma is superficial spreading melanoma (not pictured). A.
Harrison's Internal Medicine Chapter 52. Approach to the Patient with a Skin Disorder
APPROACH TO THE PATIENT WITH A SKIN DISORDER: INTRODUCTION The challenge of examining the skin lies in distinguishing normal from abnormal, significant findings from trivial ones, and in integrating pertinent signs and symptoms into an appropriate differential diagnosis. The fact that the largest organ in the body is visible is both an advantage and a disadvantage to those who examine it.
Telangiectasias (Table 54-8) In order to distinguish the various types of telangiectasias, it is important to examine the shape and configuration of the dilated blood vessels. Linear telangiectasias are seen on the face of patients with actinically damaged skin and acne rosacea, and they are found on the legs of patients with venous hypertension and essential telangiectasia. Patients with an unusual form of mastocytosis (telangiectasia macularis eruptiva perstans) and the carcinoid syndrome (see "Acne," above) also have linear telangiectasias.
Meningococcemia. An example of fulminant meningococcemia with extensive angular purpuric patches. (Courtesy of Stephen E. Gellis, MD; with permission.)
Necrotizing vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis. (Courtesy of Robert Swerlick, MD; with permission.)[newpage]
APPROACH TO THE PATIENT: SKIN DISORDER
In examining the skin it is usually advisable to assess the patient before taking an extensive history.
In tuberous sclerosis, the earliest cutaneous sign is an ash leaf spot. These lesions are often present at birth and are usually multiple; however, detection may require Wood's lamp examination, especially in fair-skinned individuals. The pigment within them is reduced but not absent. The average size is 1–3 cm, and the common shapes are polygonal and lance-ovate.
The entire cutaneous surface, including the scalp and mucous membranes, should be examined in each patient. Bright room illumination is important, and a 7x to 10x hand lens is helpful for evaluating variation in pigment pattern. A history of relevant risk factors should be elicited. Any suspicious lesions should be biopsied, evaluated by a specialist, or recorded by chart and/or photography for follow-up. Examination of the lymph nodes and palpation of the abdominal viscera are part of the staging examination for suspected melanoma.
For two main reasons, dermatology is one of the later medical disciplines to use imaging techniques: skin lesions are readily visible to the naked eye or through a magnifying glass, allowing clinical diagnosis with no invasive examination; skin lesions can easily be biopsied or removed for histological study. This approach has therefore remained the basis of clinicopathological diagnosis of skin diseases for a long time. There has also been a third factor.
Melanoma Pigmented lesions are among the most common findings on skin examination. The challenge is to distinguish cutaneous melanomas, which may be lethal, from the remainder, which with rare exceptions are benign. Examples of malignant and benign pigmented lesions are shown in Fig. 83-1. Figure 83-1
Atypical and malignant pigmented lesions. The most common melanoma is superficial spreading melanoma (not pictured).
The program has reached providers in over 33 states through train-the-trainer sessions and conferences. Much of the information provided in this report was gained or substantiated through extensive interaction with providers around the United States and internationally. Ultimately through a large evaluation component, impact of the training on preparedness, creation of plans, and staff will be reported.
Much has changed in the 30 years I have practiced
medicine, though perhaps no change
has been as significant as our collective attitude
toward health. The technological knowledge and
innovations that marked the latter decades of the
20th century have made it possible for us to repair
damaged hearts, cure many forms of cancer, and
even replace diseased organs. Men today can expect
to live a third as long as did their grandfathers.
A truly noninvasive medical measurement is any measurement system that does not
physically breach the skin or enter the body deeply through an external orifice. Thus,
the measurement of body temperature with a thermometer in the mouth, rectum, or
ear canal is considered noninvasive, as is the use of an otoscope to examine the
outer surface of the eardrum. Similarly, the opthalmoscope and the slit lamp, which
shine light in the eyes to examine the retina and the cornea and lens, respectively,
are considered noninvasive procedures....
There has been extensive past work on node localization as well
as event tracking in sensor networks (see  for a survey). These
systems differ in the way they obtain range measurements, propa-
gate location estimates transitively, utilize positive versus negative
information, and represent potential node locations.
Range measurements can be obtained through simple connectiv-
ity, signal strength, time of arrival, time difference of arrival or an-
gle of arrival measurements. Recent work has examined heuristics
for performing range measurements via hop counts .
The challenge of examining the skin lies in distinguishing normal from abnormal, significant findings from trivial ones, and in integrating pertinent signs and symptoms into an appropriate differential diagnosis. The fact that the largest organ in the body is visible is both an advantage and a disadvantage to those who examine it. It is advantageous because no special instrumentation is necessary and because the skin can be biopsied with little morbidity. However, the casual observer can be misled by a variety of stimuli and overlook important, subtle signs of skin or systemic disease. ...
So far, our analysis has focused on forecasts made in early 2010, when a number of large
fiscal consolidation plans were announced. But it is worth examining whether the relation
also holds for forecasts made in other years. We start by examining forecasts made in all
years since the start of the crisis (2009–12), both jointly and individually. This exercise has
the advantage of raising the sample size to 105 observations, up from the 26 observations in
our baseline sample. Then, we consider forecasts made in more normal times—the precrisis
Therewas no limit placed on the time period searched.
Reference lists fromarticles thatwere relevant to our purposes
were studied to identify additional studies and, where the
database included an option of identifying ‘‘related studies,’’
these were explored as well. Only studies published in peer
reviewed journals were considered. Both reports of research
as well as literature reviews were examined.
There are in principle two tests that may be used in mass screening, PSA (prostate specific antigen)
and DRE (digital rectal examination). The PSA test is simple, cheap, safe and acceptable. However the
prostatic biopsy, required to investigate positive results, is less acceptable and carries significant risks.
The accuracy (sensitivity and specificity) of the PSA test is difficult to determine (4). There is no good
standard against which to test it, since prostatic biopsy may itself miss 10% to 30% of cases.
There are two situations in which the TST is not required. Applicants providing written documentation (with a health-care provider’s signature) of a TST reaction of 5 mm or greater of induration or applicants with a history of a severe reaction with blistering to a prior TST may be excluded from this requirement. Applicants in these two groups must undergo a chest radiograph. A verbal history of a positive TST reaction from the applicant is not acceptable.
(BQ) Part 1 book "Ferri's fast facts in dermatology" presents the following contents: Evaluation of skin disorders (history and physical examination, dermatoses by region, dermatoses by morphology, dermatoses in the young), ifferential diagnosis.
(BQ) Part 1 book "Hamilton bailey's physical signs" presentation of content: History-taking and general examination, bones and fractures, joints and muscles, peripheral nerve injuries, the knee joint, the leg and ankle joint, distinctive clinical syndromes, the skin,... and other contents.
The conservation of artefacts and buildings has
a long history, but the positive emergence of
conservation as a profession can be said to
date from the foundation of the International
Institute for the Conservation of Museum
Objects (IIC) in 1950 (the last two words of
the title being later changed to Historic and
Artistic Works) and the appearance soon after
in 1952 of its journal Studies in Conservation.