NR511 MIDTERM STUDY GUIDE (NR511)

NR511 Midterm Study guide Dermatology 1. Actinic keratosis most common precancerous skin lesion in light skinned patients, more common in patients 50 years or older (most common in Celtic, Irish, and Scottish descent) Found in sun exposed areas Caused by skin cells that accumulate from repeated sun exposure Pathophys: continued sun damage from UV radiation damages the DNA in epithelial cells Primary lesions: macules or plaques, poorly circumscribed Secondary lesion: erythematous and scaly (May feel like sandpaper when touched) Not an aggressive form of cancer if/when it changes to squamous cell unless on the lip Patient complaints subjective: irritated, rough or scaly rash, pruritus, tenderness or stinging sensation Objective findings: reddened, scaly, rough, or uneven surfaces. Hard or spiny lesion. Sandpaper like texture. Diagnostic tests: fluorescence using photosensitizing drug (methyl ester of 5-aminolevulinic acid) over area of concern will have a pink fluorescence with the wood’s lamp Treatment: no evidence to support removal of lesion as most will not turn cancerous however it is standard to REMOVE the lesion(s) Topical Therapy: 5-fluorouracil (5-FU) cream (Efudex, Carac) applied in a thin layer over the lesion BID for 3 weeks, avoid eyelids, lips, and folds of the nose. This treatment causes red, raw, and painful skin in the areas applied which may lead to noncompliance. Exposure to sunlight makes this worse Imiquimod 5% cream used for face and scalp lesions. Applied 3x weekly for 8 weeks. Diclofenac 3% in 2.5% hyaluranon gell (Solaraza) applied BIF for 60 to 90 days Adapalene 0.1%to 0.3% (topical retinoid)applied daily for 4 weeks and then increased to BID Side effects of these treatments include redness, itching, rash, and dry skin Topical chemotherapy combined with phototherapy with blue or red wavelength have better cosmetic results than cryosurgery. 2 day course Cryosurgery tissue is destroyed by freezing using liquid nitrogen. Hypopigmentation may occur at site of previous lesion