Malignant melanoma
Melanoma
•Typical age range 30–50 years (average 40 years)
•Can occur anywhere on the body— more common: lower limbs in women, upper back in men
•Often asymptomatic
•Can bleed or itch
Melanoma
Prognosis
thickness (Breslow classification)
level or depth (worse in level IV or V)
site (worse on head and neck, trunk)
sex (worse for men)
age (worse >50 years)
amelanotic melanoma
ulceration
Management points for naevi and melanomas
Neuropathic ulcer
A neuropathic ulcer is one that occurs as a result of peripheral neuropathy
Neuropathic ulcers can develop with any condition with peripheral neuropathy
Associated with diabetes, syphilis, leprosy and other neuropathies.
Diabetic foot ulcer
A feature is a deep, punched-out lesion over pressure points.
The ulcers may extend to the bone and into joints.
They are prone to secondary infection.
Treatment is based on controlling the diabetes and clearing infection with appropriate antibiotics, but referral for surgical management is usually essential.
Burkholderia pseudomallei
Melioidosis is an uncommon tropical disease caused by the bacterium, Burkholderia pseudomallei
a soil saprophyte that infects humans mainly by penetrating through skin wounds, especially abrasions
It is mostly acquired while wading in rice paddies
fever + pneumonia + myalgia → melioidosis
Treatment: antibiotics are given intravenously initially for the first 10–14 days.
Burkholderia pseudomallei
Necrotising fasciitis
Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia
The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels.
The result is the destruction of the soft tissues and fascia.
There is poor adherence of tissue to the fascia on incising the site.
Necrotic tissue/pus oozes out of the fascial planes.
Dishwater-coloured fluid seeps out of the skin.
Typically, necrotising fasciitis does not bleed
Erythema ab igne
Erythema ab igne (EAI) is a skin reaction caused by chronic exposure to infrared radiation in the form of heat
Causes a mild and transient red rash resembling lacework or a fishing net
the condition will resolve by itself over several months.
If there is a persistent sore that doesn't heal or a growing lump within the rash, a skin biopsy should be performed to rule out the possibility of skin cancer