Medical Terminology Case Studies - Skin

The Scar Solution Natural Scar Removal

The Scar Solution By Sean Lowry

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Case Study 21-1: Basal Cell Carcinoma (BSC)

K.B., a 32-year-old fitness instructor, had noticed a "tiny hard lump" at the base of her left nostril while cleansing her face. The lesion had been present for about 2 months when she consulted a dermatologist. She had recently moved north from Florida, where she had worked as a lifeguard. She thought the lump might have been triggered by the regular tanning salon sessions she had used to retain her tan because it did not resemble the acne pustules, blackheads, or resulting scars of her adolescent years. Although dermabrasion had removed the obvious acne scars and left several areas of dense skin, this lump was brown-pigmented and different. K.B. was afraid it might be a malignant melanoma. On examination, the dermatologist noted a small pearly-white nodule at the lower portion of the left ala (outer flared portion of the nostril). There were no other lesions on her face or neck.

A plastic surgeon excised the lesion and was able to re-approximate the wound edges without a full-thickness skin graft. The pathology report identified the lesion as a basal cell carcinoma with clean margins of normal skin and subcutaneous tissue and stated that the entire lesion had been excised. K.B. was advised to wear SPF 30 sun protection on her face at all times and to avoid excessive sun exposure and tanning salons.

Case Study 21-2: Cutaneous Lymphoma

L.C., a 52-year-old female research chemist, has had a history of T-cell lymphoma for 8 years. She was initially treated with systemic chemotherapy with methotrexate until she contracted stomatitis. Continued therapy with topical chemotherapeutic agents brought some measurable improvement. She also had a history of hidradenitis.

A recent physical examination showed diffuse erythroderma with scaling and hyperkeratosis, plus alopecia. She had painful leukoplakia and ulcerations of the mouth and tongue. L.C. was hospitalized and given two courses of topical chemotherapy. She was referred to Dental Medicine for treatment of the oral lesions and discharged in stable condition with an appointment for follow-up in 4 weeks. Her discharge medications included hydrocortisone ointment 2% to affected lesions q hs, Keralyt gel bid for the hyperkeratosis, and Dyclone and Benadryl for her mouth ulcers prn.

Case Study 21-3: Pressure Ulcer

L.N., an elderly woman in failing health, had recently moved in with her daughter after her hospital-ization for a stroke. The daughter reported to the home care nurse that her mother had minimal appetite, was confused and disoriented, and had developed a blister on her lower back since she had been confined to bed. The nurse noted that L.N. had lost weight since her last visit and that her skin was dry with poor skin turgor. She was wearing an "adult diaper," which was wet. After examining L.N.'s sacrum, the nurse noted a nickel-sized open area, 2 cm in diameter and 1 cm in depth (stage II pressure ulcer), with a 0.5-cm reddened surrounding area with no drainage. L.N. moaned when the nurse palpated the lesion. The nurse also noted reddened areas on L.N.'s elbows and heels.

The nurse provided L.N.'s daughter with instructions for proper skin care, incontinence management, enhanced nutrition, and frequent repositioning to prevent pressure ischemia to the prominent body areas. However, 6 months later L.N.'s pressure ulcer had deteriorated to a class III. She was hospitalized under the care of a plastic surgeon and wound-ostomy care nurse. Surgery was scheduled to d├ębride the sacral wound and close it with a full-thickness skin graft taken from her thigh. L.N. was discharged 8 days later to a long-term care facility with orders for an alternating pressure mattress, position change every 2 hours, supplemental nutrition, and meticulous wound care.

CASE STUDY QUESTIONS

Multiple choice: Select the best answer and write the letter of your choice to the left of each number.

_ 1. K.B.'s basal cell carcinoma may have been caused by chronic exposure to the sun and ultraviolet tanning bed use. The scientific explanation for this is the:

a. autoimmune response b. actinic effect c. allergic reaction d. sun block tanning lotion theory e. dermatophytosis

_____ 2. The characteristic pimples of adolescent acne are whiteheads and blackheads. The medical terms for these lesions are:

a. vesicles and lymphotomes b. pustules and blisters c. pustules and comedones d. vitiligo and macules e. furuncle and sebaceous cyst

_ 3. Which skin cancer is an overgrowth of pigment-producing epidermal cells:

a. basal cell carcinoma b. Kaposi sarcoma c. cutaneous lymphoma d. melanoma e. erythema nodosum

_ 4. Basal cell carcinoma involves:

a. subcutaneous tissue b. hair follicles c. connective tissue d. adipose tissue e. epithelial cells

_ 5. Hydradenitis is inflammation of a:

a. sweat gland b. salivary gland c. sebaceous gland d. ceruminous gland e. meibomian gland

_ 6. Leukoplakia is:

a. baldness b. ulceration c. formation of white patches in the mouth d. formation of yellow patches on the skin e. formation of scales on the skin

7. Hydrocortisone is a(n):

a. vitamin b. steroid c. analgesic d. lubricant e. diuretic

8. An example of a topical drug is a:

a. systemic chemotherapeutic agent b. drug derived from rain forest plants c. subdermal allergy test antigens d. skin ointment e. Benadryl capsule 25 mg

9. Stomatitis, a common side effect of systemic chemotherapy, is an inflammatory condition of the:

a. mouth b. colostomy c. stomach d. teeth and hair e. nails

10. Skin turgor is an indicator of:

a. elasticity b. hydration c. aging d. nutrition e. all of the above

11. Another name for a pressure ulcer is a:

a. shearing force b. bedsore c. decubitus ulcer d. a and b e. b and c

12. A FTSG is usually harvested (taken) from another body area with a scalpel, whereas a STSG

is harvested with an instrument called a(n) _, which can cut a thinner graft.

a. tissue slicer b. Keralyt c. erythroderm d. dermatome e. debridement

Write a term from the case studies with each of the following meanings:

13. skin sanding procedure _

14. a solid raised lesion larger than a papule _

15. physician who cares for patients with skin diseases _

16. connective tissue and fat layer beneath the dermis _

17. diffuse redness of the skin _

18. increased production of keratin in the skin _

19. removal of dead or damaged skin _

20. reduced blood flow to the tissue _

Abbreviations. Define the following abbreviations:

25. bid

Chapter 21 Crossword The Skin

Lymphotomes

ACROSS

DOWN

1.

Horny layer of the skin: combining form

1.

Raised, thickened scar

3.

Inflammation of a sweat gland:____adenitis

2.

Pertaining to a hair

6.

Autoimmune disease that affects the skin:

3.

Measurement of packed red cells: abbreviation

abbreviation

4.

Abnormal, painful: prefix

7.

Excess growth of hair

5.

Removal of scab tissue

9.

Within the skin: abbreviation

8.

Bacterial skin infection common in children:

11.

Viral disease that affects the skin

o

13.

Skin: combining form

10.

Remove dead tissue, as from a wound

14.

Sweat: combining form

12.

A layer, as of the skin

15.

Three: prefix

17.

Meaning of the root onych/o

16.

Scar:____trix

19.

A route of injection: abbreviation

18.

Examination by pressing a glass plate against the

20.

20. True, good, easy: prefix

21. Half: prefix

22. Part of a medical history:__H: abbreviation

23. Under, below, decreased: prefix skin

20. True, good, easy: prefix

21. Half: prefix

22. Part of a medical history:__H: abbreviation

23. Under, below, decreased: prefix

CHAPTER

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