Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). It is one of the less common types of skin cancer but causes the majority of skin cancer related deaths. Malignant melanoma is a serious type of skin cancer. It is due to uncontrolled growth of pigment cells, called melanocytes.Despite many years of intensive laboratory and clinical research, the sole effective cure is surgical resection of the primary tumor before it achieves a Breslow thickness greater than 1 mm.

Around 160,000 new cases of melanoma are diagnosed nationally each year, and it is more frequent in males and Caucasians. It is more common in Caucasian populations living in sunny climates than in other groups. According to a WHO report about 48,000 melanoma related deaths occur worldwide per year.

Malignant melanoma accounts for 75 percent of all deaths associated with skin cancer.

The treatment includes surgical removal of the tumor, adjuvant treatment, chemo- and immunotherapy, or radiation therapy.

Detection

To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCD” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.

A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:

• Asymmetrical skin lesion.
• Border of the lesion is irregular.
• Color: melanomas usually have multiple colors.
• Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
• Enlarging: Enlarging or evolving

Lichen sclerosus  is an uncommon condition that creates patchy, white skin that’s thinner than normal. Lichen sclerosus may affect skin on any part of your body, but most often involves skin of the vulva, foreskin of the penis or skin around the anus.

Anyone can get lichen sclerosus, but postmenopausal women and children who have not reached puberty are at highest risk. Left untreated, lichen sclerosus may lead to other complications.

You may not need treatment because sometimes lichen sclerosus improves on its own. If you do need treatment, your doctor can suggest options to return a more normal appearance to your skin and decrease the tendency for scarring.

Lichen sclerosus can affect the skin on any part of your body. Sometimes, no symptoms are present.

When they do occur, lichen sclerosus symptoms may include:

• Itching (pruritus), which can be severe
• Discomfort, which is generally greater if lichen sclerosus appears on or around your genital or anal areas
• Smooth white spots on your skin that may grow into blotchy, wrinkled patches
• Tenderness of the affected areas of your skin
• Easy bruising or tearing
• In severe cases, bleeding, blistering or ulcerated lesions
• Painful intercourse

The exact cause of lichen sclerosus isn’t known. However, the condition may be related to a lack of sex hormones in the affected skin or to an overactive immune system. Previous skin damage at a particular site on your skin may increase the likelihood of lichen sclerosus at that location.

Although lichen sclerosus may involve skin around your genitals, it isn’t contagious and cannot spread through sexual intercourse.

Lichen sclerosus occurs most often in postmenopausal women, but it also occurs in men and children. In women, lichen sclerosus usually involves the vulva. In boys and men, uncircumcised males are most at risk, because the condition generally affects the foreskin. In children, the signs and symptoms may improve at puberty.

Your doctor may diagnose lichen sclerosus based on:

• A physical examination
• Removal of a small piece of affected tissue (biopsy) for examination under a microscope

If lichen sclerosus isn’t in your genital area, you may not need treatment for lichen sclerosus, especially if you’re not having symptoms. In fact, many cases disappear on their own.

But, for adults and children with lichen sclerosus on or around the genitals or anus, or with a more advanced case on other parts of the body, doctors most commonly prescribe corticosteroid ointments or creams, which are usually quite effective. Prolonged use of these medications isn’t recommended because they can lead to thinning of the skin.

Other treatments for lichen sclerosus that your doctor may suggest include:

• Immune-modulating medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel)
• Prescription sex hormones
• Ultraviolet light treatment, for nongenital areas

Treatments cause your skin to assume a more normal appearance and decrease its tendency for further scarring.

For men with lichen sclerosus on the foreskin, removal of the foreskin (circumcision) is a common treatment in cases resistant to other therapies or more advanced cases. Surgery generally isn’t recommended for women with lichen sclerosus because the condition may just come back after surgery.

Lichen Planus is a rare, recurrent, itchy rash or area of inflammatory eruptions (lesions) of unknown origin characterized by shiny reddish-purple spots on the skin and gray-white ones in the mouth. The disorder may present as itchy spots on the wrist, legs, torso, genitals, mouth, or lips. The eruptions may appear as small separate, angular spots that may coalesce into rough scaly patches. This disorder is frequently accompanied by oral lesions of the mucous membranes that line the mouth. The disorder affects women more frequently than men.

Treatment

Care of OLP is within the scope of Oral medicine speciality. Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Medicines used to treat lichen planus include:

• Oral and topical steroids.
• Oral retinoids
• immunosuppressant medications
• hydroxychloroquine
• tacrolimus
• dapsone
• Aloe vera

Non-drug treatments:

• UVB NarrowBand Phototherapy

Keratosis Pilaris is a very common disorder in which small, rough bumps occur in hair follicles or pores, often with some redness around the pore.

It occurs in about 60% of teens and is more commonly seen in girls.

About 40% of adults will get it in varying degrees. It is more common in those with atopic conditions (asthma, hay fever, eczema), ichthyosis vulgaris, hypothyrodism, Cushing’s disease and a number of rare genetic conditions.

The vast majority of patients will have involvement of the upper outer back of their arms. Over half have some involvement on their outer upper thighs and about 30% have some involvement on their buttocks.

Hormonal influences have been considered since it appears at puberty and is more common in overweight women who have higher androgen (male hormone) levels. There is a genetic component to this condition. It appears to be autosomal dominant, and there is also an X-linked recessive variant.

Treatment

Self help:

Some over-the-counter (OTC) treatments include the following, and should be applied after bathing, and at bedtime:

Lactic acid lotions:

• Lachydrin®
• Lacticare®

Urea lotions:

• Uremol® Lotion

Glycolic Acid Lotions:

• Reversa® solution
• Neostrata® solution

Medical treatment:

Some topical treatments (creams and lotions) include:

• Tretinoin cream 0.1%-0.1% applied daily to the affected area, Differin® cream applied daily
• Tazorac® 0.05% or 0.1% cream or gel Oral therapies (pills and capsules)

Included are:

• Isotretinoin – This would only be used for the scarring Acitretin
• Laser treatment – Used for correction of scarring

A Keloid is a type of scar with mainly type I and some type III collagen which results in an overgrowth of tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to flesh-colored or red to dark brown in color. A keloid scar is benign, non-contagious, and usually accompanied by severe itchiness, sharp pains, and changes in texture. In severe cases, it can affect movement of skin.

Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound.

As wounds heal, scar tissue forms, which at first is often red and somewhat prominent. Over several months, a scar usually becomes flat and pale. If there is a lot of tension on a healing wound, the healing area is rather thicker than usual. This is known as a hypertrophic scar.

Treatment

Hypertrophic scars generally settle in time but keloids may prove resistant to treatment. The following measures are helpful.

Dressings should be worn for 12 to 24 hours per day, for at least 8 to 12 weeks, and perhaps for much longer.

• Polyurethane or silicone scar reduction patches
• Silicone gel
• Pressure dressings
• Surgical excision (but may result in a second keloid even larger than the original one)
• Corticosteroid injection, repeated every few weeks
• Cryotherapy
• Superficial X-ray treatment soon after surgery.
• Pulsed dye laser

Jock itch, also known as tinea cruris, is a fungal infection of the skin in the groin. The warm, moist environment is the perfect place for the fungus to grow. Anything that enhances that environment puts the person at risk of getting jock itch. Therefore, wearing sweaty, wet clothing in the summer time or wearing several layers of clothing in the wintertime causes an increased incidence of jock itch. Men are affected more often than women.

The Jock Itch Fungus

The fungus that most commonly causes jock itch is called Trichophyton rubrum. It also causes fungal infections of the toes and body. Under the microscope, this fungus looks like translucent, branching, rod-shaped filaments or hyphae. The width of the hyphae is uniform throughout which helps distinguish it from hair, which tapers at the end. Some hyphae appear to have bubbles within their walls, also distinguishing them from hair. Under most conditions these fungi inhabit only the dead skin cells of the epidermis

.

Jock Itch Appearance

The rash of jock itch starts in the groin fold usually on both sides. If the rash advances, it usually advances down the inner thigh. The advancing edge is redder and more raised than areas that have been infected longer. The advancing edge is usually scaly and very easily distinguished or well demarcated. The skin within the border turns a reddish-brown and loses much of its scale. Jock itch caused by T. rubrum does not involve the scrotum or penis. If those areas are involved, the most likely agent is Candida albicans, the same type of yeast that causes vaginal yeast infections.

Rashes Similar to Jock Itch

There are other rashes of the groin that can cause symptoms similar to jock itch. The first is called intertrigo which is a red, macerated rash at the groin fold not caused by a fungus. It is seen many times in obese patients and caused by moist skin rubbing against moist skin. The skin cracks and breaks down in lines called fissures, which can be very painful. These fissures can get secondarily infected with fungi or bacteria. The edge of the rash usually does not advance until much later in the life of the rash.

The other condition that mimics tinea cruris is called erythrasma. This is a bacterial infection that affects the groin and advances down the inner thigh similar to tinea cruris. However, the rash of erythrasma is flat and more brown than red throughout the affected area. It also does not have any scale or blisters.

Jock Itch Diagnosis

The best way to diagnose tinea cruris is to look for hyphae under the microscope, a KOH test. The skin is scraped with a scalpel or glass slide causing dead skin cells to fall off onto a glass slide. A few drops of Potassium hydroxide (KOH) are added to the slide and the slide is heated for a short time. The KOH dissolves the material binding the skin cells together releasing the hyphae, but it does not distort the cell or the hyphae. Special stains such as Chlorazol Fungal Stain, Swartz Lamkins Fungal Stain, or Parker’s blue ink can be used to help visualize the hyphae better.

Jock Itch Treatment

Jock itch is best treated with topical creams or ointments since the fungus only affects the top layer of skin. Many of the antifungal medications require a prescription, but there are three that can be bought over-the-counter (OTC). The OTC antifungals are tolnaftate (Tinactin), clotrimazole (Lotrimin), and miconazole (Micatin). Creams used to treat jock itch should be applied twice a day for at least two weeks. Application can be stopped after the rash has been gone for one week. Creams should be applied to the rash and also at least two finger widths beyond the rash. Many people with jock itch also have athlete’s foot and these same creams can be applied to the feet. However, treatment of athlete’s foot can take up to four weeks. If the rash is very red and itchy, especially if it has blisters at the edge, a topical steroid such as hydrocortisone can be applied also. Steroids should not be used in the groin alone without consulting a health care provider since steroids alone can make the rash of jock itch much worse.

Jock Itch Prevention

To prevent jock itch from occurring or re-occurring, several measures may be taken.

• Wear loose fitting clothing made of cotton or synthetic materials designed to wick moisture away from the surface.
• Avoid sharing clothing and towels or washcloths.
• Allow the groin to dry completely after showering before covering with clothes.
• Antifungal powders or sprays may be used once a day to prevent infection.

Jaundice, also known as icterus (attributive adjective: icteric), is a yellowish discoloration of the skin, the conjunctival membranes over the sclerae (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluids. Typically, the concentration of bilirubin in the plasma must exceed 1.5 mg/dL, three times the usual value of approximately 0.5mg/dL, for the coloration to be easily visible. Jaundice comes from the French word jaune, meaning yellow.

One of the first tissues to change color as bilirubin levels rise in jaundice is the conjunctiva of the eye, a condition sometimes referred to as scleral icterus. However, the sclera themselves are not “icteric” (stained with bile pigment) but rather the conjunctival membranes that overlie them. The yellowing of the “white of the eye” is thus more properly conjunctival icterus.

Causes

When a pathological process interferes with the normal functioning of the metabolism and excretion of bilirubin just described, jaundice may be the result. Jaundice is classified into three categories, depending on which part of the physiological mechanism the pathology affects. The three categories are:

• Pre-hepatic: The pathology is occurring prior the liver.
• Hepatic: The pathology is located within the liver.
• Post-Hepatic: The pathology is located after the conjugation of bilirubin in the liver.

Onychocryptosis (also known as an “Ingrown nail,” or “Unguis incarnatus” ) is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails.

Causes

The main cause for onychocryptosis or “ingrown nail” is improper footwear including shoes with inadequate toe-box room and tight stockings that apply top and or side pressures; next is the damp wet atmosphere toes are subjected to all day in enclosed shoes, softening the nail-plate and swelling the epidermis keratin, which eventually increases the convex arch permanently; next is genetics; and last are trauma and disease.

Improper cutting of any nail may cause the nail to cut into the side-fold skin from growth and impact, whether or not the nail is “ingrown” (onychocryptosis). The nail bends inwards or upwards depending on the angle with which it has been cut. Looking from the perspective of the owner, when cutting the nail, if the cutting tool, such as scissors, are in an attitude where the lower blade is closer to the toe than the upper blade then that will cause the toenail to start growing from its base upwards. Vice versa, when the lower blade is farther than the upper blade, the toenail will turn inwards. The process is visible along the nail as it grows, appearing as a warp that advances towards the end of the nail. The upper corners turn more easily than the center end of the nail. As people cut their nails by holding the tool always in the same angle, they induce these conditions by accident, while as the nail turns closer to the skin, it becomes harder to fit the lower blade in the right attitude under the nail. When cutting a nail, it is not just the right angle that is important, but also how short it is cut. A shorter cut will bend the nail more, unless the cut is even on both top and bottom of the nail.

Causes include:

1. Bad maintenance, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across
2. Ill-fitting shoes, as those that are too narrow or too short can cause bunching of the toes in the developmental stages of the foot (frequently in those under 21), causing the nail to curl and dig into the skin
3. Trauma to the nail plate or toe, which can occur by stubbing the toenail, dropping things on the toe or going through the end of the shoes (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh
4. Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases, or a genetic susceptibility to nail problems like ingrowth

Treatment

Treatment of ingrown nails ranges from soaking the afflicted area to surgery. The appropriate method is dictated by the severity of the condition. In nearly all cases, drainage of blood or watery discharge should mean a trip to the doctor, usually a podiatrist, a specialist trained explicitly to treat these conditions. Most practitioners agree that trying to outwait the condition is nearly always fruitless, as well as agonizing.

Home care

In mild cases (not including the severe cases as in the photos above), doctors recommend daily soaking of the affected digit in a mixture of warm water and Epsom salts and applying an over-the-counter antiseptic. This might allow the nail to grow out so it may be trimmed properly and the flesh to heal. Also Dettol instant Hand sanitizer has been known to be effective in the treatment of minor cases. Note that infection may be somewhat difficult to prevent in cleaning and treating ingrown nails owing to the warm, dark, and damp environment in shoes.

Peroxide is immediately effective to help clean minor infections but iodine is more effective in the long term as it continues to prevent bacterial growth even after it is dry. However, iodine should not be used on deep wounds. In such cases a physician or podiatrist should be consulted. Also, although bandages can help keep out bacteria, one should never apply any of the new types of spray-on bandages to ingrown nails that show any discharge – preventing drainage will likely cause intense swelling and pain. Removal of spray-on bandages can be achieved with common rubbing alcohol.

Some doctors will apply silver nitrate to granulation tissue (overgrowth of irritated tissue at the side of the nail. This may look like reddish cauliflower, bleeds easily). This may shrink and or remove this sensitive overgrown tissue at the side of the nail.

These home remedies are, in serious cases, ineffective: when the flesh is too swollen and infected these procedures will not work. Thus, these more severe cases, such as when the area around the nail becomes infected or the nail will not grow back properly, must be treated by a professional and the patient should avoid repeated attempts at this type of ‘bathroom surgery’.

Urticaria (or hives) are a kind of skin rash notable for dark red, raised, itchy bumps. Hives are frequently caused by allergic reactions; however, there are many non-allergic causes. For example, most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six weeks) are rarely due to an allergy. The majority of patients with chronic hives have an unknown (idiopathic) cause. Perhaps as many as 30-40% of patients with chronic idiopathic urticaria will, in fact, have an autoimmune cause. Acute viral infection is another common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight. It may be true that hives are more common in those with fair skin.

Wheals (raised areas surrounded by a red base) from urticaria can appear anywhere on the surface of the skin. Whether the trigger is allergic or non-allergic, there is a complex release of inflammatory mediators, including histamine from cutaneous mast cells, resulting in fluid leakage from superficial blood vessels. Wheals may be pinpoint in size, or several inches in diameter. Angioedema is a related condition (also from allergic and non-allergic causes), though fluid leakage is from much deeper blood vessels. Individual hives that are painful, last >24 hours, or leave a bruise as they heal are more likely to be a more serious condition called urticaria pigmentosa. Hives caused by stroking the skin (often linear in appearance) are due to a benign condition called dermatographism.

The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, and resulting in an edema which persists until the interstitial fluid is absorbed into the surrounding cells.

Urticaria are caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or non-allergic reaction, differing in the eliciting mechanism of histamine release.

Differential diagnosis

The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called Urushiol-induced contact dermatitis. Urushiol is spread by contact, but can be washed off with a strong grease/oil dissolving detergent and cool water and rubbing ointments.

Treatment and management

Chronic urticaria can be difficult to treat. There are no guaranteed treatments or means of controlling attacks, and some sub-populations are treatment-resistant, with medications spontaneously losing their effectiveness and requiring new medications to control attacks. It can be difficult to determine appropriate medications since some, such as loratadine, require a day or two to build up to effective levels, and since the condition is intermittent and outbreaks typically clear up without any treatment.

Most treatment plans for urticaria involve being aware of one’s triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type. Also, since symptoms are often idiopathic (unknown reason) there might not be any clear trigger. If one’s triggers can be identified then outbreaks can often be managed by limiting one’s exposure to these situations.

Histamine antagonists

Drug treatment is typically in the form of antihistamines such as diphenhydramine, hydroxyzine, cetirizine and other H₁ receptor antagonists. These are taken on a regular basis to protective effect, lessening or halting attacks. While the disease may be physiological in origin, psychological treatments such as stress management can sometimes lessen severity and occurrence. Additionally, methods similar to psychological pain management can be used to shift focus away from the discomfort and itchiness during an attack.

The H₂-receptor antagonists such as cimetidine and ranitidine may help control symptoms either prophylactically or by lessening symptoms during an attack.^[15] When taken in combination with a H₁ antagonist it has been shown to have a synergistic effect which is more effective than either treatment alone. The use of ranitidine (or other H₂ antagonist) for urticaria is considered an off-label use, since these drugs are primarily used for the treatment of peptic ulcer disease and gastroesophageal reflux disease.