Hilton's Law- Nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles
- For example, musculocutaneous nerve:
- Supplies biceps brachii + brachialis
- Also supplies the elbow joint with pain and proprioception fibres
- Also supplies the forearm skin around the elbow (close to the insertion of each of those muscles)
Melanoma history
- Age
- Occupation
- Country of birth
- Past sun exposure
- Skin type / Response to sun
- History of lesion
- When noticed
- When GP consulted
- Referrals
- Any other moles
- PMH
- FHx of skin or other cancer
Fungating man
- Differentials
- SCC / MM
- BCC never look like that
- Smell
Melanoma staging
- Breslow thickness => 5-year survival
- <1 mm => 95-100%
- 1 - 2 mm => 80-96%
- 2 - 4 mm => 60-75%
- >4 mm => 50%
- Ulceration is bad
- Nodes
- CT for haematogenous spread
Skin types (Fitzpatrick Scale) - Type I
- Light, pale white
- Always burns, never tans
- Type II
- White; fair.
- Usually burns, tans with difficulty
- Type III
- Medium, white to light brown.
- Sometimes mild burn, gradually tans to a light brown
- Type IV
- Olive, moderate brown
- Rarely burns, tans with ease to a moderate brown
- Type V
- Brown, dark brown
- Very rarely burns, tans very easily
- Type VI
- Black, very dark brown to black
- Never burns, tans very easily, deeply pigmented
Seborrheic keratosis
- Noncancerous benign skin growth
- Originates in keratinocytes
- Seen more often as people age
- Appearance:
- "Pasted on"
- Various colors, from light tan to black
- Round or oval
- Feel flat or slightly elevated (like the scab from a healing wound)
- Range in size from very small to more than 2.5 centimetres across
- Resemble
Gastrointestinal stromal tumor (GIST)
- Definition
- Common GI mesenchymal tumor
- 1-3% of all gastrointestinal malignancies
- Defined as tumors whose behavior is driven by mutations in the Kit or PDGFRA genes
- Sarcomas (connective tissue)
- 70-80% are benign
- Signs and symptoms
- Vague abdo pain
- Trouble swallowing
- GI bleed
- Mets
- Intestinal obstruction is rare, due to the tumor's outward pattern of growth
- Location
- 70% stomach
- 20% small intestine
- 10% oesophagus
- Therapy
- All GIST tumors should be considered to have malignant potential and no GIST tumor can be correctly classified as "benign."
- Surgery is mainstay
- c-kit tyrosine kinase inhibitor imatinib => 40-70% response rate in metastatic/inoperable cases
- Initially marketed for CML
- Also useful in dermatofibrosarcoma protuberans (DFSP)
Notes
- Charcot joint
- Eccrine porocarcinoma
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