Examination of the skin p 945 HTPE p 51 (skin hair and nails) • Inspection • Palpation Skin HTPE p 52 hair • Colour • Lesions • Texture / thickness • Hydration • Turgor / elasticity • Vascularity / erythema • Temperature Examine nails HTPE p 946 p 54 • Inspect • Palpate Examine hair and skull p 946 HTPE p 54 • Inspect • Palpate Examine the head and neck p 54 Common skin lesions p 948 (define and identify) • Acne • Blister • Bulla • Cherry angioma • Crusts • Cyst • Ecchymosis • Keloid • Lichen • Macule • Nodule • Papule • Patch • Plaque • Petichae • Pustule • Scale • Scar • Spider angioma • Tumour • Ulcer • Urticuria • Vesicle • Wheal Rashes PCCM p 246 • Dermatitis table 49.4 o Atopic dermatitis p 961 o Contact dermatitis p 962 / PCCM 246  Clinical features PCCM p 246  Management PCCM p 246 o Essential health information o Topical therapies box 49.1 • Nappy rash p 964 box 49.2 o Causes o Clinical features o Management • Allergic PCCM 248 o Clinical features o Management Infectious skin diseases p 957, table 49,1 PCCM 249 • Folliculitis p 957 o Clinical manifestations o Management • Impetigo p 957 table 49.1 PCCM 249 o Causes o Clinical features p 957 / PCCM 249 o Management • Cellulitis PCCM 250 o Clinical features o Management • Boil /Carbuncle / furuncle p 957 table 49.1 o Clinical features PCCM 250 o Management PCCM 250   Viral infections p 957, table 49.2, PCCM p 251 • Herpes Zoster shingles p 958 PCCM 251 o Causes o Clinical features o Management • Warts p 958, table 49.2, PCCM 252 o Clinical features Management Fungal diseases p 959, PCCM p 254 • Tinea capitis o Clinical features o Management • Tinea corporis o Clinical features o Management • Tinea pedis o Clinical features o Management • Tinea unguium o Clinical features o Management • Tinea cruris o Clinical features o Management Urticaria PCCM 256 • Causes • Clinical features Eczema PCCM p 258 • Definition • Causes • Clinical features Psoriasis p 961 PCCM p 260 • Definition • Causes p 961 /PCCM 260 • Pathophysiology • Risk factors • Types • Clinical manifestations pp 962 / PCCM 260 • Management p 962 / PCCM 260 Acne vulgaris p 965, PCCM p 261 • Causes p 965 / PCCM 261 • Clinical features • Risk / p 965 Influencing factors PCCM 261 • Management • Essential health information p 965 Skin tumours • Malignant melanoma P 961 PCCM p 263 o Clinical features o Management o Essential health information

1. Integumentary System:
Dermatology
BY C SETTLEY

2. What is the integumentary system?
 The integumentary system comprises of the
skin and its appendages acting to protect
the body from various kinds of damage, such
as loss of water or abrasion from outside.
2

3. What is the integumentary system?
 The skin is divided into three layers;
(1) the epidermis,
(2) the dermis, and
(3) the subcutaneous tissues.
 Epidermal appendages include the hair,
nails, sweat glands, and sebaceous glands.
3

4. What is the integumentary system?
 Functions of layers:
 Maintains an internal environment by acting as a barrier
to loss of water and electrolytes
 Protection from external agents that could injure the
internal environment
 Regulation of body heat
 Acting as a sense organ for touch, temperature, and
pain.
 Self-maintenance and wound repair
 Production of vitamin D
4

5. 5

6. Inspection of the skin
 General survey
Colour shades
Scars
Birthmarks
Tattoos
Physical & psychological condition of patient
Does patient appear ill?
Other problems present such as lumps and
unusual flaking
6

7. Inspection of the skin
 Colour of the skin:
 Cyanosis
 Redness
 Allergy
 Bleeding tendencies (petechiae)- broken capillary blood vessels
 Pallor
 Abnormal yellow colour
 Abnormal pigmentation
 Vitiligo due to hyperthyroidism, anaemia or adrenocortical insufficiency
 Hypopigmentation due to fungal infection or eczema
 Port-wine stain- vascular birthmarks
 Bronzing of skin due to Addison’s disease, chronic kidney failure or liver failure
 Hyperpigmentation due to sunburn
7

8. Cyanosis Redness 8

9. Petechiae Pallor 9

10. Jaundice Vitiligo 10

11. Hypopigmentation &
Hyperpigmentation
 Albinism is a rare, genetic cause of
hypopigmentation in which the pigment
melanin cannot be form.
11

12. Port wine stain Bronzing of skin 12

13. Inspection of the skin
 Skin thickness
Thin
Breakable
Shiny
 Hair growth
Abnormal facial hair in females
No hair on lower limbs due to arterial insufficiency
13

14. Inspection of the skin
 Sweating
Fever?
High environmental temperature?
Hormonal imbalance?
 Skin oiliness
Facial lesions?
14

15. Inspection of the skin
 Moisture
Dry?
Flaky?
 Skin discoloration
Birthmarks
Stretch marks
15

16. Inspection of the skin
 Hygiene
 Skin lesions
Type
Position
Arrangement
Distribution
Shape
16

17. Palpation of the skin
Temperature
Affected area when touching skin surface
Assess and compare to other areas
Inflammation?
Infection?
Arterial insufficiency due to vasoconstriction
or atherosclerosis
17

18. Palpation of the skin
Texture
Smoothness
Roughness
Moist
Dry
Leathery
Soft
Firm
Hard
Hydrated
Overexposure to the sun
18

19. Palpation of the skin
Elasticity, mobility & skin turgor
 Normal skin is elastic and mobile
 Ability to return to normal after being stretched
 Oedema
 Turgor may indicate dehydration
 Older individuals- wrinkles, decreased elasticity due to little collagen
and elastic fibre loss
Sensation
Sensitivity to touch, tingling, itching or pain
19

20. Assessment of hair & nails
Hair
Growth, distribution,
condition, colour
Excessive hair
growth
Abnormal hair loss
Baldness
Scalp infections
Lice
Nails
Colour
Length
Configuration
Symmetry
Nailbed
Clubbing
Uniformity texture
Swelling, pain,
exudate
20

21. Assessment of hair 21

22. Assessment of nails 22

23. Common skin lesions 23

24. Common skin lesions 24

25. Common skin lesions 25

26. Common skin lesions
Acne Bulla Keloid
26

27. Common skin lesions
Lichen Papule Plaque
27

28. Common skin lesions
Urticuria Vesicle Wheal
28

29. Types of dermatitis 29

30. Dermatitis
Essential health information
30
 Observe substances prone to causing dermatitis
and avoid contact
 Avoid obvious external irritants
 Choose non fragranced detergents, toiletries &
cosmetics
 Rinse skin thoroughly under running water
immediately after any exposure
 Avoid over the counter medications, lotions &
ointments

31. Dermatitis
Topical therapies
31
 Emollients: aqueous cream, liquid paraffin,
Epaderm
 Bath oils
 Soap substitutes: aqueous cream or
emulsifying ointment
 Steroids: betamethasone
 Steroid antibiotic: clobetasol propionate
 Medicated bandages and wet wraps

32. Nappy rash (dermatitis in the
nappy area)
 Nappy rash is linked to wet or infrequently
changed nappies, diarrhoea, new foods
and antibiotics.
 The main symptom is a red rash on the
buttocks. In severe cases, symptoms such
as fever and widespread rash can occur.
 Most rashes start to improve after a few
days of at-home care with over-the-
counter ointment and more frequent
nappy changes.
32

33. Nappy rash: Causes 33
 The main cause is wearing a wet or dirty
nappy for too long.
 Prolonged dampness, friction and ammonia
substances released from urine can irritate
the child’s skin.
 Plastic pants often make nappy rash worse
because they stop air circulating normally
and keep the nappy area damp.

34. Nappy rash: Clinical manifestations 34
 Skin: rashes, blister, peeling, pimples, or
redness
 Fever
 Also common: itchiness around anus

35. Nappy rash: Management 35
 Air out the skin
 After a bowel movement, clean your baby's
bottom thoroughly and pat it dry
 Spread a thick layer of ointment containing
zinc oxide or petroleum jelly
 Consider whether the child's diet may
contribute to rash

36. Infectious skin diseases:
Impetigo
 A highly contagious
skin infection that
causes red sores on
the face.
 Common in pre
school children
 Staphylococci,
Streptococci, S.
aureus
36

37. Impetigo: Causes
 Exposed to bacteria
 Age.
 Impetigo most commonly occurs in children ages 2 to 5.
 Crowded conditions.
 Impetigo spreads easily in schools and child care settings.
 Warm, humid weather.
 Impetigo infections are more common in summer.
 Certain sports.
 Participation in sports that involve skin-to-skin contact, such as football or
wrestling, increases your risk of developing impetigo.
 Broken skin.
 The bacteria that cause impetigo often enter your skin through a small skin injury,
insect bite or rash.
37

38. Impetigo: Management
 Cleanse the skin with normal saline to remove
crusts; may need to use soap as well
 Apply topical antibiotics as prescribed
 Systemic antibiotic as prescribed
 Maintain personal hygiene
38

39. Impetigo: Treatment
 Flucloxacillin, oral 500 mg, 6 hourly for 5 days
 Penicillin allergy: Macrolide e.g. Erythromycin, oral
250 mg, 6 hourly for 5 days
39

40. Cellulitis
 Cellulitis occurs when certain types of bacteria enter
through a cut or crack in the skin.
 Cellulitis is commonly caused by Staphylococcus and
Streptococcus bacteria.
40

41. Cellulitis: Causes
 Although cellulitis can occur anywhere on your body, the
most common location is the lower leg.
 Bacteria are most likely to enter disrupted areas of skin, such
as where recent surgery, cuts, puncture wounds, an ulcer,
athlete's foot or dermatitis occured.
 Animal bites can cause cellulitis.
 Bacteria can also enter through areas of dry, flaky skin or
swollen skin.
41

42. Cellulitis: Symptoms
 Red area of skin that tends to expand
 Swelling
 Tenderness
 Pain
 Warmth
 Fever
 Red spots
 Blisters
42

43. Cellulitis: Management
 Without treatment with an antibiotic, cellulitis can be life-
threatening.
 For pain: Ibuprofen or Paracetamol
 AB therapy: Cloxacillin, IV, 1g, 6 hourly. When there is clinical
improvement, change to Flucloxacillin, oral, 500mg, 6 hourly.
 Penicillin allergy: Clindamycin, IV, 600 mg, 8 hourly then oral
after improvement.
 Referral: if debridement is needed
43

44. Furuncles (Boils, abscesses)
 A painful, pus-filled bump under the skin caused by infected,
inflamed hair follicles.
44

45. Furuncles (Boils, abscesses): Causes
& clinical features
 The most common bacterium is Staphylococcus aureus,
hence why furuncles can also be called staph infections.
 Everyone has S. aureus on their skin as a normal occurrence.
The bacterium causes an infection only if it enters the
bloodstream through an open wound, such as a cut or a
scratch.
 Boils start as red, tender lumps.
 These fill with pus, grow, then rupture and drain.
 A carbuncle is a cluster of boils.
45

46. Furuncles (Boils, abscesses):
Management
 Apply warm, moist compresses (such as a damp washcloth)
several times a day. This can speed healing and relieve some of
the pain and pressure caused by the boil. A separate washcloth
(and towel) should be used.
 Immediate medical attention- if it is located on the spine or on
your face and or accompanied by a fever.
 Patients who have diabetes or who have a condition that
affects the immune system should see a doctor for the treatment
of the boil.
46

47. Viral infections:
Herpes Zoster shingles
 A reactivation of the chickenpox virus in the body, causing
a painful rash.
 Caused by the varicella-zoster virus.
 Even after the chickenpox infection is over, the virus may live
in your nervous system for years before reactivating as
shingles.
 Shingles may also be referred to as herpes zoster.
47

48. Herpes Zoster shingles: Risk factors
 Being older than 50.
 Increased risk.
 Having certain diseases.
 Diseases that weaken your immune system, such as HIV/AIDS and cancer,
can increase the risk of developing shingles.
 Undergoing cancer treatments.
 Radiation or chemotherapy can lower the resistance to diseases and may
trigger shingles.
 Taking certain medications.
 Drugs designed to prevent rejection of transplanted organs can increase
the risk of shingles — as can prolonged use of steroids, such as prednisone.
48

49. Herpes Zoster shingles:
Complications
 Postherpetic neuralgia.
 For some people, shingles pain continues long after the blisters have cleared. This
condition is known as postherpetic neuralgia, and it occurs when damaged nerve
fibers send confused and exaggerated messages of pain from your skin to your brain.
 Vision loss.
 Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections
that may result in vision loss.
 Neurological problems.
 Depending on which nerves are affected, shingles can cause an inflammation of the
brain (encephalitis), facial paralysis, or hearing or balance problems.
 Skin infections.
 If shingles blisters aren't properly treated, bacterial skin infections may develop.
49

50. Herpes Zoster shingles:
Prevention & treatment
 Vaccines
 Symptomatic management
 Antiviral ointments
 Systematic treatment
50

51. Warts
 A small, fleshy bump on the skin or mucous
membrane caused by human papillomavirus.
51

52. Warts: Clinical manifestations
 Skin: small growths on skin or thickness
 Also common: itching or lesions in mouth or around
genital regions
52

53. Warts: Management
 Personal hygiene
 Antibiotics as prescribed if there is a bacterial
infection present
53

54. Fungal diseases:
Tinea capitis
 Also known as scalp ringworm
 T. tonsurans may occur in adults.
 Anthropophilic infections such as T. tonsurans are more common in
crowded living conditions.
 The fungus can contaminate hairbrushes, clothing, towels and the
backs of seats.
 The spores are long lived and can infect another individual months
later.
54

55. Tinea capitis:
Clinical manifestations
 Dry scaling
 Black dots – the hairs are broken off at the scalp surface, which is
scaly
 Smooth areas of hair loss
 Kerion – very inflamed mass, like an abscess
 Favus – yellow crusts and matted hair
 Carrier state no symptoms and only mild scaling (T. tonsurans).
 Tinea capitis may result in swollen lymph glands at the sides of
the back of the neck.
55

56. Tinea corposis
 Tinea corporis is a superficial fungal infection of the arms and legs, however, it
may occur on any part of the body.
 A pruritic, annular plaque is characteristic of a symptomatic infection. Patients
occasionally can experience a burning sensation.
 HIV-positive or immunocompromised patients may develop severe pruritus or
pain.
 Tinea corporis may result from contact with infected humans, animals, or
objects.
56

57. Tinea pedis
 Athlete's foot
 Feet that have been very sweaty while confined within tight-
fitting shoes.
 Symptoms include a scaly rash that usually causes itching,
stinging and burning. People with athlete's foot can have moist,
raw skin between their toes.
 Signs and symptoms of athlete's foot include a scaly rash that
usually causes itching, stinging and burning
57

58. Tinea uniguium
 Also called onychomycosis
 A nail fungus causing thickened, brittle, crumbly or ragged nails.
 Usually, the problems caused by this condition are cosmetic.
 The main symptoms are changes in the appearance of nails.
 Rarely, the condition causes pain or a slightly foul odour.
58

59. Tinea cruris
 Fungal infection in the skin of the genitals, inner thighs and
buttocks.
 Most often occurs when people wear tight-fitting clothing that
traps in moisture.
 Jock itch (a fungal infection of the groin area) causes an itchy,
red, often ring-shaped rash.
59

60. Management of fungal infections
 Systemic antifungal drugs include griseofulvin, fluconazole and
Lamisil for Tinea capitis + hair should be cut and no sharing of combs
 Advise patient to take medication with a fatty meal as the drugs
are lipolytic
 Local topical antifungal creams include miconazole and
clotrimazole
 Ensure a clean and dry skin at all times and do not share towels
 In severe cases, oral systemic treatment may be prescribed
 Advised to wear cotton underwear and avoid wet swim suits
 Tinea unguium responds to oral antifungal agents
60

61. Urticaria
 A skin rash triggered by a reaction to food, medicine or other irritants.
 Hives is a common skin rash triggered by many things, including certain foods,
medication and stress.
 Symptoms include itchy, raised, red or skin-coloured welts on the skin's surface.
 Hives usually go away without treatment, but antihistamine medication is often
helpful in improving symptoms.
61

62. Eczema
 An itchy inflammation of the skin.
 Atopic dermatitis usually develops in early childhood and is more common in
people who have a family history of the condition.
 The main symptom is a rash that typically appears on the arms and behind the
knees, but can also appear anywhere.
 Treatment includes avoiding soap and other irritants.
 Certain creams or ointments may also provide relief from the itching.
62

63. Eczema: Causes
 Genetics
 Abnormal function of the immune system
 Environment
 Activities that may cause skin to be more sensitive
 Defects in the skin barrier that allow moisture out and
germs in
63

64. Psoriasis
 Psoriasis is a noncontagious, chronic skin disease that produces plaques
of thickened, scaly skin.
 The dry flakes of silvery-white skin scales result from the excessively rapid
proliferation of skin cells.
 Psoriasis is fundamentally an immune system problem.
 The proliferation of skin cells is triggered by inflammatory chemicals
produced by specialized white blood cells called T-cells.
 Psoriasis commonly affects the skin of the elbows, knees, and scalp.
 Psoriasis is considered an incurable, long-term (chronic) inflammatory skin
condition.
 It has a variable course, periodically improving and worsening.
 It is not unusual for psoriasis to spontaneously clear for years and stay in
remission.
 Many people note a worsening of their symptoms in the colder winter
months.
64

65. Psoriasis
Plaque psoriasis is the most common type of
psoriasis. It usually causes dry, red skin lesions
(plaques) covered with silvery scales.
Guttate psoriasis, more common in children and
adults younger than 30, appears as small, water-
drop-shaped sores on the trunk, arms, legs and
scalp. The sores are typically covered by a fine
scale.
65

66. Psoriasis
Scalp psoriasis
Psoriasis causes red patches of skin covered
with silvery scales and a thick crust on the scalp
most often extending just past the hairline that
may bleed when removed.
Inverse psoriasis
Inverse psoriasis causes smooth patches of red,
inflamed skin. It's more common in overweight
people and is worsened by friction and
sweating.
66

67. Psoriasis
Nail psoriasis
Psoriasis can affect fingernails and toenails,
causing pitting, abnormal nail growth and
discoloration.
Pustular psoriasis
Pustular psoriasis generally develops quickly,
with pus-filled blisters appearing just hours after
your skin becomes red and tender. It can occur
in widespread patches or in smaller areas on
your hands, feet or fingertips.
67

68. Psoriasis
Erythrodermic psoriasis
The least common type of psoriasis,
erythrodermic psoriasis can cover your entire
body with a red, peeling rash that can itch or
burn intensely.
68

69. Psoriasis: Causative factors &
Pathophysiology
 Genetic and environmental aspects
 Due to excessive proliferation of the epidermal cells
 Which fail to mature as a result is the rapid cell passage from the
basal layer to the skin surface
 The abnormal process that takes about 3-4 days instead of 26 to 28
days does not allow for the protective layers of the skin to form
 These immature cells become evident as profuse scales or plagues
of epidermal tissue
69

70. Psoriasis: the skin layers 70

71. Psoriasis: Risk factors
 Family history. This is one of the most significant risk factors.
 Viral and bacterial infections. People with HIV are more likely to
develop psoriasis than people with healthy immune systems are.
Children and young adults with recurring infections, particularly strep
throat, also may be at increased risk.
 Stress. Because stress can impact your immune system, high stress levels
may increase the risk of psoriasis.
 Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques)
associated with all types of psoriasis often develop in skin creases and
folds.
 Smoking. Smoking tobacco not only increases the risk of psoriasis but
also may increase the severity of the disease. Smoking may also play a
role in the initial development of the disease.
71

72. Psoriasis: Clinical manifestations
 Psoriasis signs and symptoms are different for everyone.
Common signs and symptoms include:
 Red patches of skin covered with thick, silvery scales
 Small scaling spots (commonly seen in children)
 Dry, cracked skin that may bleed
 Itching, burning or soreness
 Thickened, pitted or ridged nails
 Swollen and stiff joints
72

73. Psoriasis: Therapeutic and nursing
management
 Psoriasis may have a psychological impact on the
patient; where the patient experiences:
 Self consciousness
 Helplessness
 Embarrassment
 Anger
 Frustration
 Anxiety & depression
73

74. Psoriasis: Therapeutic and nursing
management
 Topical preparations are applied to soften the skin and reduce
irritation. These include bland emollients, coal tar preparations
and corticosteroids. Wet wraps are applied to keep the skin well
hydrated and increases absorption of the topical medications.
 Oral corticosteroids can be given for anti inflammatory effect.
 Ultraviolet light therapy to reduce irritation. Psoralen 2 hours
before exposure.
 Anthralin products to reduce overproduction of epithelial cells
 Methotrexate as antimitotic agent.
74

75. Acne
 A skin condition that occurs when hair follicles plug
with oil and dead skin cells.
75

76. Acne: Risk factors
 Age. People of all ages can get acne, but it's most common in
teenagers.
 Hormonal changes. Such changes are common in teenagers,
women and girls, and people using certain medications, including
those containing corticosteroids, androgens or lithium.
 Family history. Genetics plays a role in acne.
 Greasy or oily substances. Increases the risk of developing acne.
 Friction or pressure on the skin. This can be caused by items such as
telephones, cellphones, helmets, tight collars and backpacks.
 Stress. Stress doesn't cause acne, but if you have acne already, it
may make it worse.
76

77. Acne: Signs & symptoms
 Acne signs and symptoms vary depending on the severity of your
condition:
 Whiteheads (closed plugged pores)
 Blackheads (open plugged pores)
 Small red, tender bumps (papules)
 Pimples (pustules), which are papules with pus at their tips
 Large, solid, painful lumps beneath the surface of the skin (nodules)
 Painful, pus-filled lumps beneath the surface of the skin (cystic
lesions)
77

78. Acne: Causative factors &
Pathophysiology
 The increase in the release of sex hormones during
adolescence stimulates the activity of the sebaceous glands,
causing an increased production of sebum
 When the ducts leading from the sebaceous glands become
plugged with sebum, acne results
 The accumulation of sebum, skin particles and dead cells
cause an inflammatory reaction
 Infection by bacteria causes the pustules
78

79. Acne: Causative factors &
Pathophysiology
 Black heads: In a black head, the part of the pore at the surface of the skin is
stretched and open. The black color is dead skin cells, bacteria and oil stuck
down in the pore.
 White heads: A white head is also a clogged pore, except, unlike a black head,
the top of the pore is not stretched open and exposing the clogged portion.
79

80. Acne: Therapeutic and nursing
management
Reduce the inflammatory process
Reduce blackhead formation by washing the face frequently
Personal hygiene
Topical preparations
Applied as prescribed, not more frequent or less
Hands should be washed regularly and before applying ointment
Thin layer should be applied as prescribed
Tetracycline may be prescribed in severe cases
Should not be taken with milk
80

81. Acne: Essential health information
Wash face twice a day+ affected areas
Change towels and pillowcases daily
Wash hair often
Keep hands away from face
If possible- do not use make up
Healthy lifestyle
Avoid smoking
Reduce stress
Prescribed systemic antibiotics
Encourage family support
81

82. Skin tumours
They feel like small peas beneath the surface of the skin
and usually feel smooth and roll under the skin when
pressure is applied to them.
Skin tumors are abnormal growths of tissue that can be
malignant (cancerous) or benign (harmless).
Skin tumors become extremely common as people get
older.
82

83. Malignant melanoma
 Is a neoplasm of melanocytes or a neoplasm of the cells that
develop from melanocytes.
 Three types
 Superficial spreading melanoma
 Nodular melanoma
 Lentigo malignant melanoma
83

84. Malignant melanoma
 Melanoma begins in the skin
cells (melanocytes) that
make the pigment that
colours the skin.
 When melanocytes grow out
of control, they can spread
from the epidermis, which is
the upper layer of skin, down
into the dermis.
 If melanoma isn't treated, it
can spread to other parts of
the body.
84

85. Malignant melanoma
Always require surgical removal as well as adjacent
tissues and lymphatic structures
Chemotherapy indicated
Radiation does not eliminate the tumour
completely, but reduces size therefore radiation is
recommended where metastasis is severe.
85

86. Malignant melanoma
 Surgery to remove melanoma
removes the cancer and a border of
healthy tissue. In the "Area of excision"
picture:
 The inner circle represents the
melanoma and healthy tissue that are
excised.
 An eye-shaped incision (cut) is often
done so that the surgical site can be
neatly closed.
 If the excision is small, the skin may be
closed with stitches after surgery. The
"After surgery" picture shows the usual
shape of the scar after surgery to
remove a small melanoma.
 If the excision is large, a skin graft may
be needed.
86

87. Malignant melanoma:
Essential health information
 Seek the shade, especially between 10 AM and 4 PM.
 Do not burn.
 Avoid tanning and UV tanning booths.
 Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
 Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For
extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with
an SPF of 30 or higher.
 Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going
outside. Reapply every two hours or immediately after swimming or excessive sweating.
 Keep new-borns out of the sun. Sunscreens should be used on babies over the age of six
months.
 Examine the skin head-to-toe every month.
 See physician every year for a professional skin exam.
87

88. Reference list
 http://www.plasticsurgery.co.za/skin-cancer/
 https://www.pinterest.se/pin/437764026255900322/?lp=true
 https://emedicine.medscape.com/article/1050294-overview
 https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=z
m2703&#zm2703-sec
 https://www.skincancer.org/prevention
88