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Erythroplakia

Erythroplakia is a flat red patch or lesion in the mouth that cannot be attributed to any other pathology. There are many other conditions that are similar in appearance and must be ruled out before a diagnosis of erythroplakia is made. Sometimes, a diagnosis is delayed for up to two weeks in order to see if the lesion spontaneously regresses on its own or if another cause can be found. Erythroplakia frequently is associated with dysplasia, and is thus a pre-cancerous lesion. more...

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Erythroplakia has an unknown cause but researchers presume it to be similar to the cause of squamous cell carcinoma. It is mostly found in elderly men around the ages of 65 - 74. It is commonly associated with smoking. The most common areas in the mouth where erythroplakia is found are the floor of the mouth, the tongue, and the soft palate. It appears as a red macule or plaque with well-demarcated borders. The texture is characterized as soft and velvety. An adjacent area of leukoplakia may be found along with the erythroplakia.

Microscopically, the tissue exhibits severe epithelial dysplasia, carcinoma-in-situ, or invasive squamous cell carcinoma in 90% of cases. There is an absence of keratin production and a reduced amount of epithelial cells. Since the underlying vascular structures are less hidden by tissue, erythroplakia appears red when viewed in a clinical setting.

Treatment involves biopsy of the lesion to identify extent of dysplasia. Complete excision of the lesion is sometimes advised depending on the histopathology found in the biopsy. Even in these cases, recurrence of the erythroplakia is common and, thus, long-term monitoring is needed.

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Conditions of the Skin
From American Family Physician, 9/15/99

RECOMMENDED CORE EDUCATIONAL GUIDELINES FOR FAMILY PRACTICE RESIDENTS

This document has been endorsed by the American Academy of Family Physicians and developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine. These revised guidelines represent suggestions and comments from the Committee on Interdisciplinary Dermatologic Education of the American Academy of Dermatology.

The specialty of family practice is interested in dermatologic care, with an emphasis on comprehensive and continuing care. Each family physician should be aware of the impact of skin problems on a patient and the family and should be willing to perform and capable of performing preventive and therapeutic roles in these cases. The appearance of skin problems may have significant emotional impact on individuals and families. Significant preventive factors include emotional, environmental and occupational effects that may disturb the skin. Interaction with the family of any patient who has skin problems should be stressed in the education of the family physician. In addition, family physicians must be taught to be aware of the damage that can be done to the skin by inappropriate care.

While this outline specifies certain knowledge and skills basic to the diagnosis and management of patients with skin disorders, the family physician should understand that additional areas of knowledge and skills may be essential to the appropriate care of a given patient. Therefore, these guidelines are not intended to limit the family physician's effort to acquire other important dermatologic knowledge and skills.

It is expected that the family physician will become proficient in the diagnosis and treatment of patients with many kinds of skin diseases. The family physician may find it appropriate to seek consultation from a dermatologist and to actively engage in the co-management of the patient. In some cases, referral to a dermatologist for management is indicated.

Implementation

The development of core cognitive knowledge and appropriate skill in the care of the skin, hair and nails should require experience in a structured educational component of a family practice residency program. There must be written goals and educational objectives. This component need not be a "block rotation," but the educational experience must be appropriately identified and structured. Most of this experience will be in an outpatient setting with qualified physician teachers and consultants. Residents will obtain substantial additional dermatologic experience throughout the three years of their involvement in the family practice center. Family practice residents should be instructed regarding timely and appropriate consultation with, and/or referral to a dermatologist.

Residents should be taught the difference between acquisition of consultations and the referral of patients to another specialist for management and ultimate return to the referring family physician. In addition, residents should be instructed regarding the interdependence of family practice and other specialties and the appropriate referral of patients both from the family physician to the dermatologist and from the dermatologist to the family physician.

Resources

Habif TP. Clinical Dermatology: a color guide to diagnosis and therapy. 3d ed. St. Louis: Mosby, 1996.

Sams WM Jr, Lynch PJ, eds. Principles and practice of dermatology. 2d ed. New York: Churchill Livingston, 1996.

Sauer GC. Manual of skin diseases. 7th ed. Philadelphia: Lippincott, 1996.

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COPYRIGHT 1999 American Academy of Family Physicians
COPYRIGHT 2000 Gale Group

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