Melanoma is the most serious type of skin cancer.  Allowed to grow, melanoma can spread quickly to other parts of the body. This can be deadly.

There is good news. When found early, melanoma is highly treatable. You can find melanoma early by following this 3-step process. Melanoma, the deadliest skin cancer, can show up on your body in different ways. You may see a:

• Change to an existing mole
• New spot or patch on your skin
• A spot that looks like a changing freckle or age spot
• Dark streak under a fingernail or toenail
• Band of darker skin around a fingernail or toenail
• Slowly growing patch of thick skin that looks like a scar

Warning signs to look for

Dermatologists encourage people of all skin colors to perform skin self-exams. Checking your skin can help you find melanoma early when it’s highly treatable. When examining your skin for melanoma, you want to look for the warning signs, which are called the ABCDEs of melanoma :

Your risk of getting melanoma increases if you:Seek the sun, tanning beds, or sunlamps: The sun, tanning beds, and sunlamps emit ultraviolet light (UV). Scientists have proven that UV light can cause skin cancer in people. Their research also shows you increase your risk of getting melanoma if you:

• Use tanning beds. Using indoor tanning beds before age 35 can increase your risk of melanoma by 59%, and the risk increases with each use.
• Had 5 or more blistering sunburns between ages 15 and 20. Research shows this increases one’s risk of getting melanoma by 80%.
• Live close to the equator. Sunlight is more intense there.
• Live in a sunny area of the United States like Florida or Arizona.
• Failed to protect your skin from the sun. People older than 65 may experience melanoma more frequently because of UV exposure they’ve received over the course of their lives. Men older than 50 also have a higher risk of developing melanoma.

While exposure to UV light greatly increases your risk of developing melanoma, your other characteristics also play a role. These include:

Having light-colored skin, hair, or eyes or certain moles: The risk of getting melanoma increases if you have one or more of the following:

• Fair skin
• Red or blond hair
• Blue or green eyes
• Sun-sensitive skin
• Skin that rarely tans or burns easily
• 50 or more moles
• Large moles
• An atypical mole (mole that looks like melanoma)

Taking certain medications or having some medical conditions: Your risk of getting melanoma increases if you have:

• Had melanoma or another type of skin cancer
• Had another type of cancer, such as breast or thyroid cancer
• A disease that weakens your immune system, such as acquired immunodeficiency syndrome (AIDS)
• To take medicine to quiet your immune system, such as taking life-saving medicines to prevent organ rejection after transplant surgery

Have a history of melanoma in your family: If a close blood relative has or had melanoma, you have a higher risk of getting melanoma. Organ transplant recipients have an increased risk of getting melanoma.

What causes melanoma?

Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. Scientists have shown that UV light from the sun and tanning beds can do two things:

1. Cause melanoma on normal skin.
2. Increase the risk of a mole on your skin turning into a melanoma

How do dermatologists treat melanoma?

The type of treatment a patient receives depends on the following:

• How deeply the melanoma has grown into the skin.
• Whether the melanoma has spread to other parts of the body.
• The patient’s health.

The following describes treatment used for melanoma.

Surgery: When treating melanoma, doctors want to remove all of the cancer. When the cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. The patient often remains awake during the surgical procedures described below.

• Excision: To perform this, the dermatologist numbs the skin. Then, the dermatologist surgically cuts out the melanoma and some of the normal-looking skin around the melanoma. This normal-looking skin is called a margin. There are different types of excision. Most of the time, this can be performed in a dermatologist’s office.
• Mohs surgery: A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. Once a dermatologist completes this training, the dermatologist is called a Mohs surgeon.Mohs surgery begins with the Mohs surgeon removing the visible part of the melanoma. Next, the surgeon begins removing the cancer cells. Cancer cells are not visible to the naked eye, so the surgeon removes skin that may contain cancer cells one layer at a time. After removing a layer, it is prepped so that the surgeon can examine it under a microscope and look for cancer cells. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. Mohs has a high cure rate.

When caught early, removing the melanoma by excision or Mohs may be all the treatment a patient needs. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). Your dermatologist may refer to this as melanoma in situ or stage 0. In this stage, the cure rate with surgical removal is nearly 100%.

When melanoma grows deeper into the skin or spreads, treatment becomes more complex. It may begin with one of the surgeries described above. A patient may need more treatment. Other treatments for melanoma include:

• Lymphadenectomy: Surgery to remove lymph nodes.

• Immunotherapy: Treatment that helps the patient’s immune system fight the cancer.
• Targeted therapy: Drugs that can temporarily shrink the cancer; however, some patients appear to be fully cured.

• Chemotherapy: Medicine that kills the cancer cells (and some normal cells).

• Radiation therapy: X-rays that kill the cancer cells (and some normal cells).

Squamous cell Carcinoma is the second most common form of skin cancer. It’s usually found on areas of the body damaged by UV rays from the sun or tanning beds. Sun-exposed skin includes the head, neck, ears, lips, arms, legs, and hands.

SCC is a fairly slow-growing skin cancer. Unlike other types of skin cancer, it can spread to the tissues, bones, and nearby lymph nodes, where it may become hard to treat. When caught early, it’s easy to treat.

Certain things make you more likely to develop SCC:

• Older age
• Male
• Fair-skinned
• Blue, green, or gray eyes
• Blonde or red hair
• Spend time outside; exposed to the sun’s UV Rays
• Tanning beds and bulbs
• Long-term exposure to chemicals such as arsenic in the water
• Bowen’s disease, HPV, HIV, or AIDS
• Exposed to radiation
• Inherited DNA condition

SCC usually begins as a dome-shaped bump or a red, scaly patch of skin. It’s usually rough and crusty, and can bleed easily when scraped. Large growths may itch or hurt. It may also pop through scars or chronic skin sores, so check for any changes and report them to your doctor.

Your doctor may refer you to a dermatologist who specializes in skin conditions. He will ask about your medical history, your history of severe sunburns or indoor tanning, any pain or symptoms you’re having, and when the spot first appeared.

You’ll have a physical exam to check the size, shape, color, and texture of the spot. The dermatologist will also look for other spots on your body and feel your lymph nodes to make sure they aren’t bigger or harder than normal. If your doctor thinks a bump looks questionable, he’ll remove a sample of the spot (a skin biopsy) to send to a lab for testing.

Squamous cell carcinoma can usually be treated with minor surgery that can be done in a doctor’s office or hospital clinic. Depending on the size and location of the SCC, your doctor may choose to use any of the following techniques to remove it:

• Excision: cutting out the cancer spot and some healthy skin around it
• Surgery using a small hand tool and an electronic needle to kill cancer cells
• Mohs surgery: excision and then inspecting the excised skin using a microscope
• Lymph node surgery: remove a piece of the lymph node; uses general anesthesia
• Dermabrasion: “sanding” your affected area of skin with a tool to make way for a new layer
• Cryosurgery: freezing of the spot using liquid nitrogen
• Topical chemotherapy: a gel or cream applied to the skin
• Targeted drug treatment

• Avoid the sun during peak hours.
• Use sunscreen daily.
• Wear clothing to cover exposed areas.
• Avoid tanning beds.

Fibromas are overgrowths of soft tissue. They appear as raised, relatively small areas. They commonly occur on the lips, inside the cheeks and on the tongue. Fibromas are usually pink. They also can be whitish or light-colored. If injured, fibromas may be reddish or bluish. Fibromas may develop because of constant irritation of the lips, the inside of the cheeks, or the tongue.

Symptoms

You may see or feel the fibroma. There are usually no symptoms. Fibromas may get bigger over time.

Diagnosis

Your dentist will examine your mouth and ask you a few questions. Usually that will be enough for the dentist to diagnose a fibroma and determine a cause. A fibroma can be removed to confirm the diagnosis. In this case it should be examined in a lab to make sure it is not cancerous.

Prevention

To avoid fibromas, avoid habits such as biting your lips or the inside of your cheeks. If you grind your teeth, ask your dentist to fit you with a night guard.

 Treatments

A fibroma will grow if the area continues to be injured. Fibromas that are large or interfere with speech should be removed.

When fibromas are removed, the tissue is sent to a laboratory for a biopsy. If you drink or smoke, your dentist is likely to order a biopsy to rule out oral cancer. Another reason to do a biopsy is if the fibroma has an unusual color. Fibromas are not known to become cancerous over time.

The leg length discrepancy means there is inequality of the length of the lower limbs. It is also called as limb length inequality. The problem is extremely common with 23% of the general population having a discrepancy of 1 cm or more

Leg length discrepancy causes compensatory gait abnormalities, degenerative arthritis of the lower extremity and lumbar spine. In addition to the length inequality, these patients may also have angular and torsional deformities that may influence their functional leg lengths. For example, flexion contractures around the knee and hip can cause apparent shortening of the leg.

Hip abduction contracture and ankle equinus causes functional lengthening.

Small leg length discrepancy is well compensated by body and hardly requires any treatment. Bigger differences need to be equalized to prevent osteoarthritis , scoliosis and backache in later life.

Causes of Leg Length Discrepancy

The causes can generally be divided into two broad categories: congenital and acquired.

Congenital limb length inequality

• Longitudinal deficiency of the fibula
• Hemihypertrophy syndromes
• Klippel-Trénaunay-Weber syndrome
• Skeletal dysplasias.
• Proximal femoral focal deficiency
• Developmental dysplalsia of hip
• Unilateral clubfoot
• Vascular malformation
• Congenital pseudarthrosis of the tibia
• Ollier’s disease

Paralytic disorders

• Spasticity (cerebral palsy)
• Poliomyelitis
• Spina bifida
• Spinal dysraphism

Acquired

• Physis disruption
  • infection
  • trauma
  • tumor
  • Malunion of fracture

Functional Effects of Limb Length Discrepancy

• Back pain
  • increased prevalence of back pain
• Osteoarthritis
  • decreased coverage of femoral head on long leg side leads to osteoarthritis
• Structural scoliosis
  • Limb length discrepancy increases the incidence of structural scoliosis
• Inefficient gait

Classification of Limb Length Discrepancy:

• Static
  • malunion of femur or tibia
• Progressive
  • Physeal growth arrest
  • Congenital
    • Absolute discrepancy increases
    • Proportion stands the same

Treatment of Leg Length Discrepancy

Goals of treatment are

• Leg length equality within 1 cm
• Level pelvis
• Functional improvement

In certain cases small leg length inequality may be beneficial to the patient especially in neuromuscular disorders to aid in clearance in the swing phase of gait.

Depending on the severity of the difference, different treatments can be used for correction of the inequality.

Treatment of leg length inequality involves many different approaches. Non operative treatment involves use of shoe raises or orthotics.

Surgical approach deals with the problem by

• Correction of deformity if present
• Shortening of the normal leg
• Lengthening of affected leg
• Combination of shortening and lengthening.

Non-operative Treatment

An inequality < 2cm projected at maturity is generally without any functional problems. Often, surfices. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up.

Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift.

A foot-in-foot prosthesis can be used for larger leg length inequalities but is often not tolerated well. It is often used as temporary measure.

Surgical Treatment

Shortening of long side

Epiphysiodesis of femur, tibia, or both

Epiphysiodesis inhibits the growth of the limb and can be used to correct 2-5 cm of projected limb length discrepancy.

It can be performed only in skeletally immature patients where growthpotential is still present.

Because the procedure effectively shortens the longer leg and is usually done on the uninvolved side, it may be unappealing to the patient and family.

It can be used alone or with limb lengthening of short limb.

Shortening of Mature Limb

This involves ostectomy and removal of bone segment followed by fixation of remaining fragments with desirable fixation device.

Limb lengthening of short side

It is contemplated in cases > 5 cm projected discrepancy. It can be  combined with a shortening procedure (epiphysiodesis, ostectomy) on long side when the discrepancy is large [>8 cmm]

Lengthening is usually done by corticotomy and gradual distraction

The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb.

Numerous fixation devices are available, such as the ring fixator with fine wires, monolateral fixator with half pins, or a hybrid frame.

There are multiple signs and symptoms for leg length discrepancy (LLD). Some are obvious and some are subtle. There are differences between individuals on the extent and causes of leg length discrepancy (LLD). The difference in length between the two legs may vary from 3 and a half to 4 percent. These differences often determine the impact that may be experienced by different individuals. Signs and symptoms usually experienced in the patients with leg length discrepancy (LLD) include:

• If the difference in leg length discrepancy (LLD) is 3 cms and higher, difference will be easily noticed as the person walks.
• The person affected with leg length discrepancy (LLD) will need to exert more energy to walk.
• Some people may experience some pain in the lower back, ankle, or hip as they walk. Some studies have collaborated this, while other have refuted this.
• The person’s posture will be highly affected, causing him/ her to hold the longer leg on the knee for support.
• The person’s gait will be adversely affected, which will be obviously noticed.

The risk factors for leg length discrepancy (LLD) include:

Patients might have serious dissimilarities in the length of the legs as an effect brought by Leg Length Discrepancy (LLD) due to:

• Infection.
• Birth defects.
• Injuries.
• Accidents and other causes.

Leg length discrepancy (LLD) with very high difference can become complicated and lead to severe orthopaedic conditions like lower back pain, scoliosis, or arthritis, if left untreated.

• The patient may experience complications due to contractures of the muscles while having to constantly stand on their toes of the shorter leg for support.
• Another complication is that the shorter side of their body is often lowered down and suddenly lifted by the longer side, causing them to have abnormal gait that goes up and down.
• The abnormal gait can cause the child to be highly disturbed psychologically.
• The patient is often ridiculed and teased by other children, hindering the child’s social life.
• Most patients with leg length discrepancy (LLD) have to constantly support the shorter leg on the knee while standing, causing them to bend often or they may have to stand on their toes.

When a person has scoliosis, their backbone curves to the side.

The angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.

You probably don’t look directly at too many spines, but what you might notice about someone with scoliosis is the way they stand. They may lean a little or have shoulders or hips that look uneven.

In as many as 80% of cases, doctors don’t find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call “idiopathic.”

Some kinds of scoliosis do have clear causes. Doctors divide those curves into two types — structural and nonstructural.

In nonstructural scoliosis, the spine works normally, but looks curved. Why does this happen? There are a number of reasons, such as one leg’s being longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, this type of scoliosis often goes away.

In structural scoliosis, the curve of the spine is rigid and can’t be reversed.

Causes include:

• Cerebral palsy
• Muscular dystrophy
• Birth defects
• Infections
• Tumors
• Genetic conditions like Marfan syndrome and Down syndrome

Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back, called vertebrae, can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may detect this condition when the child is born. Or, they may not find it until the teen years.

Family history and genetics can also be risk factors for idiopathic scoliosis. If you or one of your children has this condition, make sure your other kids are screened regularly.

Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.

Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.

Degenerative scoliosis affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.

Treatments:

The main type of surgery for scoliosis involves attaching rods to the spine and doing a spinal fusion. Spinal fusion is used to stabilize and reduce the size of the curve and stop the curve from getting worse by permanently joining the vertebrae into a solid mass of bone.

Other techniques are sometimes used, including instrumentation without fusion, which attaches devices such as metal rods to the spine to stabilize a spinal curve without fusing the spine together. This is only done in very young children when a fusion, which stops the growth of the fused part of the spine, is not desirable. The child usually has to wear a brace full-time after having this surgery.

Neck strain is often just called whiplash. Although it’s usually associated with car accidents, any impact or blow that causes your head to jerk forward or backward can cause neck strain. The sudden force stretches and tears the muscles and tendons in your neck.

Neck strain afflicts many amateur and professional athletes. People who play contact sports like football are especially prone to neck strain.

Neck strains are often confused with neck sprains. They’re a bit different. Neck strains are caused by damage to the muscle or the tendons, bands of tissue that connect muscles to bones. Neck sprains are caused by tearing of the ligaments, the tissues that connect the bones to each other.

However, the differences between these strains and sprains probably won’t mean much to you. The causes, symptoms, and treatment of neck sprains and neck strains are usually the same.

The pain of whiplash is often hard to ignore. The symptoms may include:

• Pain, decreased range of motion, and tightness in the neck. The muscles may feel hard or knotted.
• Pain when rocking your head from side to side or backward and forward.
• Pain or stiffness when moving your head to look over each shoulder.
• Tenderness.
• Headaches at the base of the skull that radiate towards the forehead.

Sometimes, the pain of a neck strain is immediate. In other cases, it can take several hours or days before your neck begins to hurt.

The blow that causes neck strain can sometimes cause a concussion, too. Since concussions can be serious, you need to see a doctor right away. You need emergency medical care if you have a headache that worsens or persists, have weakness or trouble talking, or are confused, dizzy, nauseous, excessively sleepy, or unconscious.

To diagnose neck strain, your doctor will give you a thorough examination. You may also need X-rays, CT (computed tomography) scans, and other tests, to rule out other problems.

Here’s the good news: given time, whiplash should heal on its own. To help with recovery, you should:

• Ice your neck to reduce pain and swelling as soon as you can after the injury. Do it for 15 minutes every 3-4 hours for 2-3 days. Wrap the ice in a thin towel or cloth to prevent injury to the skin.
• Take painkillers or other drugs, if recommended by your doctor. Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin) or naproxen (Aleve), will help with pain and swelling. However, these medicines can have side effects. Never use them regularly unless your doctor specifically says you should. Check with your doctor before taking them if you take other medicines or have any medical problems. If over the counter medications do not work, prescription painkillers and muscle relaxants may be necessary.
• Use a neck brace or collar to add support, if your doctor recommends it. However, they are not recommended for long-term use, because they can actually weaken the muscles in your neck.
• Apply moist heat to your neck — but only after 2-3 days of icing it first. Use heat on your neck only after the initial swelling has gone down. You could use warm, wet towels or take a warm bath.
• Other treatments, like ultrasound and massage, may also help.

A bulging disc can have a number of different causes, including trauma from a sports-related injury or a car accident. The condition’s most common cause, however, is the natural aging process. Over time, parts of the spine begin to break down after age-related changes make them less able to support body weight and allow the spine to bend and twist. The spinal discs, which are located between adjacent vertebrae and act as shock absorbers, are prone to shrinkage and water loss as you grow older. This can lead to a loss of elasticity, which can cause the outer layer of a disc to bulge out from between the surrounding vertebrae.

Valley fever is a fungal infection caused by coccidioides organisms. It can cause fever, chest pain and coughing, among other signs and symptoms.

Two species of coccidioides fungi cause valley fever. These fungi are commonly found in soil in specific regions. The fungi’s spores can be stirred into the air by anything that disrupts the soil, such as farming, construction and wind.

The fungi can then be breathed into the lungs and cause valley fever, also known as acute coccidioidomycosis. Mild cases of valley fever usually resolve on their own. In more severe cases, doctors prescribe antifungal medications that can treat the underlying infection.

Symptoms

Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into a more serious disease, including chronic and disseminated coccidioidomycosis.

Acute coccidioidomycosis (valley fever)

The initial, or acute, form of coccidioidomycosis is often mild, with few, if any, symptoms. When signs and symptoms do occur, they appear one to three weeks after exposure. They tend to resemble those of the flu, and can range from minor to severe, including:

• Fever
• Cough
• Chest pain
• Chills
• Night sweats
• Headache
• Fatigue
• Joint aches
• Red, spotty rash

The rash that sometimes accompanies valley fever is made up of painful red bumps that may later turn brown. The rash mainly appears on your lower legs, but sometimes on your chest, arms and back. Others may have a raised red rash with blisters or eruptions that look like pimples.

If you don’t become ill from valley fever, you may only find out you’ve been infected when you later have a positive skin or blood test or when small areas of residual infection (nodules) in the lungs show up on a routine chest X-ray. Although the nodules typically don’t cause problems, they can look like cancer on X-rays.

If you do develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale.

Chronic coccidioidomycosis

If the initial coccidioidomycosis infection doesn’t completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems.

Signs and symptoms include:

• Low-grade fever
• Weight loss
• Cough
• Chest pain
• Blood-tinged sputum (matter discharged during coughing)
• Nodules in the lungs

Disseminated coccidioidomycosis

The most serious form of the disease, disseminated coccidioidomycosis, occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).

The signs and symptoms of disseminated disease depend on which parts of your body are affected and may include:

• Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
• Painful lesions in the skull, spine or other bones
• Painful, swollen joints, especially in the knees or ankles
• Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord

When to see a doctor

Seek medical care if you are over 60, have a weakened immune system, are pregnant, you develop the signs and symptoms of valley fever, especially if you:

• Live in or have recently traveled to an area where this disease is common
• Have symptoms that aren’t improving

Be sure to tell your doctor if you’ve traveled to a place where valley fever is endemic and you have symptoms.

Treatment

Rest

Most people with acute valley fever don’t require treatment. Even when symptoms are severe, the best therapy for otherwise healthy adults is often bed rest and fluids — the same approach used for colds and the flu. Still, doctors carefully monitor people with valley fever.

Antifungal medications

If symptoms don’t improve or become worse or if you are at increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole. Antifungal medications are also used for people with chronic or disseminated disease.

In general, the antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Onmel) are used for all but the most serious forms of coccidioidomycosis disease.

All antifungals can have serious side effects. However, these side effects usually go away once the medication is stopped. Possible side effects of fluconazole and itraconazole are nausea, vomiting, abdominal pain and diarrhea.

More serious infection may be treated initially with an intravenous antifungal medication such as amphotericin B (Abelcet, Amphotec, others).

Two newer medications — voriconazole and posaconazole (Noxafil) — may also be used to treat more serious infections.

Antifungals control the fungus, but sometimes don’t destroy it, and relapses may occur. For many people, a single bout of valley fever results in lifelong immunity, but the disease can be reactivated, or you can be reinfected if your immune system is significantly weakened.

Prevention

If you live in or visit areas where valley fever is common, take commonsense precautions, especially during the summer months when the chance of infection is highest. Consider wearing a mask, staying inside during dust storms, wetting the soil before digging, and keeping doors and windows tightly closed