[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-533572-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-533572-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","block-13","Block 13","","Medical Q&A content focused on evaluating pigmented skin lesions with emphasis on identifying melanoma using the ABCDE predictive rule and selecting appropriate biopsy techniques. The material explains clinical features such as asymmetry, border irregularities, color variegation, diameter, and evolving changes, and outlines when biopsy is indicated versus surveillance. A second case reviews management of suspected ventriculoperitoneal shunt complications, highlighting signs of increased intracranial pressure and the need for urgent neuroimaging and infection evaluation.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/block-13/533572/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/block-13/533572.png","ImageObject",300,407,{"name":42,"@type":43},"LangkahRina","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-22","2026-10-10",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Which clinical features most strongly suggest melanoma in pigmented skin lesions?","Question",{"text":62,"@type":63},"Melanoma is suggested by asymmetry, irregular borders, color variegation, diameter ≥ 6 mm, and evolving changes in size, shape, or color.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"When is biopsy recommended for a pigmented skin lesion?",{"text":67,"@type":63},"Biopsy is recommended when the lesion meets validated ABCDE criteria, shows inflammatory changes such as itching, crusting, or bleeding, has sensory changes, looks significantly different from other lesions on the same patient, or develops thickening/nodularity.",{"name":69,"@type":60,"acceptedAnswer":70},"What is the best initial step to evaluate a symptomatic child with a ventriculoperitoneal shunt?",{"text":71,"@type":63},"Because symptoms indicate increased intracranial pressure and shunt malfunction is the main concern, urgent neuroimaging with CT of the head or fast MRI should be obtained, along with an evaluation for infection.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},533572,1792239190,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & 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Zoom  \n三×  \nAn 82-year-old man comes to the office for evaluation of a spot on his back.He thinks the skin lesion has been present for many months to a fewyears but is unsure.The lesion was asymptomatic until it recently started itching;it is large and dark,but the patient is not sure whether it isevolving.The spot is shown in the image below:  \n|  |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Scanned by   | .   | 旦  \u003Cbr>Camera Scanner   |  | 4  \u003Cbr>⑪   |\n|  |  |  |  |  |\n\n\n|  |\n| --- |\n\nSettings  \n1 of 40tion ld:16863Mark卡A AA  \n三×  \nPreviousExit ModeTutorialLab ValuesNotesCalculatorReverse Color Text ZoomUWorld  \nWhich of the following is the most appropriate next step in management of this patient's skin lesion?  \n○ A.Cryotherapy destruction of the lesion○ B.Excisional biopsy of the lesion○ C.Observation over 3-6 months○ D.Punch biopsy from the lesion border○ E.Punch biopsy from the lesion center  \nSubmit  \nSettings  \n三×  \n\n| Clinical features of melanoma(ABCDE)   |\n| --- |\n| ·Asymmetry:when bisected,the 2 sides are not identical  \u003Cbr>·Border irregularities:uneven edges,pigment fading off  \u003Cbr>·Color variegation:variable mixtures of brown,tan,black &red  \u003Cbr>·Diameter:≥6 mm  \u003Cbr>·Evolving:lesion changing in size,shape,or color;new lesion   |\n\nThe initial clinical assessment of pigmented skin lesions should emphasize identifying those that could be melanoma and therefore warrantbiopsy.Biopsy is appropriate in any of the following situations:  \n·The lesion has features that suggest melanoma using a validated predictive rule (eg,lesions displaying≥1-2 of the ABCDE criteria).  \n·The lesion has inflammatory changes;itching,crusting,or bleeding;or sensory changes(eg,paresthesia).  \n·The lesion is significantly different in appearance from other lesions on the same patient(ugly duckling sign).  \n·The lesion develops thickening or nodularity,which may indicate vertical growth and increase metastatic risk.  \nThis patient's lesion is asymmetrical with a somewhat irregular border and notable color variegation (dark brown,light brown,and pink).Theassociated itching further raises the risk,as does the apparent nodularity.  \nTo rule out melanoma,full-thickness excisional biopsy with 1-to 3-mm margins of normal tissue is recommended.Partial excision(eg,deepshave biopsy,central or peripheral punch biopsy)is generally only considered for very large lesions or lesions in locations where completeexcision may be problematic(eg,ear,face);partial excision may not allow adequate sampling for diagnosis or accurate measurement of thelesion's depth(the most important prognostic indicator in melanoma)(Choices Dand E).  \n(Choice A)In-situ destruction via cryotherapy or topical fluorouracil is indicated for treatment of actinic keratosis.Actinic keratosis presents as  \nsmall,roughened papules in sun-exposed areas(eg,scalp,face,hands)and typically is not pigmented.  \n(Choice C)Periodic surveillance is recommended for patients with numerous or atypical nevi that do not have suspicious features.Suspectedmelanomas warrant tissue confirmation without delay.  \n# Educational objective:\n\nThe assessment of pigmented skin lesions should include a predictive rule to estimate the risk of melanoma,such as the ABCDE(Asymmetry,Border irregularities,Color variegation,Diameter,Evolving)rule;lesions with ≥1-2 of the ABCDE criteria warrant excisional biopsy.Biopsy is alsorecommended for lesions with inflammation;itching,crusting,or bleeding;or sensory changes and for lesions that are significantly different inappearance from other pigmented spots on the same patient (ugly duckling sign).  \nSettings  \nA4-year-old girl is brought to the clinic due to 24 hours of vomiting,irritability,and lethargy.She was born at 29 weeks gestation and has aventriculoperitoneal shunt that was placed after birth due to intraventricular hemorrhage.Temperature is 36.7 C(98.1 F),blood pressure","cbCaiullJXr3WUdB","https://ap.wps.com/l/cbCaiullJXr3WUdB","pdf",44176164,151,"English","# Management of pigmented skin lesions\n## ABCDE features and indications for biopsy\n# Approach to suspected ventriculoperitoneal shunt complications\n## Signs of increased intracranial pressure and initial work-up","[{\"question\":\"Which clinical features most strongly suggest melanoma in pigmented skin lesions?\",\"answer\":\"Melanoma is suggested by asymmetry, irregular borders, color variegation, diameter ≥ 6 mm, and evolving changes in size, shape, or color.\"},{\"question\":\"When is biopsy recommended for a pigmented skin lesion?\",\"answer\":\"Biopsy is recommended when the lesion meets validated ABCDE criteria, shows inflammatory changes such as itching, crusting, or bleeding, has sensory changes, looks significantly different from other lesions on the same patient, or develops thickening/nodularity.\"},{\"question\":\"What is the best initial step to evaluate a symptomatic child with a ventriculoperitoneal shunt?\",\"answer\":\"Because symptoms indicate increased intracranial pressure and shunt malfunction is the main concern, urgent neuroimaging with CT of the head or fast MRI should be obtained, along with an evaluation for infection.\"}]","Block 13 | PDF",1791592573,381]