4-66
Plan:
Treatment
Primary: Manage mild cases with proper shaving techniques. Allow the hair to grow out onto the surface
of the skin and then trim with a safety razor or clipper. Gently lift out remaining buried ingrown hair tips onto
the surface and clip-- do not pluck or pull.
Alternative: A chemical depilatory.
Empiric: Minocycline 100 mg po bid will help decrease the irritation and secondary infection.
Patient Education
General: Shave gently with “bump ghter” razor, without pulling the skin taut or repeating over the same area;
shave “with the grain” of the hair. Close shaving promotes oblique penetration of the sharpened hairs into the
skin and should be avoided whenever possible.
Prevention and Hygiene: Apply moist heat after shaving, followed by a moisturizer (like razor bump ghter),
and avoid strong astringents like alcohol that will only dry the face and cause more irritation.
Follow-up Actions
Evacuation/Consultation Criteria: No need to evacuate. Consult dermatology as needed.
Skin: Skin Cancer
(Basal & Squamous Cell Carcinoma, Malignant Melanoma)
Lt Col Gerald Peters, USAF, MCBasal Cell Carcinoma (BCC)
Introduction: BCC is by far the most common cancer in the world, with over 700,000 cases each year in
the U.S. alone. Early detection and treatment are paramount in order to avoid extensive tissue destruction,
damage to adjacent structures, and complex surgery and reconstruction. The good news is that this cancer
is virtually 100% curable if approached early and properly. Metastasis is very rare. Sun exposure and fair
complexion, light-colored hair and eyes are the main risk factors for skin cancer. Unfortunately about 80% of
all the ultraviolet radiation (sun) exposure comes before age 18 when most people think they are immortal
and not affected by skin cancer. Patients who have had a BCC are at a 50% risk of developing at least one
more within the subsequent 5 years.
Subjective: Symptoms
Very slow-growing, small, pearly or waxy papule, usually in a sun-exposed area. Sometimes the presenting
complaint is that of a sore that will not heal. There may be a history of trauma preceding the lesion.
Objective: Signs
Using Basic Tools: Waxy or pearly papule (2-3mm diameter) that can grow to several cm over time;
peripheral telangiectasias (small, dilated blood vessels); supercial erosion; some lesions are at scars,
usually without a history of trauma; sun-exposed areas are the most common sites: ears, periauricular skin,
eyelids and periocular skin, nose, cheeks, temples, forehead, upper chest and back, and arms and forearms;
can occur even in protected areas like the axilla, so skin exams should be thorough and complete.
Assessment:
Differential Diagnosis - benign lichenoid keratosis, intradermal nevus, neurobroma, irritated seborrheic
keratosis, amelanotic melanoma, tricholemmoma. Differentiating these conditions in the eld is nearly impos-
sible, since they require expert microscopic evaluation of a biopsy.
Plan:
Treatment: Defer treatment of team members until return from mission (tumors are very slow growing).
Observation is preferable to any treatment. For local nationals, if evacuation or referral cannot be accom-
plished within the coming 6 months, perform full thickness excision with 5mm margins all around the tumor.