0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43
1066 Nonmelanoma Skin Cancers: SCC NSAIDs➣Sun safety behavior life-long:
Seek shade between 10 AM&4PM.
Wear light-colored, tightly woven, protective clothing
Apply sunscreens with a broad-spectrum SPF 15 or greater and
reapply every 2 hours when outdoors for long periods.
➣Treat precancerous lesions or in situ lesions such as AKs and HPV
infections.complications and prognosis
■Recurrence rates vary with tumor type and treatment.
■Lowest recurrence rate 10% for small well-differentiated lesions by
MME, 40%+if perineural spread
■Metastasis with mortality of 18% if lesions arise on sun-damaged
skin; 20–30% or more if they develop in a scarring process such as
an ulcer
■Very likely to develop other skin cancers, esp. if positive family his-
tory, extreme photodamage, actinic keratoses present, HPV infec-
tions or immunosuppression.NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
MICHAEL B. KIMMEY, MD
history & physical
History
■Dyspepsia most common side effect of NSAIDs
➣occurs in 15% of chronic users on a daily basis
➣less common with cyclo-oxygenase (COX) – 2 specific NSAIDs
➣does not correlate with endoscopic findings of ulcers
■Gastric and duodenal ulcers are usually asymptomatic until they
bleed or perforate
■Small intestinal ulcers and strictures are uncommon but can cause
symptoms of intestinal obstruction or chronic GI bleeding and
anemia
■Type of NSAID important when considering the risk of GI side effects
➣NSAIDs can inhibit COX-1 and/or COX-2 isoenzymes. COX-1
inhibition is responsible for GI ulceration and antiplatelet effects,
while COX-2 inhibition reduces pain and inflammation
➣most NSAIDs inhibit both COX-1 and COX-2 isoenzymes and
are considered “non-selective” NSAIDs; these NSAIDs linked to