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Integumentary Physical Therapy

피부계 물리치료학

Dong-Ryul Lee, PT, Ph.D. Movement Impairment Specialist

& Performance Enhancement Specialist

Neurofeedback, Robotics & Virtual Reality Research

Specialites: NeuroRehabilitation & Pediatric Rehabilitation

[email protected] [email protected]

mailto:[email protected]

mailto:[email protected]

Skin Cancer (피부암)


• Most cases are caused by over-exposure to UV rays from the sun or sunbeds

• Skin neoplasms

• named after the type of skin cell from which they arise • Basal cell cancer originates from the lowest layer of

the epidermis, and is the most common but least dangerous skin cancer.

• Squamous cell cancer originates from the middle layer, and is less common but more likely to spread and, if untreated, become fatal.

• Melanoma, which originates in the pigment색소-producing cells (melanocytes), is the least common, but most aggressive, most likely to spread and, if untreated, become fatal

Definition

http://en.wikipedia.org/wiki/Skin_cancer





• result in 80,000 deaths a year as of 2010; • 49,000 of which are due to melanoma

• and 31,000 of which are due to non-melanoma skin cancers.

• This is up from 51,000 in 1990.

• Australia and New Zealand exhibit one of the highest rates of skin cancer incidence in the world,

• almost four times the rates registered in the United States,

Epidemiology


Epidemiology


• Ultraviolet radiation from sun exposure

• the primary cause of skin cancer

• Other factors

• Smoking tobacco

• HPV infections: risk of squamous cell carcinoma.

• Some genetic syndromes – including congenital

melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4") in size are at higher risk for becoming cancerous.

Causes • Chronic non-healing wounds.

– These are called Marjolin's ulcers based on their appearance, and can develop into squamous cell carcinoma.

• Ionizing radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color.

– It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous cell carcinomas.

– The World Health Organization now places people who use artificial tanning beds in its highest risk category for skin cancer.

• The use of many immunosuppressive medication increase the risk of skin cancer. Cyclosporin A, a calcineurin inhibitor for example increases the risk approximately 200 times, and azathioprine about 60 times.


• Ultraviolet radiation from sun exposure

• the primary cause of skin cancer

• Other factors

• Smoking tobacco

• HPV infections: risk of squamous cell carcinoma.

• Some genetic syndromes – including congenital melanocytic nevi

syndrome

• Chronic non-healing wounds.:Marjolin's ulcers

• Ionizing radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color.

• The use of many immunosuppressive medication increase the risk of skin cancer.

Causes • 햇빛 • 스트레스 • 식습관 • 가족력 • 인종 • 상처 • 화상 • 유전 • 알레르기 • 자가면역결핍 • 공해물질

Skin Cancer (피부암) Classification

Cancer Description Illustration

Basal cell carcinoma 기저세포암

• Note the pearly translucency to fleshy color, tiny blood vessels on the surface, and sometime ulceration which can be characteristics.

• The key term is translucency.

Squamous cell carcinoma 편평세포암

• Commonly presents as a red, crusted, or scaly patch or bump.

• Often a very rapid growing tumor.

Malignant melanoma 악성흑색종

• The common appearance is an asymmetrical area, with an irregular border, color variation, and often greater than 6 mm diameter

Skin Cancer (피부암) Signs and symptoms

Cancer Description


• Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders.

• Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops.

• It is often mistaken for a sore that does not heal. • This form of skin cancer is the least deadly and with proper treatment can be

completely eliminated, often without scarring.


• Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin.

• Some are firm hard nodules and dome shaped like keratoacanthomas. • Ulceration and bleeding may occur. When SCC is not treated, it may develop into a

large mass. • Squamous cell is the second most common skin cancer. • It is dangerous, but not nearly as dangerous as a melanoma.


• Most melanomas consist of various colors from shades of brown to black. • A small amount of melanomas are pink, red or fleshy in color; these are called amelanotic

melanomas which tend to be more aggressive. • Warning signs of malignant melanoma include change in the size, shape, color or elevation of a

mole. • Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration,

redness around the site, or bleeding at the site. • An often-used mnemonic is "ABCDE", where A= asymmetrical, B= "borders" (irregular= "Coast

of Maine sign"), C= "color" (variegated), D= "diameter" (larger than 6 mm—the size of a pencil eraser) and E= "evolving."


Cancer Description


• Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders.

• Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops.

• It is often mistaken for a sore that does not heal. • This form of skin cancer is the least deadly and with

proper treatment can be completely eliminated, often without scarring.


• Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. • Some are firm hard nodules and dome shaped like keratoacanthomas. • Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. • Squamous cell is the second most common skin cancer. • It is dangerous, but not nearly as dangerous as a melanoma.


• Most melanomas consist of various colors from shades of brown to black. • A small amount of melanomas are pink, red or fleshy in color; these are called amelanotic melanomas which tend to be more aggressive. • Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. • Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site. • An often-used mnemonic is "ABCDE", where A= asymmetrical, B= "borders" (irregular= "Coast of Maine sign"), C= "color" (variegated), D= "diameter" (larger than 6 mm—the

size of a pencil eraser) and E= "evolving."


Cancer Description


• Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. • Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. • It is often mistaken for a sore that does not heal. • This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.


• Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin.

• Some are firm hard nodules and dome shaped like keratoacanthomas.

• Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass.

• Squamous cell is the second most common skin cancer. • It is dangerous, but not nearly as dangerous as a

melanoma. Malignant melanoma 악성흑색종

• Most melanomas consist of various colors from shades of brown to black. • A small amount of melanomas are pink, red or fleshy in color; these are called amelanotic melanomas which tend to be more

aggressive. • Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. • Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at

the site. • An often-used mnemonic is "ABCDE", where A= asymmetrical, B= "borders" (irregular= "Coast of Maine sign"), C= "color"

(variegated), D= "diameter" (larger than 6 mm—the size of a pencil eraser) and E= "evolving."


Cancer Description


• Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. • Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. • It is often mistaken for a sore that does not heal. • This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.


• Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. • Some are firm hard nodules and dome shaped like keratoacanthomas. • Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. • Squamous cell is the second most common skin cancer. • It is dangerous, but not nearly as dangerous as a melanoma.


• Most melanomas consist of various colors from shades of brown to black.

• A small amount of melanomas are pink, red or fleshy in color; these are called amelanotic melanomas which tend to be more aggressive.

• Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole.

• Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site.

• An often-used mnemonic is "ABCDE", where A= asymmetrical, B= "borders" (irregular= "Coast of Maine sign"), C= "color" (variegated), D= "diameter" (larger than 6 mm—the size of a pencil eraser) and E= "evolving."


• Diagnosis • 혈액학 검사

• X-ray 검사

• US진단

• CT

• MRI….

• 1단계 : 표피만

• 2단계: 진피까지

• 3단계: 대부분의 위쪽 진피

• 4단계: 아래쪽 진피까지

• 5단계: 피부밑 조직까지 파급

단계가 높아질수록 전이 발생률이 높음

Examination & Evaluations

16

Treatments

PT 의학적 처치

운동치료 물리적 인자치료

약물/수술/방사선

• 운동치료 • ROM ex • Strengthening Ex.

• 등속성/등장성 기구운동/저항운동 • 저항운동 (구심성/원심성 동적저항운동)

• 강도: 1RM의 50-60%, 최대 6-12회 반복

• 빈도: 최소 1-3회 /주 • 시간: 최소 20-30분 지속적운동

• 유산소 운동 • 고정식 자전거, 노젓기. 트레드밀 보

행, 점진적 계단오르기 등 • 강도: 50-70% VO2 max or 50-

75 % HRR, 60-80% Hrmax • 빈도 : 주 3-5회 • 저강도, 단시간, 여러 번 • 시간: 최소20-30분이상 지속적운동

• 도수치료

• 열치료

• 냉치료

• 압박치료

• 외과적 처지 • 근본적 수술 • 재래식 수술 • 방사선치료

• 약물치료

• 면역치료 • 항암화학약물치

료


17

Treatments

PT 의학적 처치

운동치료 물리적 인자치료

약물/수술/방사선


• 등속성/등장성 기구운동/저항운동 • 저항운동 (구심성/원심성 동적저항운동)

• 강도: 1RM의 50-60%, 최대 6-12회 반복

• 빈도: 최소 1-3회 /주 • 시간: 최소 20-30분 지속적운동

• 유산소 운동 • 고정식 자전거, 노젓기. 트레드밀 보

행, 점진적 계단오르기 등 • 강도: 50-70% VO2 max or 50-

75 % HRR, 60-80% Hrmax • 빈도 : 주 3-5회 • 저강도, 단시간, 여러 번 • 시간: 최소20-30분이상 지속적운동

• 도수치료

• 열치료

• 냉치료

• 압박치료


• 약물치료


료


18

Treatments

PT 의학적 처치

운동치료 물리적 인자치료 약물/수술/방사선


• 등속성/등장성 기구운동/저항운동

• 저항운동 (구심성/원심성 동적

저항운동)

• 강도: 1RM의 50-60%, 최대 6-12회 반복

• 빈도: 최소 1-3회 /주 • 시간: 최소 20-30분

지속적운동 • 유산소 운동

• 고정식 자전거, 노젓기. 트레드밀 보행, 점진적 계단오르기 등

• 강도: 50-70% VO2 max or 50-75 % HRR, 60-80% Hrmax

• 빈도 : 주 3-5회 • 저강도, 단시간, 여러 번 • 시간: 최소20-30분이상 지

속적운동 • 도수치료

• 열치료

• 냉치료

• 압박치료


• 약물치료


료


• 피부물리치료학, 이재형 외, 정담미디어, 2013

• 피부물리치료중재학, 박지환, 범문에듀케이션, 2013

참고 문헌

Dong-Ryul Lee, PT, Ph.D.

Copyright by Dong-Ryul Lee, PT, Ph.D.

integumentary physical therapycontents.kocw.net/kocw/document/2014/honam/leedongryul1/... ·...

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