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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
Skin Cancer (피부암)
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
Skin Cancer (피부암)
• 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
Skin Cancer (피부암)
Epidemiology
Skin Cancer (피부암)
• 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.
Skin Cancer (피부암)
• 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) 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 기저세포암
• 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 편평세포암
• 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."
Skin Cancer (피부암) Signs and symptoms
Cancer Description
Basal cell carcinoma 기저세포암
• 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 편평세포암
• 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."
Skin Cancer (피부암) Signs and symptoms
Cancer Description
Basal cell carcinoma 기저세포암
• 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 편평세포암
• 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."
Skin Cancer (피부암) Signs and symptoms
Cancer Description
Basal cell carcinoma 기저세포암
• 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 편평세포암
• 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."
Skin Cancer (피부암)
• 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
Skin Cancer (피부암)
• 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
Skin Cancer (피부암)
17
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
Skin Cancer (피부암)
18
Treatments
PT 의학적 처치
운동치료 물리적 인자치료 약물/수술/방사선
• 운동치료 • ROM ex • Strengthening Ex.
• 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
• 외과적 처지 • 근본적 수술 • 재래식 수술 • 방사선치료
• 약물치료
• 면역치료 • 항암화학약물치
료
Skin Cancer (피부암)
• 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.