ANATOMY IN ACTION SERIES: Rashes and Moles
Educational articles designed to help CAs understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Laurie Mueller
Why Should You Learn About Rashes and Moles?
Spring has sprung and we will be seeing a lot more skin on our patients. Just by the nature of our work, chiropractic offices see a lot of skin in all seasons! This can occur during the exam and adjusting process performed by the doctor, but also in the therapy room where CAs will often be the ones to apply physiotherapy modalities, such as ice/heat, electric muscle stimulation, or ultrasound. In chiropractic, we see our patients' backs and posterior neck regions, and we also can view the posterior sides of their arms and legs. All of these areas are difficult for the patient to see.
On certain visits, the doctor may not see any skin at all. The doctor may adjust through a T-shirt, so the CA may be the first person who notices a rash or mole on the patient. If the office catches a dangerous mole on a patient, such as melanoma, you just may save a life!
A Word About Rashes
A rash is a reaction. When you see one, the patient is having an adverse reaction to something that they were exposed to. This could be a flat, diffuse widespread redness, such as from a reaction to an antibiotic or pustules from poison ivy, or a scabby, itchy irritation to a substance, such as metal. In the images on this page, we see an example of each. The rash around the bellybutton actually occurred because a patient was allergic to nickel, the
“On certain visits, the doctor may not see any skin at all. ”
substance used to make the rivet on the button of her blue jeans. She covered the rivet with cloth when wearing her jeans and the rash went away.
What to Do When You See a Rash on a Patient
Don't assume that the doctor saw the rash. Ask the patient if he or she is aware of the rash. Ask if the patient is on any medications or has been exposed to anything. In other words, gather some information, and then get the doctor. For a drug reaction, the DC will need to refer the patient back to his or her MD immediately to change the medication.
Emergency warning: In the rare instance that a patient enters the office with a raised inflammatory rash called hives, then you need to suspect the possibility of an acute reaction. Sometimes this can be accompanied by anaphylactic symptoms, such as puffiness around the eyes, swollen lips, closing of the throat, ortrouble breathing. In such a case, the patient may be reacting to a bee or wasp sting, or may have inadvertently eaten something, such as
nuts or shellfish, and is exhibiting symptoms of an allergic reaction to it. Anaphylactic reactions are life threatening. If the patient carries an EpiPen (a portable shot of epinephrine/adrenaline), then he or she will know to use it to counteract the reaction. Otherwise, if the patient has swelling around the mouth and throat, you should call 911 and tell the emergency personnel that you suspect a severe allergic reaction.
“Understanding of anatomy helps all health office employees better communicate with patients and provide care more safely. ”
Menacing Moles
Everyone has some type of spots on their body. Spots on the skin can range from freckles and beauty marks to benign moles and life-threatening growths. We should keep in mind, however, that benign spots can also turn malignant.
The chart on this page outlines the ABCDEs of potentially dangerous growths. We are most commonly watching for basal cell carcinoma, squamous cell carcinoma, and melanoma. For melanoma in particular, an early discovery is of paramount importance because of how fast it can spread. If one or more of the ABCDEs are noticed, the patient should be referred to a dermatologist.
Something else to keep in mind is that not all growths are brown. They can be flesh tone, white/pearly, pink, red, purple, brown, or black, or can be a mottled combination and still be menacing.
Asymmetry
Round=Good
lrregular=Bad
Border
Even=Good
Ragged/notches=Bad
Color
Single shade=Good Many shades=Bad Diameter
;6mm=Watch it ;6mm=Check it!
Evolvi ng=Bad
Eg. Flat mole becoming elevated/changing colorete.
The point is that we see great variance among all moles, even within the same type. The images on this page will help you visualize a few of the different "looks" that menacing moles can have.
Basal Cell Carcinoma
Most common
Three out of 10 Caucasians will have in their lifetime
Squamous Cell Carcinoma
Second most common Can metastasize
Melanoma
Must catch fast!
75% of skin cancer deaths 160,000 new cases per year
Management of Moles
Any suspicious spot on a patient should be noted and then seen by the doctor and discussed with the patient. In the chart, the location of the mole, color, size, and other descriptors should be documented. If the mole is a new growth and/or has dangerous characteristics, then the patient should be referred to a dermatologist immediately.
If the patient has been aware of the mole/has had it his or her entire life, then it may not be menacing. However, if it is in a spot the patient cannot see well, the doctor should dothe patient the service of monitoringthespoton every visit so that if changes do occur, then the patient can be referred to a dermatologist. If the spot is in a location easily viewed by the patient, then the patient should be instructed to watch it, and if he or she notes any changes to it, then go to a dermatologist.
Education Fosters Understanding
An understanding of anatomy helps all health office employees better communicate with patients and provide care more safely. Online training programs in particular make high-quality training affordable and convenient, and can be taken any tíme of day. At www.CCCAonline.com learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study and fulfills the training requirement needed for the national examination!
DCs will often pay for employees to train. Full price for this training is an affordable $339 forthe entire 24-hour program. At www.CCCAonline.com, there is a special discount available foryou! If you are receiving this article through The American Chiropractor magazine, use AMCHIRO as your discount code. When this code is entered during the registration process, it will automatically provide a $15 discount off the regular price of the program. This is the program that gives back to the profession.
Learners can expect text, images/schematics, dynamic video lectures, and robust, customized experiential interactivities in a thorough 19-module program. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an email at [email protected]
Laurie Mueller, BA, DC served in private practice in San Diego, California. She was the postgraduate director at Palmer College from 2000 to 2010; served as the ACC postgraduate subcommittee chair for six years; peer reviewed for the Research Agenda Conference; and wrote the informal role determination study that aided in the development ofFCLB ’s guidelines for chiropractic assistants. Dr Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions and subsidiary www. CCCAonline. com. She is a clinician, an educator, and an expert in online educational pedagogy.
