Lentigo Maligna

Melanoma, a type of skin cancer is categorized into four types, three are 'in situ' and the fourth type is invasive. In situ is a very early stage of melanoma and does not invade enough to be considered invasive. Lentigo Maligna is 'in situ'. The cancer cells are in the top layer of the skin (epidermis) and are contained in the area in which the cells started to develop. If left untreated, 'in situ' lentigo maligna can become invasive.

• Lentigo maligna is more common in males.
  
• Working outdoors (exposure to UV rays) increases risk.
  
• Early childhood exposure to sunburn blisters increases chance of developing at later stage of life.
  
• Family history increases chance of developing lentigo maligna.
  
• Begins as a patch.
  
• Occurs around hair follicles on the sun-damaged skin of the head and neck or even face.
  
• Grows very slowly over many years.
  
• Diagnosed usually during middle age and the elderly.

Lentigo Maligna - ABCD rule

Initially, it appears as a mole in the sun exposed areas. Over time, it grows into an odd-looking, multi-colored structure that doesn't go away. The ABCD rule is useful to recognize lentigo maligna. Considering these as lentigo maligna symptoms, without any delay, it is best to seek medical attention.

A: Stands for asymmetry. The mole can be anywhere on the skin which is not symmetric in shape.

B: Stands for border. The border of the mole is ragged, notched, and irregular.

C: Stands for color. The mole is multi-colored, a mixture of brown, black, red, blue or white in varying shades and patterns.

D: Stands for diameter. The size of the mole is more than 6mm.

Lentigo maligna diagnosis

Post a visual examination of the affected areas, a skin biopsy is recommended by the doctor. A biopsy is required for diagnosis. The biopsy involves removing the growth and a small part of the surrounding skin to analyze it under a microscope. Confirming lentigo maligna diagnosis, the doctor determines the best course of treatment.

Lentigo maligna treatment

Early detection and medical attention restrains the lesions or mole from spreading across the skin's surface. If left untreated, it can spread deeper into the skin and can eventually pass to other parts of the body.

Slow Mohs is a preferred surgical technique for completely removing the melanoma. Along with it, about 5mm margin of normal tissue is also excised. Radiation or cryosurgery is resorted to when the lesion is difficult to access and excise. Under local anaesthesia, surgery is performed. Healthy tissues around the area are also removed as a precautionary step leaving no cancerous cells. If the mole or lesion is in an area where spare skin is not available, like the face or lower leg, skin graft to remove the lesions may be required. A plastic surgeon would remove skin and replace it from another area. A follow-up visit may or may not be required.

Lentigo maligna self care tips

Lentigo maligna is not hereditary but it is more likely to develop when a close relative has suffered a melanoma. Self care tips can prevent getting another lentigo maligna.

• Monthly self examination of the whole body applying ABCD lentigo maligna rule.
  
• Protect your skin from too much exposure to the sun. Use sun-care tips like sun protection cream, wearing a hat, cotton clothes, avoiding sun bathing, sunburn and tanning etc.
  
• Avoid sun beds and tanning lamps.
  
• Avoiding direct sunlight exposure can be substituted to an extent with Vitamin D supplements.
  
• Inform family members particularly the youngsters keeping in mind the genetic influence.

Pick's Complex

This is a less common form of dementia, more prominent in those under the age 65. Frequently misdiagnosed as Alzheimer's disease, Pick's patients initially exhibit marked personality and behavioral changes. And gradually the ability to speak coherently declines.

Although there is no cure for Pick's complex presently, it can however be managed well and the quality of life improved. According to Arnold Pick, who first described the disease in 1892, Pick's disease causes an irreversible decline in a person's functioning for several years. Pick's affects adults between the ages of 40 and 60 and is more common in women than men.

Causes

The frontal and temporal lobes of the brain control a person's speech and personality. Excess protein build-up in these parts causes slow atrophy in these regions. The cause for this build-up of protein is unknown. Other than causing speech and behavioral changes, Pick's disease can also cause memory loss quite like those with Alzheimer's as well as socially inappropriate behavior, poor decision making, progressing to severe impairment in intellect, speech and memory. Some opine that Pick's disease may have a genetic or heredity component although not all family members are affected.

Symptoms of Pick's disease

The first sign of Pick's complex is personality changes and decline of basic functioning. Pick's can occur in an age earlier than Alzheimer's and memory loss need not be a predominant early sign of Pick's disease. Although there could be reports of Pick's occurring as young as 20 years of age, the progression is slower in Pick's disease. However, there are cases where symptoms could worsen over time and brain cells degenerate. More severe symptoms appear at later stages of Pick's. Some noticeable behavioral symptoms of Pick's disease are poor judgment, extreme restlessness especially in the early stages, overeating or drinking, lack of personal hygiene, sexual exhibitionism, decreased interest in daily activities and obsessive behavior.

Mood swings, lack of empathy, apathy, rudeness, impatience and aggression, easy distraction and being unaware of strange behavior and memory loss are some of the prominent emotional symptoms of Pick's disease. Loss of vocabulary, difficulty in speaking and understanding, uncoordinated speech and decrease in the ability to speak and write are some serious signs of Pick's.

Diagnosis of Pick's Complex

Other than careful symptomatic evaluation, brain scans and EEG, three of the following five characteristics are found to be present in the early stages. They include:

Onset before age 65
Personality changes
Lack of normal behavior / Loss of control
Lack of inhibition
Roaming behavior
When compared to Alzheimer's, memory loss and mental impairment occur later in Pick's.

Diet and activity

There should be a restriction on foods with high sugar content. There could be carbohydrate cravings in some. While in Alzheimer's and Parkinsons, a diet relatively high in fat and protein and low in carbohydrates is necessary, it is unclear if the same is recommended for Pick's complex. It is better to get a doctor's opinion on an appropriate heart-healthy diet. A regimen of therapeutic exercises such as brisk walking can help to regulate the patient's mood and benefit on cognitive function.

Treatment

Pick's disease, like any other dementia progresses rapidly and life gets shortened about six to eight years, although some do live for as long as twenty years. As currently there is no cure for Pick's like Alzheimer's, the aim is to maximize quality of life by way of medications to manage particular symptoms, regular supervision, and assistance.

Emotional and substantive support is an important aspect of the treatment. The family of the affected may help with the following control symptoms:

• Eyeglasses and hearing aids to bolster the failing senses.
  
• Positive behavior when symptoms set in by creating a calm and soothing atmosphere so that the patient feels safe and less anxious.
  
• Speech therapy or any other physical therapy that can improve communication and movement.
  
• Selective antidepressants that can provide some relief from apathy and depression and help reduce food cravings, impulse control and compulsive activity.
  
• Treatment for other disorders such as anemia, thyroid disorders and kidney or liver diseases.
  
• Stopping medications like paracetamol, NSAIDS, anti-cholergenics or changing them under medical guidance.

Tips for coping with Pick's complex

Being diagnosed with Pick's complex can be overwhelming especially when it involves any form of dementia. It is good to learn more about Pick's disease and frontotemporal dementia. In this way, more control can be exhibited and they will be better prepared to manage symptoms.

• Music therapy, meditation, deep breathing exercises can help control stress and anxiety.
  
• Pet therapy and visits from specially trained animals can help relieve stress and improve mood.
  
• Treating depression can make it easier to handle other challenges of the disease.
  
• Reaching out to family and friends for emotional support can help avoid isolation. A support group of similar patients can help overcome feelings of depression and isolation and provide a wealth of coping tips. Staying socially active will lighten the load and increase patient comfort.
  
• Playing cards and word games such as scrabble, crossword and Sudoku puzzles can exercise the brain and help slow cognitive decline.
  
• It would be wise for a Pick's patient to avoid medical, financial and legal confusion and instead create a design plan and discuss and document end-of-life preferences with doctors and family members.

Tourette's Syndrome

Gilles de la Tourette syndrome is a neurological disorder that involves uncontrollable repetitive movements or abnormal sounds called tics. These tics are rapid movements such as blinking, shrugging the shoulders, or jerking an arm or sounds like humming, clearing the throat, grunting, or yelling out a word or phrase. Tics involved with movement are called motor tics and tics involving sound are called vocal tics. There is no specific cause that results in Tourette's syndrome. It could be either due to inherited gene disorder or certain chemical imbalance in the brain.

People with Tourette's syndrome are not able to control themselves from tics. The condition typically starts in childhood between the ages of 2 and 12. A male child is more likely to develop Tourette's syndrome than a girl child. Tourette's syndrome occurs in people from all ethnic groups. It stays with the person for life. However symptoms are at their peak during the early teens and gradually improve during adulthood. Motor and vocal tics are intensified with fear, stress, apathy, fatigue or excitement. Tics are normally under control when the affected person is asleep.

Simple and complex tics

Tourette's syndrome almost always starts with motor tics and the affected person slowly develops vocal tips too in due course. The symptoms of Tourette's syndrome may range from simple tics to complex ones. Simple motor tics may include only few muscle groups such as eye-blinking, facial grimacing, nose-twitching, head-jerking. Complex tics involve many muscle groups. Complex ones include jumping, touching other people or things or it can even be an extreme tic.

Throat clearing, yelping, sniffing, hissing, barking, coughing and tongue clicking are some of the simple vocal tics while complex vocal tics include uttering words or phrases out of context, Coprolalia (obscene gestures), and echolalia (repeating a sound, word, or phrase just heard).

Treatment

There is no cure for Tourette's syndrome. No intervention is required when the tics are simple and do not affect daily activity. However the affected person as well as the people around him need to be educated about Tourette's syndrome so as to avoid weird reactions. Severe tics may be treated with medication and behavioral therapies. However medications do not help in suppressing the tics completely. Neuroleptics and alpha-adrenergic agonists have been effective in treating severe tics. These medications may lead to certain side effects.