American family physician
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Cutaneous malignant melanoma accounts for 5% of cancer diagnoses and is the fifth most common cancer diagnosed in the United States. Risk factors for cutaneous malignant melanoma include ultraviolet radiation from sun exposure, Fitzpatrick skin type I or II, a history of dysplastic nevi, indoor tanning, older age, and a personal or family history of melanoma. The U. ⋯ Thin lesions with a Breslow depth of less than 0.8 mm usually do not need further treatment after wide local excision and have an excellent prognosis. Lesions with a Breslow depth greater than 0.8 mm may need further diagnostic tests or procedures, including sentinel lymph node biopsy, complete lymph node dissection, gene mutation analysis, and possible treatment with systemic immunotherapy. Use of systemic immunotherapies has improved the prognosis for advanced melanoma (stages III and IV), with 5-year survival rates of 74.8% and 35%, respectively, compared with 62.6% and 16% from 1975 to 2011 before immunotherapy was available.
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Patients commonly present to family physicians with skin findings, and distinguishing common benign skin tumors from potentially malignant tumors is important. Benign skin tumors can often be diagnosed by their history, distribution, and characteristic morphology. A biopsy or excision is indicated if there is diagnostic uncertainty or the lesion undergoes uncharacteristic or rapid change. ⋯ Pyogenic granulomas sometimes self-involute but bleed easily and often recur at the original site. They generally respond to shave excision and electrodesiccation. In patients with darker skin, treatment with cryotherapy and laser therapy should include discussions about hypopigmentation risk.
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American family physician · Oct 2024
ReviewDiagnosis and Management of Obsessive-Compulsive Disorder in the Primary Care Setting.
Obsessive-compulsive disorder is a common neuropsychiatric disorder that is often underdiagnosed or misdiagnosed. It is characterized by obsessions, which are intrusive and include unwanted thoughts, images, or urges that cause marked anxiety or distress. Obsessions also drive patients to engage in repetitive actions or thoughts, known as compulsions. ⋯ If monotherapy is not effective, psychotherapy and pharmacotherapy can be combined. Treatment of obsessive-compulsive disorder is typically recommended for at least 12 months for maintenance and prevention of relapse. In patients requiring augmentation, higher-risk or novel adjunctive treatments or investigational therapies should be managed by an experienced multidisciplinary team.
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American family physician · Oct 2024
Understanding the Health Care Needs of the Deaf Community Through Medical Interpreters.
For approximately 500,000 Deaf people in the United States who use American Sign Language (ASL), accessing quality health care is challenging.1 Deaf people are more likely to have been admitted to a hospital in the past 12 months and have a history of chronic illness (e.g., cardiovascular disease, arthritis, HIV, obesity) compared with those without hearing impairment.2,3 Contributing factors include lack of cultural competency, few appropriately trained ASL interpreters, insufficient clinician education, and low health literacy levels.4 Deaf is defined here as people who are culturally Deaf (values, traditions, and norms5,6) and use ASL as a primary mode of communication.