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Brown spots on Marys skin The ABCD rule is A is for ASYMMETRY One-half of a mole or birthmark does not match the other B is for BORDER The edges are irregular ragged notched or blurred C is for COLOR The color is not the same all over but may have differing shades of brown or black sometimes with patches of red white or blue D is for DIAMETER The area is larger than 6 millimeters about inch -- the size of a pencil eraser or is growing larger Superficial spreading melanoma can in many cases be recognized as an extension of the abnormalities noted in dysplastic nevi Its features include Asymmetry irregularity of Border Color variation and large Diameter These ABCD rules can be useful but many melanomas are not identified using them For instance the D of ABCD includes a lesion diameter greater than 6 mm in diameter Thanks to an educated physician and general public melanomas in Australia are diagnosed smaller than 6 mm 60 percent of the time Thus size alone is not a useful predictor unless the lesion is large Similarly edge and color variation are common in very tiny new nevi that are not dysplastic As nevi evolve beyond 2 to 4 mm the variation becomes less and less in the normal nevus Conversely the irregularity of edge and color can be accentuated in the dysplastic nevus evolving into a melanoma Thus while the ABCD rule is useful as a way of thinking about morphology strict adherence to it may result in the missing of some melanomas Case 2 Fractured Tibia of Johnny Long Bone has a rich vascular supply It receives 10-20 of the cardiac output Blood supply varies with different types of bones Blood vessels are especially rich in areas containing red bone marrow Long bone blood suppliers Diaphyseal nutrient artery This is the most
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