1. MOTIVATION
“Our deepest fear is not that we are inadequate, our deepest fear is that we are powerful beyond measure…”
-Marianne Williamson

2. DERMATOLOGY
NOT DONE YET!

3. OTITIS EXTERNA
An acute or chronic inflammatory disease of the external ear canal
Clinical signs: **
Head rubbing or shaking
Ear scratching
Head tilt – with the affected ear tilted down
Malodorous otic discharge (brown, greenish-yellow)
Lichenification, hyperpigmentation, crusts, erythema and excoriations may be present
Aural hematoma
Excoriations(EX-COR-ATION): scraped or abraded skin
Malodorous: unpleasant smell
Lichenification: thickened leathery skin
Erythema: Superficial reddening
An aural hematoma is a pool of blood that collects between the skin and the cartilage of a pet's ear flap. Caused by aggressive scratching/ear shaking.

4. OTITIS EXTERNA NOTE THE EXCESS BROWN EXUDATE
ERYTHEMA, HYPERPIGMENTATION,
LICHENIFICATION
(DOVE)
Ear wrap, can help with ear wounds or aural hematoma
AURAL HEMATOMA

5. OTITIS EXTERNA PREDISPOSING FACTORS: Conformation Excessive moisture
Heavy, pendulous ears
Stenotic ear canals
Ear hair
Excessive moisture
Frequent bathing or swimming
Hypersensitivities
Food allergy, atopy
pendulous ears: long ears. More likely to pick up debri or bacteria when sniffing.
Ear canal stenosis can be caused by repeated ear canal infections that cause scarring
Stenotic: narrow due to scarring

6. OTITIS EXTERNA DIAGNOSIS: Otoscopic exam Clinical signs
Cytology, ear smear
Yeast, bacteria, cerumen, skin cells
Cerumen: ear wax -It protects the skin of the ear canal, assists in cleaning and lubrication, and also provides some protection against bacteria, fungi, insects, and water
Clinical signs: head shaking, painful ears, bad odor

7. OTITIS EXTERNA MALASSEZIA OTITIS Malassezia resemble
footprints, bowling pins,
or snowmen
Yeast

8. OTITIS EXTERNA
BACTERIAL OTITIS
ROD-SHAPED BACTERIA
AND A SKIN CELL

9. OTITIS EXTERNA TREATMENT
Always treat the underlying condition if present
Topical meds instilled daily
Antibacterial, antifungal, or combination products often with steroids (otomax, tresaderm, baytril otic)
Cleaning ears during treatment
Surgical intervention may be required
Aural hematoma
Chronic conditions (Total Ear Canal Ablation)
– Otitis externa
– surgery ear hemotoma
– TECA 4 minutes

10. TUMORS OF THE SKIN
Tumors are a new growth of tissue characterized by progressive, uncontrolled proliferation of cells. Benign vs. Malignant Localized vs. Invasive Adenoma/Carcinoma vs. Sarcomas
Proliferation: rapid increase in numbers
Benign: no harm, Malignant: result in death due to metastasizing to other parts of the body.
Carcinomas: epithelial origin (outer layer), sarcomas: connective tissue origin
Localized: where it started , Invasive: has spread

11. BENIGN TUMORS OF THE SKIN
HISTIOCYTOMA: small, button-like tumors that are usually pink, hairless, and raised. They are rapidly growing
Common locations include the pinnae, head, and legs

12. BENIGN TUMORS OF THE SKIN
HISTIOCYTOMA
Occurs almost exclusively in young dogs <4yrs old
DIAGNOSIS
Appearance
biopsy
TREATMENT
These tumors may spontaneously regress, but surgical excision is the treatment of choice
These tumors are not seen in cats.
ROUND CELL TUMOR

13. BENIGN TUMORS OF THE SKIN
LIPOMA: tumor of the subcutaneous adipocytes (fat cells) that are typically freely movable and well-circumscribed
Common in older, female, obese dogs
DIAGNOSIS:
Biopsy
Fine needle aspirate

14. BENIGN TUMORS OF THE SKIN
LIPOMA
TREATMENT:
Surgical excision
Benign neglect
FNA will show gray, greasy, mucoid like substance,
They could recur after removal. They could become large where they cause an issue, so removal would be indicated in that situation.
lipocytes

15. BENIGN TUMORS OF THE SKIN
PAPILLOMAS: wart-like growths that develop as smooth, white/pink/pigmented, elevated lesions in the oral cavity (oral papillomatosis) or on the skin (cutaneous papillomas)
These growths are caused by a papilloma virus
Any dog can become infected with this virus, but it more frequently occurs in dogs younger than 2 years old. Adult dogs that are exposed to the papilloma virus are usually able to fight it off without warts appearing. Senior dogs are usually resistant to it. Dogs become immune for life. Does not affect cats.
Young dogs because of immune system. When they have them, they are contagious

16. BENIGN TUMORS OF THE SKIN
PAPILLOMAS
DIAGNOSIS:
Appearance
Biopsy
TREATMENT
Usually spontaneous regression
Autogenous vaccine (grind tumor tissue and add it to 0.5% phenol) – Administer 1-5ml Intradermally weekly for 3 weeks.
CPV is contagious (but not to humans). Your dog can become infected through direct contact with another dog. They enter the patients body through cuts, scrapes, insect bites or areas of inflammation.
Autogenous vaccine: a vaccine prepared from cultures of microorganisms obtained from an individual and then used to immunize that same individual against further spread and progress of the same microorganisms
Usually will fight off on own though. (fall off-couple weeks to months)
Can remove if causes an issue for the patient.

17. BENIGN TUMORS OF THE SKIN
SEBACEOUS GLAND CYSTS: Slow growing, encapsulated, round, and exude a gray, cheeselike material. Caused by degenerative changes in the glandular area surrounding the follicle.
Common in cocker spaniels
DIAGNOSIS
Contents of the cyst
histology
TREATMENT
Surgical removal of entire encapsulated cyst
Can occur in dogs of any age
glandular area: gland around the follicle
Encapsulated: enclosed
SEBACEOUS GLAND: a small gland in the skin which secretes sebum into the hair follicles to lubricate the skin and hair
Histology: study of tissue

18. glandular area: gland around the follicle
Occurs when the gland gets blocked by dirt, debris, or scar tissue, or as the result of an infection

19. BENIGN TUMORS OF THE SKIN
Grow slow and could rupture
Surgical removal will fix the problem
SEBACEOUS CYSTS

20. SEBACEOUS GLAND CYSTS

21. MALIGNANT SKIN TUMORS
FELINE VACCINE-INDUCED FIBROSARCOMAS: rapidly developing, highly invasive, malignant tumors that occur at the site of vaccination ~4-6 weeks later.
VACCINES MOST COMMONLY IMPLICATED ARE THOSE WITH ADJUVANTS (substance that enhances the immune response by increasing the stability of a vaccine in the body) SUCH AS FELV AND RABIES
ADJUVANTS (add-ja-vent): a substance that enhances the body's immune response to an antigen
- Adjuvants are added to a vaccine to boost the immune response by producing more antibodies and longer-lasting immunity, this makes the vaccine needed less. Rabies is administered once and FELV is only boosted once.

22. MALIGNANT SKIN TUMORS VACCINE-ASSOCIATED SARCOMAS DIAGNOSIS:
Biopsy of fine needle aspirate
Physical exam findings
Swelling in area of recent vaccination
Rapidly growing firm elongated mass
Fibrosarcoma: part of a family known as sarcomas

23. MALIGNANT SKIN TUMORS VACCINE-ASSOCIATED SARCOMAS TREATMENT
Radical surgical excision which may involve limb amputation (the treatment of choice)
CLIENT INFORMATION
Poor prognosis if not detected early and treated aggressively
Inflammatory lumps may develop after vaccines but usually disappear within 1-2 weeks
Radical surgical excision: removal of blood supply

24. MALIGNANT SKIN TUMORS FELINE VACCINE-ASSOCIATED SARCOMAS
Rabies should be given as low as possible on right side, FELV as low as possible on left side and FVRCP low on right shoulder. No vaccines between the shoulder blades. Need to take the cat in if lump does not resolve in 4-6 weeks.
FELINE VACCINE-ASSOCIATED SARCOMAS

25. MALIGNANT SKIN TUMORS
MAST CELL TUMORS: firm nodules on the skin that may be ulcerated or edematous. Mast cells contain histamine and heparin
Edematous (ADEM- A- TUS): an excessive amount of watery fluid in cells, tissues, or body cavities
Could be pink and small like an eraser or could be big and fluid filled.
Heparin helps decrease the ability to form a clot. Hints why it is used in blood tube. Too much release could result in bleeding disorders.

26. MAST CELL TUMORS
Usually seen in dogs older than 6 years and cats older than 10 years old
Risk factors include age and breed
The cause is unknown
Other proposed causes of MCTs include chronic inflammation and viral infection, although no proof exists to support a viral etiology
50% are found on the rear legs, perineum, or external genitalia
(boxers, Boston terriers, Labradors, beagles and schnauzers are at higher risk)
Perineum: the area between the anus and the scrotum or vulva

27. MALIGNANT SKIN TUMORS
Mast cells are a type of white blood cell in the body that contains histamine.  They normally operate to help rid the body of foreign invaders or material.
Release of histamine helps attract other white cells to an area or an invader to help clean up the area to make an immune system reaction.
Too much histamine produced is not good for the body. This could be an allergic reaction or cancerous mast cell tumors forming in the body.
FINE NEEDLE ASPIRATE OF MAST CELL TUMOR; NOTE THE NUMEROUS GRANULES

28. MALIGNANT SKIN TUMORS
IN CATS, MAST CELL TUMORS ARE USUALLY BENIGN AND MAY SPONTANEOUSLY
REGRESS

29. MALIGNANT SKIN TUMORS MAST CELL TUMOR TREATMENT PROGNOSIS Chemotherapy
Radiation therapy
Surgical removal
BENADRYL
H2 blockers to treat gastric ulceration and irritation
PROGNOSIS
Depends on biopsy “grading” results
3 grades of mast cell tumors. Grade I MCT act in a benign manner, and most can be cured with surgical removal. Grade II can spread but often do not. Grade III MCT are more aggressive tumors that are locally invasive and have a high rate of spread
I have also seen them just disappear. Need good margins when they are removed. Opioids can cause a release, that’s why you use Benadryl.

30. MALIGNANT SKIN TUMORS MELANOMA (Benign or Malignant)
BENIGN: small, slow growing, hairless, pigmented
MALIGNANT: large, dome-shaped sessile +/- pigmentation
Ex: Tumors of the oral cavity and digits
Poor prognosis
Metastasize readily
Recurrence after surgery is common
Sessile: fully attached

31. MALIGNANT SKIN TUMORS
Usually a poor prognosis
Small lesions, 12months, large lesions, 4months
TREATMENT INVOLVES SURGICAL REMOVAL AND POSSIBLY TREATMENT WITH
THE MELANOMA VACCINE