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ABSITE 2022 > Chapter 18 - Plastics > Flashcards

Chapter 18 - Plastics Flashcards

1
Q

What are the main types of cells in the epidermis

A

Keratinocytes. Originate from basal layer; provide mechanical barrier

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2
Q

Where do the melanocytes originate from?

A

Neuroectodermal origin; in basal layer of epidermis.

Have dendritic processes that transfer melanin to neighboring keratinocytes via melanosomes

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3
Q

What are langerhan cells, and where are they?

A

in the dermis. Act as antigen presenting cells. They originate from bone marrow. They have a role in contact hypersensitivity reactions (type IV)

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4
Q

These are pressure sensory nerves

A

Pacinian corpuscles

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5
Q

What are the warmth sensory nerves

A

Ruffini’s endings

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6
Q

What are the cold sensory nerves?

A

Krause’s and bulbs

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7
Q

What are the tactile sensation sensory nerves?

A

Meissner’s corpuscles

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8
Q

What do Eccrine sweat glands do?

A
  • Produce aqueous sweat
  • Used for thermal regulation
  • Usually produce hypotonic sweat
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9
Q

What do apocrine sweat glands do?

A
  • Produce milky sweat
  • Highest concentration of glands in palms and soles
  • Most sweat is the result of sympathetic nervous system via acetylcholine
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10
Q

What is the most predominant type of collagen in the dermis?

A

Type one collagen. 70% of the weight of dermis; gives tensile strength

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11
Q

What are Cushing’s striae caused by?

A

Loss of tensile strength and elasticity

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12
Q

What is the donor site of a split thickness skin graft regenerated from?

A

Hair follicles and skin edges

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13
Q

How is a split thickness skin graft supported for the first three days

A

imbibition, osmotic blood supply

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14
Q

When does neovascularization of a split thickness skin graft begin?

A

Starts at day three. Tendon, bone without periosteum, XRT areas are unlikely to support graft

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15
Q

What is the most common cause of pedicled or free flap necrosis?

A

Venous thrombosis

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16
Q

What are the complications of a tram flap?

A

Flap necrosis, ventral hernia, bleeding, infection, abdominal wall weakness

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17
Q

How does UV radiation cause damage?

A
  • Damages DNA and repair mechanisms
  • It is both a promoter and an initiator
  • Melanin is the single best factor for protecting skin from UV radiation
  • UVB is responsible for chronic sun damage
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18
Q

What percentage of skin cancers melanoma?

A

3 to 5% of skin cancer but accounts for 65% of deaths

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19
Q

What are some genetic risk factors for melanoma?

A

Dysplastic, atypical, or large congenital nevi - 10% lifetime risk for melanoma

Familial BK mole syndrome - almost 100% risk of melanoma

Xeroderma pigmentosum

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20
Q

What percentage of melanomas are familial?

A

10%

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21
Q

What is the most common melanoma site on skin?

A

Back in men, legs in women

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22
Q

What are signs of poor prognosis in melanoma

A

Color change, angulation, indentation/notching, enlargement, darkening, bleeding, ulceration

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23
Q

How do you go about diagnosing suspicious lesions for melanoma?

A
  • Less than 2 cm lesion (or core needle) - excisional biopsy unless a cosmetically sensitive area
  • Greater than 2 cm lesions or cosmetically sensitive areas - incisional biopsy (or punch)
  • Need resection with margins if pathology comes back Melanoma
24
Q

What is lentigo maligna melanoma? Is it aggressive? How does it behave?

A
  • Least aggressive melanoma, minimal invasion, radial growth first
  • Elevated nodules
25
Q

What is superficial spreading melanoma?

A

Most common, intermediate malignancy; originates from Nevus/sun exposed areas

26
Q

What is nodular melanoma?

A

Most aggressive; most likely to have metastasized at time of diagnosis; Deepest growth at time of diagnosis; vertical growth first; bluish black with smooth borders; occurs anywhere on the body

27
Q

What is accral lentiginous melanoma?

A

Very aggressive; palms/soles of African-Americans

28
Q

What do you do with melanoma in situ or thin lentigo maligna?

A

0.5 cm margins okay

29
Q

What do you do with nodes in melanoma?

A
  • Always resect clinically positive nodes in melanoma
  • Perform SLNBx if nodes clinically negative and tumor greater than 1 mm deep
  • Involved nodes often nontender, round, hard, 1.5 cm
  • Need to include superficial parotidectomy for anterior head and neck melanomas
30
Q

What do you do with axillary node melanoma with no other primary?

A

Complete axillary node dissection

31
Q

Do you resect the metastases of melanoma?

A

Yes, can provide some patients with long disease free interval and is best chance for cure

32
Q

Basal cell carcinoma?

  • epidemiology
  • location
  • appearance
  • path
A
  • Most common malignancy in US; 4X more common than squamous cell carcinoma
  • 80% on Head/neck
  • Pearly appearance, rolled borders
  • Pathology shows peripheral palisading of nuclei and stromal retraction
  • Morpheaform type most aggressive; has collagenase production
33
Q

Squamous cell carcinoma? Appearance? More/less frequent metastasis?

A
  • Overlying erythema
  • Papulonodular w/ crust and ulceration
  • Usually red-brown; can also be Pearly
  • Metastasize more frequently than basal cell carcinoma but less than melanoma
34
Q

What are some characteristics of soft tissue sarcoma?

A
  • Most common soft tissue sarcoma: malignant fibrous histiosarcoma, then liposarcoma
  • 50% extremities
  • 50% in children (from embryonic mesoderm)
  • Present with asymptomatic mass, G.I. bleeding, bowel obstruction, neurologic deficit
  • Need CXR to rule out lung mets
  • MRI to rule out vascular, neuro, bone invasion (before biopsy)
  • Biopsy
35
Q

How do you biopsy soft tissue sarcoma?

A
  • Core needle biopsy is best
  • Excisional biopsy if mass < 4 cm
  • Longitudinal incision biopsy for masses > 4 cm
  • Hematogenous spread, not to lymphatics
  • Lung most common site for metastasis
  • Biopsy site must be excised if pathx is sarcoma
36
Q

How do you stage soft tissue sarcomas?

A
  • Based on grade, not size or nodes
  • Grade is most important prognostic factor
  • Undifferentiated gives worst prognosis
37
Q

Characteristics of head and neck sarcomas?

A
  • Can be in kids
  • Usually rhabdomyosarcoma
  • Hard to get negative margins
38
Q

What is the most common pathx of visceral and retroperitoneal sarcomas?

What is the most important prognostic factor?

A
  • Most commonly leiomyosarcoma and liposarcomas
  • Ability to completely remove the tumor is the most important prognostic factor
39
Q

PVC and arsenic exposure increase risk for what?

A

Angiosarcoma

40
Q

Chronic lymphedema is associated with what sarcoma?

A

Lymphangiosarcoma

41
Q

What is Kaposi’s sarcoma?

A
  • Vascular sarcoma
  • Can involve skin, mucous membranes, G.I. tract
  • Treat with XRT or intralesional vinblastine
42
Q

Childhood rhabdomyosarcoma?

A
  • Number one soft tissue sarcoma in kids
  • Head/neck, GU, ext, trunk (worst prognosis)
  • Embryonal subtype is most common
  • Alveolar subtype worse prognosis
  • Surgery; doxorubicin-based chemotherapy
43
Q

Bone sarcoma characteristics?

A
  • Most are metastatic at diagnosis
  • Osteosarcoma-increased incidence around the knee, originates from metaphyseal cells
  • Need to take the joint followed by reconstruction
44
Q

What soft tissue tumors are caused by neurofibromatosis?

A
  • CNS tumors
  • Peripheral sheath tumors
  • Pheochromocytoma
45
Q

What soft tissue tumors are caused by Li-fraumeni syndrome?

A

Childhood rhabdomyosarcoma and many others

46
Q

What soft tissue tumors are caused by tuberous sclerosis?

A

Angiomyolipoma

47
Q

What do xanthomas look like, what do they contain, how do you treat them?

A

Yellow in appearance, contain histiocytes, excise

48
Q

What is actinic keratosis?

A

Premalignant, found in sun damaged areas; need excisional biopsy if suspicious

49
Q

What is arsenical keratosis associated with?

A

squamous cell carcinoma

50
Q

What are Merkel cell carcinomas?

A
  • Neuroendocrine in nature
  • Aggressive
  • Red to purple papular nodule and indurated plaque
  • Have neuron specific in enolase, cytokeratin, and neurofilament protein
51
Q

What is a glomus cell tumor?

A

Painful tumor composed of blood vessels and nerves

Benign, most common in the terminal aspect of the digit

52
Q

What is a Hutchinsons freckle?

A

Found in the elderly on the face, premalignant, not aggressive

53
Q

What are desmoid tumors?

A
  • Usually benign; occur in facial planes
  • Anterior abdominal wall can occur during or after pregnancy, trauma, or surgery
  • Intra-abdominal associated with Gardner syndrome and retroperitoneal fibrosis
54
Q

What is the most common location for melanoma metastasis?

A

Lung

55
Q

SCC management of high risk lesions (large, poorly differentiated, perineural differentiation)? Alternative treatments?

A

Surgical excision.

If do not wish surgery or poor candidate - cryotherapy, electrosurgery, radiation therapy.

56
Q

What do melanomas stain for on pathology?

A

S-100 and HMB-45 proteins

57
Q

How do you treat soft tissue sarcomas?

A
  • Resect w/ 2-3 margins & 1 uninvolved fascial plane
  • Postop XRT for high grade, close margins, >5 cm
  • Chemotherapy is doxorubicin-based (Adriamycin)
  • If >10 cm, preop chemo-XRT may be limb-sparing
  • Resect isolated metastasis without evidence of systemic disease
  • Poor prognosis, 40% five-year survival rate with complete resection

ABSITE 2022 (50 decks)

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