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Fiser's ABSITE Review > 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

Neuro ectodermal 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 Eccrine sweat glands

A

Produce aqueous sweat

Used for thermal regulation, usually hypotonic sweat

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9
Q

What are apocrine sweat glands

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 the 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-excisional biopsy unless cosmetically sensitive area. Need resection with margins if Pathology comes back Melanoma
  • greater than 2 cm lesions or cosmetically sensitive areas-incisional biopsy, will need Resection with margins if pathology shows melanoma
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24
Q

What is lentigo maligna?

A

Least aggressive, minimal invasion, radial growth first. Elevated nodules

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25
Q

What is superficial spreading melanoma?

A

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

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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

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27
Q

What is accral lentiginous?

A

Very aggressive; Palms/soles of African-Americans

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28
Q

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

A
  • 0.5 cm margins okay
  • Need CXR and LFTs; examine all possible draining lymph nodes
  • alpha-interferon, IL –2, antitumor vaccines can be used for systemic disease
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29
Q

What do you do with nodes in melanoma?

A
  • Always need to resect clinically positive nodes with melanoma
  • Perform sentinel lymph node biopsy if nodes clinically negative and tumor greater than 1 mm deep
  • Involve nodes are usually nontender, round, hard, 1 to 2 cm
  • Need to include superficial parotidectomy for anterior head and neck melanomas
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30
Q

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

A

Complete axillary node dissection

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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

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32
Q

Basal cell carcinoma?

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
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33
Q

Squamous cell carcinoma?

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

Soft tissue sarcoma?

A

Most common soft tissue sarcoma –number one malignant fibrous histiosarcoma

  • Two-liposarcoma
  • 50% extremities; 50% in children from embryonic mesoderm
  • -Present with asymptomatic mass, G.I. bleeding, bowel obstruction, neurologic deficit
  • Need CXR, MRI to rule out vascular, neuro, bone invasion
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35
Q

How do you treat soft tissue sarcoma?

A

Excisional biopsy if mass less than 4 cm
-Longitudinal incision biopsy for masses greater than 4 cm
-Hematogenous spread, not to lymphatics
Lung most common site for metastasis

36
Q

How do you stage soft tissue sarcomas?

A

Based on grade, not size or nodes
XRT for high-grade tumors
-Chemotherapy is doxorubicin-based
-Resect isolated metastasis without evidence of systemic disease
-Poor prognosis, 40% five-year survival rate with complete resection

37
Q

Head and neck sarcomas?

A

Can be in kids-usually rhabdomyosarcoma

-Hard to get negative margins

38
Q

Visceral and retroperitoneal sarcomas?

A

Most commonly leiomyosarcoma and liposarcomas

-Ability to completely remove the tumor the most important prognostic factor

39
Q

PVC and arsenic are at risk for what?

A

Angiosarcoma

40
Q

Chronic lymphedema is associated with what?

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

  • Found on head/Neck, genitourinary, extremities and trunk (poorest prognosis)
  • Embryonal subtype is most common
  • Alveolar subtype worse prognosis
  • Surgery; doxorubicin-based chemotherapy
43
Q

Bone sarcomas?

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?

A

Associated with 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

How do you go about diagnosing suspicious lesions for melanoma?

A
  • Less than 2 cm lesion-excisional biopsy unless cosmetically sensitive area. Need resection with margins if Pathology comes back Melanoma
  • greater than 2 cm lesions or cosmetically sensitive areas-incisional biopsy, will need Resection with margins if pathology shows melanoma
55
Q

What is lentigo maligna?

A

Least aggressive, minimal invasion, radial growth first. Elevated nodules

56
Q

What is superficial spreading melanoma?

A

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

57
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

58
Q

What is accral lentiginous?

A

Very aggressive; Palms/soles of African-Americans

59
Q

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

A
  • 0.5 cm margins okay
  • Need CXR and LFTs; examine all possible draining lymph nodes
  • alpha-interferon, IL –2, antitumor vaccines can be used for systemic disease
60
Q

What do you do with nodes in melanoma?

A
  • Always need to resect clinically positive nodes with melanoma
  • Perform sentinel lymph node biopsy if nodes clinically negative and tumor greater than 1 mm deep
  • Involve nodes are usually nontender, round, hard, 1 to 2 cm
  • Need to include superficial parotidectomy for anterior head and neck melanomas
61
Q

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

A

Complete axillary node dissection

62
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

63
Q

Basal cell carcinoma?

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
64
Q

Squamous cell carcinoma?

A
  • Overlying erythema, papulonodular with crust and ulceration
  • Usually red-brown; can also be Pearly
  • Metastasize more frequently than basal cell carcinoma but less than melanoma
65
Q

Soft tissue sarcoma?

A

Most common soft tissue sarcoma –number one malignant fibrous histiosarcoma

  • Two-liposarcoma
  • 50% extremities; 50% in children from embryonic mesoderm
  • -Present with asymptomatic mass, G.I. bleeding, bowel obstruction, neurologic deficit
  • Need CXR, MRI to rule out vascular, neuro, bone invasion
66
Q

How do you treat soft tissue sarcoma?

A

Excisional biopsy if mass less than 4 cm
-Longitudinal incision biopsy for masses greater than 4 cm
-Hematogenous spread, not to lymphatics
Lung most common site for metastasis

67
Q

How do you stage soft tissue sarcomas?

A

Based on grade, not size or nodes
XRT for high-grade tumors
-Chemotherapy is doxorubicin-based
-Resect isolated metastasis without evidence of systemic disease
-Poor prognosis, 40% five-year survival rate with complete resection

68
Q

Head and neck sarcomas?

A

Can be in kids-usually rhabdomyosarcoma

-Hard to get negative margins

69
Q

Visceral and retroperitoneal sarcomas?

A

Most commonly leiomyosarcoma and liposarcomas

-Ability to completely remove the tumor the most important prognostic factor

70
Q

PVC and arsenic are at risk for what?

A

Angiosarcoma

71
Q

Chronic lymphedema is associated with what?

A

Lymphangiosarcoma

72
Q

What is Kaposi’s sarcoma?

A

Vascular sarcoma

  • Can involve skin, mucous membranes, G.I. tract
  • Treat with XRT or intralesional vinblastine
73
Q

Childhood rhabdomyosarcoma?

A

Number one soft tissue sarcoma in kids

  • Found on head/Neck, genitourinary, extremities and trunk (poorest prognosis)
  • Embryonal subtype is most common
  • Alveolar subtype worse prognosis
  • Surgery; doxorubicin-based chemotherapy
74
Q

Bone sarcomas?

A

Most are metastatic at diagnosis

  • Osteosarcoma-increased incidence around the knee, originates from metaphyseal cells
  • Need to take the joint followed by reconstruction
75
Q

What soft tissue tumors are caused by neurofibromatosis?

A

CNS tumors
Peripheral sheath tumors
Pheochromocytoma

76
Q

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

A

Childhood rhabdomyosarcoma and many others

77
Q

What soft tissue tumors are caused by tuberous sclerosis?

A

Angiomyolipoma

78
Q

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

A

Yellow in appearance, contain histiocytes, excise

79
Q

What is actinic keratosis?

A

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

80
Q

What is arsenical keratosis?

A

Associated with squamous cell carcinoma

81
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
82
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

83
Q

What is a Hutchinsons freckle?

A

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

84
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
85
Q

What is the most common location for melanoma metastasis?

A

Lung

Fiser's ABSITE Review (50 decks)

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