Chapter 8: Skin Surgery

Question 1

Incidence of different types of skin cancer:

Answer 1

1. basal cell: 50%
2. SCC: 25%
3. Melanoma: 15%

Question 2

How do you diagnose different cancers?

Answer 2

1. full-thickness incisional or punch biopsy at edge of lesion (including normal skin)

Question 3

Basal cell carcinoma description?

Answer 3

1. waxy, raised lesion or non-healing ulcer
2. prefers upper part of face (above line drawn across lips)
3. doesn’t metastasize but signif local damage
   Tx: local excision w negative margins (1mm) is curative

Question 4

Squamous cell carcinoma description?

Answer 4

1. non-healing ulcer that has a preference for the lower lip and territories below a line draw across the lips
2. can metastasize to lymph nodes
   Tx: excision has WIDER margins (0.5-2 cm) compared to bcc. Node dissection is also done and radiation therapy is another option.

Question 5

Melanoma description?

Answer 5

1. pigmented lesion
Asymmetric 
Borders irregular
Color (different colors) w/i lesion
Diameter (exceeds 0.5 cm) 
Evolution (changes--i.e. gets bigger, ulcerates, changes color or shape, bleeds)

Question 6

Prognosis of skin lesions by depth:

Answer 6

1. less than 1 mm deep: good prognosis, only local excision
2. deeper lesions: wider margins with excision (2-3cms)
3. lesions deeper than 4mm have a very poor prognosis
4. lesions between 1-4 cm–> do aggressive therapy including node dissection

Question 7

Places that malignant melanoma metastasizes?

Answer 7

Weird places;

1. muscle of left ventricle
2. wall of duodenum
3. anywhere!

Conventional places;
lymph nodes
liver
lung
brain
bone

Question 8

Natual history of malignant melanoma?

Answer 8

no predictable timeline!

months-decades bw diagnosis and metastasis

Question 9

What’s the preferred adjuvant systemic therapy for metastatic melanoma?

Answer 9

interferon