Cutaneous Lesions & Its Recons Flashcards
Diff dx of localized pigmentations
Simple lentigo
Melanocytic nevus
Melanoma
Diff dx of generalized pigmentations
Solar lentigo
Dysplastic melanocytic nevi
Cafe au lait spots assoc with NFM type 1, Mc cune albright syndrome.
Sebarrhoiec keratisis
BCC vs SCC of skin
Bcc 80% skin cancer. Scc 10-15%
Both has same risk factors
SCC appear as eryhtematous nodule, ulceration, induration; BCC can appear as nodular, surface, cystic, resembling scar, basosquamous
Risk factors of BCC and SCC
Both has same risk factors:
- Fitzpatrick type 1-3
- Chronic sun exposure
- UV exposure
- Increase age
- Decreasing latitude
- Immunosurpressed
- Radiation
- HPV
Mets of BCC SCC
BCC 1% - highest within 5yrs
SCC 5% - esp if perineural spread and they spread to neck fast
What are the risk of recurrece for BCC SCC
>2cm Positive margin Bcc at central face/ear; SCC at lip, eyelid and ear Aggressive histology Long duration
Melanoma frequency
5% of all skin cancers
BCC 80%
SCC 10-15%
Risk factor for Melanoma
Fitzpatrick type 1,2,3
Sun exposure
Tanning beds and sunburns
Clinical presentation of Melanoma
ABCDE A asymmetry B border irregularity C color variegation D diameter >6mm E evolution of lesion changin color or size
Types of melanoma
Superficial spreading
Nodular
Acral lentiginous
Lentigo maligna
Hw do you stage melanoma
Breslow depth (mm) and Clark level of skin staging
Treatment options of skin lesions
Electrodessication & currettage Cryosurgery Radiation Srgical excision Mohs surgery
What is mohs surgery
Microscopically controlled surgery Which involves 1. Surgical removal of tissue 2. Mapping or staining of specimen 3. Histologic interpretation 4. Further tissue removal
What r indications of mohs surgery
- Recurrent skin cancer (scc or bcc)
- High risk anatomical area (H zones of face)
- Histologically aggressive
- Large skin cancer >3cm
- Skin ca in irradiated skin
Contraindications of mohs surgery
Malignant melanoma
Small lesions
How to prevent recurrence of skin cancer
Staying in shades avoiding prolong sun exposure
Sunscreen
Cover up
Adjuvant therapy with chemo, targeted therapy, immunotherapy
Aggressive cancer surveillance within 5yrs
Treatment for SCC involving vermillion lip
Wide surgical excision with 1cm margin
Reconstructed with Karapandzic flap or Webster bernard flap
What is the Karapandzic technique and what vessel is it based on?
An axial pattern musculocutaneous flap based on the facial artery/vein - superior and inferior labial arteries. Branch of facial a. v.
Indicated lip reconstruction where defect is <3/4
Simultaneous, bilateral, full-thickness circumoral flaps with isolation and preser- vation of vascular and neural structures
Has good motor and sensory function of the new lip
Describe technique of Karapandzic flap
- Outline the excision of the disease lip with wide margin of 1cm
- Extend the outline below the lower lip along the labiomental fold, extending upwards towards the nasolabial fold
- wide excision of tumor
- Incision thru skin n subcut
- Blunt dissection of orbicularis muscle radially to free from its attachment
- Preserving vessels and nerves
- Mucosal incision up to commisure to mobilize the flap
- Layered closure
BCC more commonly occur at?
Central of face
SCC skin commonly occur at?
Lip and eyelid
What other options for repair of Localized mucosa or vermilion defects?
Excision Z-plasty V-Y mucomuscular advancement flap Lateral mucomuscular advancement flap Abbe flap Estlander flap (for involvement of commisures) Gillies flap McGregor flap
How do u repair a cheek defect
Small. Primary closure & local flap
Medium. Nasolabial flap
Large. Cervicofacial rotational flap/ submental island flap
Thru and thru defect. ALT free flap
Bluish lesions at floor of mouth diff dx
Venous malformation at floor of mouth - swelling at floor of mouth- bluish/ tro ranula
Ddx:
ranula
Venous malformation
Tx:
Scleroting agent (bleomycin/ pingyang? / )
