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OMFS > Cutaneous Lesions & Its Recons > Flashcards

Cutaneous Lesions & Its Recons Flashcards

1
Q

Diff dx of localized pigmentations

A

Simple lentigo
Melanocytic nevus
Melanoma

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2
Q

Diff dx of generalized pigmentations

A

Solar lentigo
Dysplastic melanocytic nevi
Cafe au lait spots assoc with NFM type 1, Mc cune albright syndrome.
Sebarrhoiec keratisis

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3
Q

BCC vs SCC of skin

A

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

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4
Q

Risk factors of BCC and SCC

A

Both has same risk factors:

  • Fitzpatrick type 1-3
  • Chronic sun exposure
  • UV exposure
  • Increase age
  • Decreasing latitude
  • Immunosurpressed
  • Radiation
  • HPV
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5
Q

Mets of BCC SCC

A

BCC 1% - highest within 5yrs

SCC 5% - esp if perineural spread and they spread to neck fast

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6
Q

What are the risk of recurrece for BCC SCC

A 
>2cm
Positive margin
Bcc at central face/ear; SCC at lip, eyelid and ear
Aggressive histology
Long duration
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7
Q

Melanoma frequency

A

5% of all skin cancers

BCC 80%
SCC 10-15%

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8
Q

Risk factor for Melanoma

A

Fitzpatrick type 1,2,3
Sun exposure
Tanning beds and sunburns

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9
Q

Clinical presentation of Melanoma

A 
ABCDE
A asymmetry
B border irregularity
C color variegation
D diameter >6mm
E evolution of lesion changin color or size
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10
Q

Types of melanoma

A

Superficial spreading
Nodular
Acral lentiginous
Lentigo maligna

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11
Q

Hw do you stage melanoma

A

Breslow depth (mm) and Clark level of skin staging

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12
Q

Treatment options of skin lesions

A 
Electrodessication & currettage
Cryosurgery
Radiation
Srgical excision
Mohs surgery
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13
Q

What is mohs surgery

A 
Microscopically controlled surgery
Which involves 
1. Surgical removal of tissue
2. Mapping or staining of specimen
3. Histologic interpretation
4. Further tissue removal
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14
Q

What r indications of mohs surgery

A
  1. Recurrent skin cancer (scc or bcc)
  2. High risk anatomical area (H zones of face)
  3. Histologically aggressive
  4. Large skin cancer >3cm
  5. Skin ca in irradiated skin
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15
Q

Contraindications of mohs surgery

A

Malignant melanoma

Small lesions

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16
Q

How to prevent recurrence of skin cancer

A

Staying in shades avoiding prolong sun exposure
Sunscreen
Cover up
Adjuvant therapy with chemo, targeted therapy, immunotherapy
Aggressive cancer surveillance within 5yrs

17
Q

Treatment for SCC involving vermillion lip

A

Wide surgical excision with 1cm margin

Reconstructed with Karapandzic flap or Webster bernard flap

18
Q

What is the Karapandzic technique and what vessel is it based on?

A

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

19
Q

Describe technique of Karapandzic flap

A
  1. Outline the excision of the disease lip with wide margin of 1cm
  2. Extend the outline below the lower lip along the labiomental fold, extending upwards towards the nasolabial fold
  3. wide excision of tumor
  4. Incision thru skin n subcut
  5. Blunt dissection of orbicularis muscle radially to free from its attachment
  6. Preserving vessels and nerves
  7. Mucosal incision up to commisure to mobilize the flap
  8. Layered closure
20
Q

BCC more commonly occur at?

A

Central of face

21
Q

SCC skin commonly occur at?

A

Lip and eyelid

22
Q

What other options for repair of Localized mucosa or vermilion defects?

A 
Excision
Z-plasty
V-Y mucomuscular advancement flap
Lateral mucomuscular advancement flap
Abbe flap
Estlander flap (for involvement of commisures)
Gillies flap
McGregor flap
23
Q

How do u repair a cheek defect

A

Small. Primary closure & local flap
Medium. Nasolabial flap
Large. Cervicofacial rotational flap/ submental island flap
Thru and thru defect. ALT free flap

24
Q

Bluish lesions at floor of mouth diff dx

A

Venous malformation at floor of mouth - swelling at floor of mouth- bluish/ tro ranula
Ddx:
ranula
Venous malformation
Tx:
Scleroting agent (bleomycin/ pingyang? / )

OMFS (54 decks)

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