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Minor Surgery 2 > Final > Flashcards

Final Flashcards

1
Q

Where does cSCC tend to arise in dark skinned people? Is it associated with chronic inflammation, chronic wounds and scaring?

A

On Non Sun-exposed areas.

Yes it is associated with chronic situations

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2
Q

What are genetic factors for SCC

A

fair skin, light-colored eyes, red hair and northern european origin

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3
Q

Cumulative UVB sun exposure in the past ________ years of a person’s life increases the likelihood of cSCC in the presence of other risk factors.

A

5-10

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4
Q

are sites of chronic inflammation, chronic wounds, or scars are susceptible to the development of cSCC?

A

yes

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5
Q

A lesion on the vermillion border is what?

A

cSCC until proven otherwise!

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6
Q

cSCC that occurs in sun-exposed areas have what rate of metastasis

A

5% slow

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7
Q

In contrast to BCCs which only rarely metastasize (0.003%), ___ of cSCCs spread to regional lymph nodes or more distant sites (the lungs, liver, brain, skin, or bone) à a relatively poor outcome.

A

5-10 percent

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8
Q

What are the features of CSCC lesions that correlate with high risk for recurrence and regional or distant metastasis.

A 
Depth >4mm,
poorly differentiated
perineural involvement
intravascular invasion
 Located on the ear, lip, genitals or within a scar/burn/ulcer. 
ORAL SCC.

Larger in size, invades into the subcutaneous tissue, doesn’t arise frun sun exposure, high risk features

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9
Q

Although there is no uniform agreed upon screening protocol for malignant melanomas in US a what is considered the best option to identify suspicious lesions

A

skin survey

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10
Q

Individuals with atypical nevi have a ________ fold elevated risk of developing malignant melanoma.

A

3-20

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11
Q

Is there a strong association between high nevus counts and malignant melanoma. How many nevi?

A

Yes, more than 25

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12
Q

Studies demonstrate higher rates of malignant melanoma in adults with ____ or ___________ exposure to sunlight.

A

Extensive or

Repeated Intense

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13
Q

Case studies found the strongest association for malignant melanoma for _________ sun exposure and ___________ in adolescence or childhood.

A

Intermittent and sunburn

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14
Q

During what growth phase is malignant melanoma is almost always curable by surgical excision alone.

A

Raidal

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15
Q

Nodular melanomas have no identifiable ___growth phase and enter the __________ growth phase almost from their inception.

A

Radial

Vertical

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16
Q

Over 60% of superficial spreading malignant melanomas are diagnosed as thin, highly curable tumors of less than __ mm thickness.

A

1

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17
Q

Nodular malignant melanomas are the most difficult to diagnose at an early stage – at least half are greater than __ mm in thickness when diagnosed!

A

2

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18
Q

Most common type of malignant melanoma among Asians and in African-Americans is the ______Acral Lentinous Melanoma_which arise most commonly on palmar, plantar, and subungual surfaces

A

Acral Lentinous Melanoma

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19
Q

What is the single most important determinant of prognosis for a malignant melanoma?

A

Tumor Thickness

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20
Q

Stage T1: ≤1 mm malignant melanomas have a ten year survival of what?

A

92_ percent.

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21
Q

The definitive “initial” surgical treatment for primary cutaneous melanoma is a _______ down to the deep fascia.

A

Wide Local Incision

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22
Q

Because of the potential of metastasis and possible death, any biopsy that comes back positive for malignant melanoma needs to be referred for additional surgery via procedure.

A

look up

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23
Q

In the absence of physical trauma, what appears to be a subungual hematoma might be due to what type of infection.

A

Proteus or Pseudemonas_

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24
Q

When draining a subungual hematoma with any method you may have to do what?

A

repeat the procedure several times to provide a hole that is large enough to remain open for continued drainage.

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25
Q

What do you advise the patient to do if the drainage hole made in a nail for a subungual hematoma closes up and pressure and pain reoccur?

A

Soak it in cold water, adding peroxide to help dissolve the clot

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26
Q

What are the 5 etiologies of onycholysis?

A
  • Idiopathic
  • Systemic (thyrotoxicosis)
  • Congenital/hereditary
  • Cutaneous diseases(psoriasis, drug-induced, photo)
  • Local causes (trauma, chemicals)
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27
Q

What are the various causes of onychogryphosis

A
  • Acute injury
  • Chronic Injury
  • Infection
  • Poor blood supply
  • Diabetes
  • Inadequate intake of nutrients
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28
Q

List four ways to help prevent onychogryphosis.

A
  • Keep nails trimmed
  • Avoid tight fitting footwear
  • Avoid nail polish
  • Avoid footwear or stockings that gather at the toes
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29
Q

Tinea unguium is usually caused by one dermatophyte , either T.

A

trichophyton mentagrophytes_____ or T _____rubrum

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30
Q

What are thought to be the two likely causes of ganglion cysts?

A

Degenerative process in the mesoblastic tissues surrounding the joint, herniation of a tendon sheath

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31
Q

What is the consistency of a ganglion cyst?

A

Smooth, rounded, multilocular
Hard/firm like a bony cartilaginous lesion fluctuant
May be cystic

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32
Q

What are the three typical indications for treatment of ganglia?

A
  • Relief of soreness/pain
  • Removal of unsightly mass
  • Relief of the feeling of weakness
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33
Q

What are the “pros” and “cons” of the Rupture treatment for a ganglion cyst.

A
  1. Rupture: dramatic but permanent, cure rate is low, not recommend
34
Q

What are the 4 types of treatments for ganglion cysts

A

Rupture
Aspiration
Injection
Excision

35
Q

Know the “pros” and “cons” of the Aspiration treatment for a ganglion cyst.

A

Aspiration: usually aspiration unsuccessful because contents are firm and jelly like, difficult to be certain that the contents of a multiocular ganglion cyst are entirely evacuated from all lobes.
1. Risk for infection

36
Q

Know the “pros” and “cons” of the Injection treatment for a ganglion cyst.

A

Injection: Injections produce moderate pain and local edema that lasts a day or two but not disabling, mixed results obtained

37
Q

Know the “pros” and “cons” of theExcision treatment for a ganglion cyst.

A

Excision: most successful treatment is careful dissection and excision, but no garentee for cure

38
Q

Why do basal cell carcinomas have a limited capacity to metastasize?

A

the absence of growth factors derived from the stroma of the original tumor site.

39
Q

What are problem locations for Basil Cell Carcinoma

A

around the eyes,
in the nasolabial folds,
around the ear canal,
in the posterior auricular sulcus.

40
Q

Persons aged 55-75 have a ______ -fold higher incidence of BCCs than those younger than 20.

A

100-fold

41
Q

About ____ percent of patients who have had one BCC will develop another lesion within five years.

A

40% of patients

42
Q

What is the most important environmental risk factor for developing BCCs?

A

Chronic ultraviolet (UV) radiation exposure

43
Q

Frequency and intensity of sun exposure – intermittent, intense increments increases the risk of BCC more than what?

A

similar dose delivered more continuously over the same period of time

44
Q

Describe a “rodent ulcer”?

A

Center ulcerates/bleeds, accumulates crust/scale

Ulcerated areas heal with scarring

Patients often assume their conditions are improving.

Cycle of growth, ulceration, and healing continues as the mass extends peripherally and deeper

Lesions may become enormous!

45
Q

What is border localization of BCC by inspection or biopsy impossible.

A

The borders of a morpheaform BCC are indistinct and blend with normal skin making

46
Q

Treatment of morpheaform BCCs consists of what?

A

wide excision or, preferably, Mohs micrographic surgery.

47
Q

Diagnosis of BCC must be confirmed by ______________.

A

Biopsy

48
Q

Why must BCCs must be treated early on?

A

to avoid the locally invasive, aggressive, and destructive effects on skin and surrounding tissue

49
Q

Why is Surgical excision of BCCs more effective than ED&C

A

because there is better margin control, but has less effective margin control than Mohs surgery.

50
Q

Why would one chose radiation therapy to treat a BCC?

A

Noninvasive – relative sparing of critical structures

Relatively painless

Good for patients who are not otherwise candidates for surgery

High cure rate for selected lesions

51
Q

What is the differential diagnosis of BCC

A

Early nodular variants with little ulceration:
Clinically may be identical to benign growths such as dermal nevi, small epidermal inclusion cysts, or even sebaceous hyperplasia.
A single lesion of molluscum contagiosum or amelanotic melanoma has a similar appearance.

Larger cup-shaped lesions with central ulceration:
Can resemble squamous cell carcinoma, keratoacanthomas, or dermal metastases from internal organs such as the colon.

52
Q

Existing AKs may become more active after sunlight exposure and may undergo spontaneous remission if sunlight exposure is reduced.

A

ok

53
Q

Induration, inflammation, and oozing of an AK suggests _______________ into ______________.

A

degeneration into malignancy.

54
Q

AKs are most commonly confused with a____ which have a “pasted-on” appearance.

A

seborrheic keratosis (SK)

55
Q

Because of the marked amount of inflammation that can occur when treating AKs with 5-FU, small regions should be treated when?

A

at a time in those patients with extensive AKs.

56
Q

Over time ____ % of AKs may degenerate into SCCs.

A

0.3%

57
Q

The lazy S excision uses the basic principle of camouflaging a scar in cutaneous surgery how?

A

by breaking up a straight line, by making two curves

58
Q

Where areProblem locations for BCCs

A

around the eyes, in the nasolabial folds,

around the ear canal, and in the posterior

auricular sulcus.

59
Q

Persons aged 55-75 have a ______ -fold higher incidence of BCCs than those younger than 20.

A

100-fold higher incidence

60
Q

About ____ percent of patients who have had one BCC will develop another lesion within five years.

A

40%

61
Q

List three features of BCCs that account for a high likelihood for recurrence after initial treatment.

A

Type O Blood Type 4% higher risk
•Caucasians higher risk than others
•Basal cell nevus syndrome increases risk
•Larger (>5mm) lesion

62
Q

The common locations for abscesses to occur are?

A

areas prone to friction or minor trauma, such as underneath a belt, the anterior thighs, buttocks, groin, axillae, waist and the proximal phalanges of the fingers.

63
Q

It commonly takes _4___ to ___6__ days for an abscess to become fully “ripe”, complete with central core of necrosis.

A

4 to 6 days for the lesion to become fully “ripe

64
Q

An abscess is not a hollow sphere, but a cavity formed by what?

A

a cavity formed by fingerlike loculations of granulation tissue and pus that extends outward along planes of least resistance.

65
Q

In individuals with recurring abscesses the infecting strain of bacteria may be found during quiescent periods in the _________, _____________, _____________ and/or the ___________.

A

nares, axillae, perineum and/or the navel (known as “incubator sites”).

66
Q

generally, the microbiology of abscesses reflects the microflora of what?

A

the microflora of the anatomic part of the body involved.

67
Q

Approximately ____% of abscesses become sterile – some without antimicrobial treatment.

A

5%

68
Q

Furunculosis occurs as a self-limited infection in which one or several lesions are present or as a chronic, recurrent disease that lasts how long

A

months or years, affecting one or sev¬eral family members.

69
Q

What are various known predisposing factors for abscesses and furuncles.

A

Traumatic inoculation of bacteria into the skin by a puncture wound, laceration, or surgical incision.
Skin exposure to irritants and deodorants
Poor hygiene; easily the most significant predisposing factor.
Local causes of pruritis, such as insect bites and pediculosis capitis.
Excessive sweating of the hands, d feet and intertriginous sites.
Climatic factors, primarily hot humid areas.
Follicular abnormalities (comedones and acneiform papules and pustules) on the buttocks and axillae (suggests the diagnosis of hidradenitis suppurativa).
Immunodeficiency
Perhaps also diabetes mellitus
Atopic dermatitis, eczema, and scabies.

70
Q

The preferred sites for the development of carbuncles are ________________________________, ______________________________________ and ______________________________________.

A

areas with thick dermis, e.g., the back of the neck, the back of the trunk, and the lateral aspects of the thighs

71
Q

Principal therapy of an abscess is still _____________and _______________.

A

incision and drainage

72
Q

If a drain has been placed in the opening after incision of an abscess it should be “advanced” how?

A

gradually out of the opening and trimmed off each day as well (“advancing the drain”).

73
Q

Untreated abscesses often spontaneously rupture and drain or if early and small may shrink and resolve how?

A

completely without incision and drainage.

74
Q

Pilonidal cysts typically present with a draining sinus in the midline and usually a secondary opening, almost always ________ cm. cephalad and to one side.

A

2.5-5cm

75
Q

What are the conservative treatment for pilonidal cysts

A

Loose weight if needed.
Keep the area clean – daily, gentle washing with washcloth
Carefully remove any protruding hair on a regular basis.
Avoid tight clothing.
Hot water baths/compresses, tea bag compresses or alternating hot and cold may  spontaneous drainage!
Potato, carrot, etc. poultices
Zinc, multivitamin supplements
Hepar sulphuris homeopathic
Oral antimicrobials or antibiotics added to the home remedies may still not be enough to heala pilonidal cyst short of surgery!

76
Q

If a drain has been placed in the opening after incision of an abscess it should be “advanced” how?

A

gradually out of the opening and trimmed off each day as well (“advancing the drain”).

77
Q

Untreated abscesses often spontaneously rupture and drain or if early and small may shrink and resolve how?

A

completely without incision and drainage.

78
Q

Pilonidal cysts typically present with a draining sinus in the midline and usually a secondary opening, almost always ________ cm. cephalad and to one side.

A

2.5-5cm

79
Q

What are the conservative treatment for pilonidal cysts

A

Loose weight if needed.
Keep the area clean – daily, gentle washing with washcloth
Carefully remove any protruding hair on a regular basis.
Avoid tight clothing.
Hot water baths/compresses, tea bag compresses or alternating hot and cold may  spontaneous drainage!
Potato, carrot, etc. poultices
Zinc, multivitamin supplements
Hepar sulphuris homeopathic
Oral antimicrobials or antibiotics added to the home remedies may still not be enough to heala pilonidal cyst short of surgery!

80
Q

___________________ is the preferred surgical technique for a new pilonidal cyst.

A

Incision and Drainage

81
Q

What is the concept of marsupialization treatment of a pilonidal cyst.

A

Procedure - incision and draining, removal of pus and hair, and sewing of the edges of the fibrous tract to the wound edges to make a pouch.

82
Q

What preforming a Curve the ellipse: In cutaneous surgery, it is often necessary to

A

to curve the line of closure to match or to parallel relaxed skin tension lines (i.e. around the eye or mouth).

Minor Surgery 2 (1 decks)

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