Fiser.18.Plastics Flashcards
1
Q
What is the main component of the epidermis?
A
primarily celular
2
Q
what is the main cell type in the epidermis?
A
keratinocytes
3
Q
where do keratinocytes originate from in the skin?
A
from the basal cell layer
4
Q
what is the function of keratinocytes?
A
provide mechanical barrier
5
Q
what is the origin of melanocytes?
A
neuroectodermal origin from neural crest cells
6
Q
where do melanocytes reside in the skin?
A
in the basal cell layers
7
Q
what causes the racial differences in skin color in terms of melanocytes?
A
the denisty of melanocytes is the same among races with the difference in melanin production
8
Q
what is the main component of the dermis
A
primarily made up of structural proteins (collagen) for the epidermis
9
Q
what is the function of Langerhans celles?
A
act as antigen-presenting cells (MHC class II)
10
Q
where do Langherhans cells come from?
A
originate from bone marrow
11
Q
what is the role of Langerhands cells?
A
have a role in contact hypersensitivity reactions (type IV)
12
Q
*what type of sensation is transduced by Pacinian corpuscles?
A
pressure
13
Q
what type of sensation is transduced by Ruffini’s endings?
A
warmth
14
Q
what type of sensation is transduced by Krause’s end-bulbs?
A
cold
15
Q
what type of sensation is transduced by Meissner’s corpuscles?
A
tactile sense
16
Q
what is the difference in the type of sweat produced by eccrine sweat glands and apocrine sweat glands?
A
eccrine sweat glands produce hypotonic aqueous sweat and apocrine sweat glands produce milky sweat
17
Q
what is the function of eccrine sweat glands?
A
thermal regulation
18
Q
where are the highest concentrations of apocrine sweat glands?
A
palms and soles
19
Q
what is the innervation / trigger for apocrine sweat gland production?
A
stimulated by sympathetic nervous system via acetylcholine
20
Q
how does lipid solubility of a drug affect skin absorption?
A
lipid soluble drugs have increased skin absorption
21
Q
what is the predominant type of collagen in skin?
A
Type I collagen
22
Q
what percent of the dermis is made of Type I collagen and what is its function?
A
70% of dermis is made of Type I collagen, gives it tensile strength
23
Q
define tension in terms of skin and skin molecules
A
resistance to stretching, provided by collagen
24
Q
define elasticity in terms of skin and skin molecules
A
ability to regain shape, provided by branching proteins that can stretch to 2x normal length
25
what is the underlying cause of Cushing's striae?
caused by loss of tensile strength and elasticity
26
what is the MCC of pedicled or anastomosed free flap necrosis
venous thrombosis
27
name three underlying causes of tissue expansion
local recruitment, thinning of dermis and epidermis, mitosis
28
name 5 complications of TRAM flaps
flap necrosis, ventral hernia, bleeding, infection, abdominal wall weakness
29
what is a TRAM flap?
transverse rectus abdominis myocutaneous flap reconstruction
30
what vessels do TRAM flaps rely on?
superior epigastric vesels
31
what type of vessel is the most important determinant of TRAM flap viability?
periumbilical perforators
32
Describe a Stage I pressure sore
erythema and pain, no skin loss
33
describe a Stage II pressure sore
partial skin loss with yellow debris
34
what is the treatment for a stage II pressure sore?
localized treatment, keep pressure off
35
describe a stage III pressure sore
full thickness skin loss, subcutaneous fat exposure
36
what is the treatment of a stage III pressure sore?
sharp debridement, likely need myocutaneous flaps
37
Describe a stage IV pressure sore
involves bony cortex, muscle
38
what is the treatment for a stage IV pressure sore?
myocutaneous flaps
39
how does UV radiation cause DNA damage
damages DNA and repair mechanisms; both a promoter and an initiator
40
what is the single best factor for protecting skin from UV radiation?
melanin
41
what is the type of UV radiation responsible for chronic sun damage?
UV-B
42
what percent of skin cancers are 2/2 melanoma?
5%
43
what percent of skin cancer deaths are 2/2 melanoma?
65%
44
what is the risk of melanoma seen with familial BK mole syndrome?
100% risk of melanoma
45
what is the lifetime risk of melanoma with dysplastic, atypical, or large congenital nevi
10% lifetime risk for melanoma
46
name six risk factors for melanoma
xeroderma pigmentosum, fair complexion, easy sunburn, intermittent sunburns, previous skin CA, previous XRT
47
what percent of melanomas are familial?
10%
48
what is the MC melanoma site in men?
back
49
what is the MC melanoma site in women?
legs
50
name four poor prognostic signs for melanoma
men, ulcerated lesions, ocular, mucosal
51
describe the "A" of the ABCDE of melanoma
A: asymmetry (angulations, indentation, notching, ulceration, bleeding)
52
describe the "B" of the ABCDE of melanoma
B: borders that are irregular
53
describe the "C" of the ABCDE of melanoma
color change (darkening)
54
describe the "D" of the ABCDE of melanoma
diameter increase
55
describe the "E" of the ABCDE of melanoma
evolving over time
56
where do melanomas originate from? (cell type, layer of skin)
originate from neural crest cells (melanocytes) in the basal layer of the epidermis
57
what is the most ominous color of melanoma?
blue
58
what is the MC location for distant melanoma metastases?
lung
59
what is the MCC of small bowel mets?
melanoma
60
how do you dx and treat a suspected melanoma that is \<2cm in diameter?
excisional bx with a tru-cut core needle bx unless in a cosmetically sensitive area. Will need resection with margins if pathology comes back as melanoma
61
how do you dx and treat a suspected melanoma that is \>2cm in diameter?
incisional biopsy (or punch biopsy); will need to resect with margins if pathology shows melanoma
62
how do you dx and treat a suspected melanoma that is in a cosmetically sensitive area?
incisional biopsy (or punch biopsy); will need to resect with margins if pathology shows melanoma
63
how deep does the melanoma in situ / thin lentigo maligna extend?
extends into the superficial papillary dermis only
64
what is the proper name for melanoma in situ / thin lentigo maligna?
Hutchinson's freckle
65
what margins are required for excision of melanoma in situ / thin lentigo maligna?
0.5cm margins
66
what is the least aggressive subtype of melanoma
lentigo maligna melanoma - minimimal invasion
67
what type of growth occurs with lentigo maligna melanoma and how does it present?
radial growth first, presents with elevated nodules
68
what is the MC type of melanoma?
superficial spreading melanoma, MC with intermediate malignancy
69
what is the origin of superficial spreading melanoma?
originates from nevus / sun-exposed areas
70
what is the most aggressive type of melanoma and why?
nodular melanoma, vertical growth first, most likely to present with mets at the time of dx
71
what type of growth occurs with nodular melanoma?
vertical growth first
72
how do nodular melanomas present (appearance, location)?
bluish-black with smooth borders, can occur anywhere on the body
73
how aggressive are acral lentiginous melanomas?
very aggressive
74
where and in what population do acral lentiginous melanomas present?
on palms and soles in African Americans
75
what imaging and labs are required for melanoma staging?
CT - C/A/P, LFTs, LDH. Physical exam of all possible draining LNs
76
what is the size threshold to require staging of a melanoma?
\> or = 1mm
77
how do you treat for all stages of melanoma?
1) resection of primary tumor with appropriate margins and 2) management of lymph nodes
78
what is the recommended clinical excision margin for melanoma in situ?
0.5-1.0cm
79
what is the recommended clinical excision margin for melanoma that is \< or = 1.0mm thick?
1.0cm
80
what is the recommended clinical excision margin for melanoma that is 1.1-2.0 mm thick?
1.0-2.0cm
81
what is the recommended clinical excision margin for melanoma that is \> 2.0mm thick?
2.0cm
82
how do you manage clinically positive lymph nodes in a melanoma patient?
always need to resect clinically positive lymph nodes
83
how do you manage clinically negative lymph nodes in a melanoma patients with tumor that is \> or = 1.0mm deep?
need to perform SLNB
84
what clinical findings are seen with involved lymph nodes when performing clinical exam? \*4 findings)
nontender, round, hard, 1-2cm
85
what additional procedure needs to be performed for all anterior head/neck melanomas \> or = 1.0mm deep?
superficial parotidectomy
86
what is the rate of metastasis to parotid for anterior head/neck melanomas that are \> or = 1.0mm deep?
20% rate of mets
87
how do you treat axillary node melanoma with no other primary
complete axillary node dissection, remove levels I, II, III, unlike breast CA
88
what are outcomes after resection of melanoma mets?
provides some patients with long disease-free intervals and is the best chance for cure
89
how do you treat isolated mets to the lung or liver?
if resectable with a low risk procedure, should probably undergo resection
90
name two treatments for systemic disease with melanoma
IL2 and tumor vaccines
91
what is the MC malignancy in the US?
basal cell carcinoma
92
how much more prevalent is basal cell carcinoma compared to SCC?
BCC is 4x MC than SCC
93
what percentage of BCCs occur on the head and neck?
80%
94
where do BCCs originate from? (skin layer and cell type)
originates from epidermis with basal epithelial cells and hair follicles
95
what are the physical exam findings of BCC? (3)
pearly appearance, rolled borders, slow / indolent growth
96
what is the pathology findings a/w BCC?
peripheral palisading of nuclei and stromal retraction
97
what procedure should you perform for clinically positive LNs a/w BCC?
regional adenectomy
98
what is the most aggressive form of basal cell carcinoma?
morpheaform type
99
what enzyme is produced by the morpheaform subtype of basal cell carcinoma?
collagenase
100
what are the margins needed to treat BCC?
0.3-0.5cm margins
101
when are XRT and chemotherapy indicated for BCC?
limited benefit for inoperable disease, mets, or neuro/lymphatic/vessel invasion
102
what are the physical exam findings a/w SCC?
overlying erythema, papulonodular with crust and ulceration, usually red-brown. May have surrounding induration and satellite nodules
103
what is the rate of metastases for SCC, BCC, and melanoma?
most frequent for melanoma, then SCC, then BCC
104
name 13 risk factors for SCC
post-XRT areas, old burn scars, actinic keratosis, xeroderma pigmentosum, Bowen's disease, atrophic epidermis, arsenics, hydrocarbons (coal tar), chlorophenols, HPV, immunosuppression, sun exposure, fair skin, previous skin CA
105
name four risk factors for metastasis?
poorly differentiated, greater depth, recurrent lesions, immunosuppression
106
what are the margins to treat SCC?
0.5-1.0cm margins for low risk
107
how can you treat high risk SCC or SCC in aesthetically sensitive areas?
Mohs surgery with margin mapping using conservative slices
108
how do you treat clinically positive LNs a/w SCC?
regional adenectomy
109
can you use Moh's surgery to treat melanoma?
nope
110
what is the role of XRT and chemotherapy in treatment of SCC?
limited benefit for inoperable disease, metastases or neuro/lymphatic/vascular invasion
111
what are the #1 and #2 MC soft tissue sarcomas?
1) malignant fibrious histiosarcoma; 2) liposarcoma
112
what percent of sarcomas arise from extremities?
50%
113
what percent of sarcomas arise in children?
50%
114
what is the source (cell type) of pediatric sarcomas
arise from embryonic mesoderm
115
what are the symptoms a/w sarcomas (4)
they are large, fast growing and painless. p/w asymptomatic mass, GI bleeding, bowel obstruction, or neurologic deficit
116
why do you need to obtain a CXR when evaluating a suspected sarcoma?
r/o lung mets
117
why do you need to obtain an MRI before sarcoma biopsy?
r/o vascular, neuro, or bone invasion
118
when is excisional biopsy indicated when evaluating for soft-tissue sarcoma?
when mass is \< 4cm
119
when is longitudinal incisional biopsy indicated when evaluating for soft-tissue sarcoma?
when mass is \> 4cm
120
what is the next step in management if longitudinal incisional biopsy comes back positive for sarcoma?
need to resect biopsy skin site if biopsy site positive for sarcoma
121
what is the mechanism of spread of sarcoma and how does this affect physical exam findings?
hematogenous spread, rare to find node mets
122
what is the MC site of sarcoma mets?
lung
123
what is the basis of sarcoma staging?
based on grade not size
124
what are the margins for sarcoma resection?
at least 3cm margins and at least 1 uninvolved fascial plane. Also try to perform limb-sparing operation
125
how should you treat extremity sarcomas?
try to perform limb sparing operations
126
what should you do intraoperatively to areas of likely sarcoma recurrence and why?
place clips to mark site of likely recurrence to XRT later
127
when is postop XRT indicated for sarcoma? (3)
high grade tumors, close margins, or tumors \> 5 cm
128
when is preop chemo/XRT indicated for sarcoma (2)
tumors \> 10cm and may allow limb-sparing resection
129
what is the treatment for isolated sarcoma mets without other evidence of systemic disease?
resected with best chance for survival, otherwise palliate with XRT
130
what type of incision is preferred for pelvic and RP sarcomas?
midline incision
131
what neurovascular precautions should you take intraop with sarcoma resection?
try to preserve motor nerves and retain or reconstruct vessels
132
Describe the technique for biopsy of an extremity soft tissue mass suspected of being a sarcoma
orient incision along long axis of extremity at the point where the lesion is closest to the surface; do not raise flaps or disturb tissue superficial to the tumor; do not enucleate mass within pseudocapsule - leave as undisturbed as possible; obtain hemostasis before wound closure to prevent hematoma which could disseminate tumor cells along tissue planes
133
what is the 5 year survival rate of soft tissue sarcomas s/p complete resection?
40%
134
name three poor prognostic indicators with soft tissue sarcoma
delay in diagnosis, difficulty with total resction, difficulty getting XRT to pelvic tumors
135
what is the MCC of pediatric head and neck sarcoma?
rhabdomyosarcoma
136
what makes surgery on head and neck sarcoma challenging?
difficult to get negative margins b/c of proximity to vital structures
137
when is postop XRT indicated for head and neck sarcomas?
positive or close margins since negative margins are hard to obtain
138
what are the two MCC of visceral and RP sarcomas?
leiomyosarcomas and liposarcomas
139
what is the most important prognostic factor in visceral and RP sarcomas?
ability to completely remove the tumor
140
what CA are you at increased risk for with asbestos exposure?
mesothelioma
141
what CA are you at increased risk for with PVC exposure?
angiosarcoma
142
what CA are you at increased risk for with arsenic exposure?
angiosarcoma
143
what CA are you at increased risk for with chronic lymphedema?
lymphangiosarcoma
144
what is the subtype (descriptor) for Kaposi's sarcoma?
a vascular sarcoma
145
what are the two MC sites of Kaposi's sarcoma?
oral and pharyngeal mucosa
146
how do oral/pharyngeal Kaposi's sarcoma present?
bleeding, dysphagia
147
what is the MC malignancy in AIDS?
Kaposi's sarcoma, rarely a cause of death
148
what comorbidity is a/w Kaposi's sarcoma?
immunocompromise
149
what is the primary goal of treatment of Kaposi's sarcoma?
palliation
150
what is the best tx of Kaposi's sarcoma in AIDS patients?
AIDS Tx (HAART) shrinks AIDS-related Kaposi's Sarcoma
151
what is the best treatment for local Kaposi's sarcoma (2)
XRT or intralesional vinblastine
152
what is the best tx for disseminated Kaposi's sarcoma
interferon alpha
153
what is the indication for surgery with Kaposi's sarcoma
when a/w severe intestinal hemorrhage
154
what is the MC soft tissue sarcoma in kids?
childhood rhabdomyosarcoma
155
what are the locations that childhood rhabdomyosarcoma are found and which carries the poorest prognosis?
head/neck, GU, extremities, trunk. Trunk with poorest prognosis)
156
what is the MC subtype of childhood rhabdomyosarcoma?
embryonal subtype
157
what type of childhood rhabdomyosarcoma carries the worse prognosis?
alveolar subtype
158
what is the treatment of childhood rhabdomyosarcoma?
surgery, doxorubicin-based chemo
159
what are the findings a/w bone sarcomas?
most are metastatic at the time of diagnosis
160
what is the cell of origin of osteosarcoma?
metaphyseal cells
161
what is the MC location of osteosarcoma?
around the knee
162
which age group is most likely to present with osteosarcoma?
peds
163
what three soft tissue tumors are you at increased risk for with Neurofibromatosis?
CNS tumors, peripheral sheath tumors, pheochromocytoma
164
what soft tissue tumor are you at increased risk for with Li-Fraumeni syndrome?
childhood rhabdomyosarcoma
165
what soft tissue tumors are you at increased risk for with hereditary retinoblastoma
along with Rb, all other sarcomes
166
what soft tissue tumor are you at increased risk for with tuberous sclerosis?
angiomyolipoma
167
what two soft tissue tumors are you at increased risk for with Gardner's syndrome?
familial adenomatous polyposis and intraadominal desmoid tumors
168
what is a plastic surgery consderation with lip lacerations
important to line up vermillon border
169
how do xanthomas present and what cells do they contain?
yellow, contain histiocytes
170
what is the treatment for xanthomas?
excision
171
name the origin and communicability of warts (verruca vulgaris)
viral origin, contagious, autoinoculable, can be painful
172
how do you treat warts?
liquid nitrogen initially
173
what are the MC locations of lipomas? (3)
back, neck, between shoulders
174
are lipomas often malignant?
nope rarely malignant
175
name the four findings a/w von Recklinghausen's disease (neurofibromatomsis type I
cafe au lait spots, axillary freckling, peripheral nerve and CNS tumors (neuromas)
176
where do actinic keratosis present?
in sun-damaged areas
177
what is the management of actinic keratosis and why?
premalignant, need excisional biopsy if suspicious
178
how do you treat seborrheic keratosis
not premalignant, no tx needed
179
how does seborrheic keratosis present? (appearance, age, location)
can be dark, on trunk, elderly pts
180
what CA is a/w arsenical keratosis?
a/w SCC
181
what subtype of cancer is a Merkel cell carcinoma?
its a neuroendocrine tumor
182
what is the malignancy of Merkel cell carcioma?
very aggressive malignant tumor with early regional and systemic spread
183
what does Merkel Cell carcioma look like on physical exam?
red to purple papulonodule or indurated plaque
184
what does Merkel Cell carcinoma look like on physical exam?
red to purple papulonodule or indurated plaque
185
what three proteins are released by merkel cell carcinoma?
neuron-specific enolase (NSE), cytokeratin, neurofilament protein
186
what are glomus cell tumors made of?
blood vessels and nerves
187
how do glomus cell tumors present?
painful, MC in terminal aspect of the digit
188
what is the px and tx of glomus cell tumor?
benign, tx with tumor excision
189
what is the prognosis of desmoid tumors?
benign but locally very invasive, occur in fascial planes, high risk of local recurrence, no distant spread
190
what is the MC location of desmoid tumors?
in the anterior abdominal wall
191
what are three risk factors for anterior abdominal wall desmoid tumors?
during/following pregnancy, after trauma, after surgery
192
what are two risk factors for intraabdominal desmoid tumors?
Gardner's syndrome and RP fibrosis
193
what makes intraabodminal desmoid tumors difficult ot resect?
often encases bowel making it difficult to perform en bloc resection
194
what is the treatment of desmoid tumors?
surgery if possible, chemo with sulindac or tamoxifen if vital structure involved or too much bowel would be resected (high risk of short gut with surgery)
195
what is Bowen's disease and which virus is it a/w?
SCC in situ a/w HPV
196
what percent of Bowen's disease turn invasive?
10% turn into invasive SCC
197
what is the treatment of Bowen disease?
imiquimod, cautery ablation, topical 5FU
198
why should you avoid WLE of Bowen disease?
high recurrence rate with HPV
199
what long term surveillance is required with Bowen disease?
regular biopsies to r/o CA
200
what is the clinical presentation of keratoacanthoma
rapid growth, rolle edges, crater filled with keratin, can be confused with SCC
201
is keratoacanthoma benign or malignant?
benign
202
what is the management of keratoacanthoma and px?
always biopsy to be sure to r/o SCC, involute spontaneously, can excise if small and biopsy and observe if large
203
define hyperhidrosis
increased sweating especially noticeable in palms
204
what is the treatment for hyperhidrosis
antiperspirants, if refractory then thoracic sympathectomy
205
define hidradenitis
infection of the apocrine sweat glands, usually in the axilla and groin
206
what are the 2 MCC of hidradenitis (bax)
staph / strep
207
what is the treatment of hidradenitis?
antibiotics and improved hygeine are first line. May need surgery to remove skin and associated wesat glands
208
what is the MC benign cyst?
epidermal inclusion cyst
209
what are the findings a/w epidermal inclusion cyst?
completely mature epidermis with creamy keratin material
210
what are the findings a/w trichilemmal cyst?
in scalp, no epidermis
211
is trichilemmal cyst benign or malignant?
benign
212
is ganglion cyst benign or malignant?
benign
213
is dermoid cyst benign or malignant?
benign but there is an associated risk of malignancy
214
is pilonidal cyst benign or malignant?
benign
215
what are the findings a/w ganglion cyst?
over tendons, usually over wrist, filled with collagen
216
what are the findings a/w dermoid cyst?
midline intraabdominal and sacral lesions usual
217
what is the treatment of dermoid cyst?
need resection due to malignancy risk
218
what are the findings a/w pilonidal cyst?
congenital coccygeal sinus with ingrown hair
219
what is the management of infected pilonidal cyst?
needs excision
