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MBBS Surgery > Lumps & Bumps > Flashcards

Lumps & Bumps Flashcards

1
Q

Features of Basal cell carcinoma

A
  • sunexposed and hair bearing areas
  • pearly rolled edges
  • irregular pigmentation w telangiectasia
  • central ulceration
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2
Q

RF of Basal cell carcinoma

A 
Sun exposure
Fitzpatrick skin type I and II
immunosuppression
genetic syndrome (nevoid BCC, xeroderma pigmentosum)
ionizing radiation
carcinogens (arsenic)
psoralen and UV A light
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3
Q

Subtypes of BCC

A 
Raised lesions
- nodular/ nodulo-ulcerated
- cystic
Flat lesions
- pigmented
- sclerosing/ morpheaform
- superficial
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4
Q
  • Origin of BCC

- risk of mets

A
  • from pluripotent epithelial cells of basal layer of the epidermis and its appendages
  • low risk, but locally invasive
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5
Q

Tx of BCC

  • margins
  • type of sx
  • alternative and limitations
A

wide local excision with negative margins +/- reconstruction/ skin flap/ graft

raised: 0.5cm margin
not raised: wider margin. check frozen section for clearance.

Moh’s micrographic sx

Alt: radiotherapy (if CI to sx, usually as adjuvant therapy)

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6
Q

Classical description of squamous cell carcinoma

A

raised/ heaped edges with central ulceration, irregular margins

granulation tissue: pale, unhealthy
+/- discharge

non tender
usually mobile over underlying structures

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7
Q

RF for squamous cell carcinoma

A

sun damage, actinic keratosis, radiation, immunosuppression (post transplant, HIV), smoking, arsenic, irradiation, HPV

chronic ulcers: old burns, venous ulcers

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8
Q

Ix and tx of SCC

A

Ix:

  • punch biopsy/ incisional biopsy (inc borders)
  • stage: CT head: depth of invasion, LN involvement

Tx: wide local resection (small: 5mm margin, large:10mm) with reconstruction
+/- neck dissection (if CT shows LN positive)
offer sentinel LN biopsy

Moh’s micrographic sx for anatomically challenging areas

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9
Q

Pre malignant conditions that progress to SCC?

A

actinic keratosis, bowen disease, leukoplakia, keratoacanthoma

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10
Q

Pre malignant conditions that progress to SCC?

A

actinic/ solar keratosis, bowen disease, leukoplakia, keratoacanthoma

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11
Q

Description of keratoacanthoma

A

elevated, nodular lesion with central hyperkeratotic core/ crater

dome shaped, symmetrical, surrounded by smooth wall of inflammed skin

grows rapidly in days/ weeks

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12
Q

Associations of marjolin ulcer

A

burns scar, chronic venous ulcer

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13
Q

name of Bowen disease located on penis, vulva, oral cavity

A

erythroplasia of Queyrat

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14
Q

Types of melanoma

A

1 superficial spreading: legs F/backs M, red/white/blue
2 nodular: trunk, raised, ulcerated
3 lentigo maligna: face/ dorsum of hand and forearms. thickers and darker (in caucasians)
4 acral lentiginous: hairless areas, peripheral - palms, soles

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15
Q

Features suspicious of malignant mole

A 
ABCDE
Asymmetry
Borders/ bleeding/ulceration
Change: colour, size, shape, surface, number
Diameter >6mm
Elevation
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16
Q

RF of malignant melanoma

A

Congenital:

  • light skinned
  • xeroderma pigmentosum
  • dysplastic naevus syndrome
  • large congenital naevi
  • fam hx

Acquired:

  • sunlight
  • pre-existing skin lesions: lentigo, multiple pigmented naevi
  • previous melanoma
17
Q

What affects tx management in melanoma

A

staging - degree of invasion

  • Clark’s level of invasion (I to V)
  • Breslow thickness
18
Q

Poor prognostic factors of malignant melanoma

A

elderly, male, lesions on trunk, ulceration, depigmentation

19
Q

Malignant melanoma

  • ix
  • tx
  • f/u
A

Ix: whole excision biopsy (assess depth), assess LN involvement/ distant spread with PET scan

excision with wide margins (2cm)
+ sentinel LN biopsy

f/u 3 mthly - recurrence at same site/ draining basin

20
Q

What is a dermoid cyst

A

Ectodermal sequestration at line of fusion during embryonal development with cyst of epithelial lining

(note: do CT imaging to evaluate CNS involvement)

21
Q

What to evaluate in a parotid mass

  • PE
  • Ix
A
  1. facial n
  2. bimanual palpation – superficial/ deep
  3. opening of stensen duct – stones, pus
  4. cervical LN
  5. contralateral parotid, check behind/ around ear lobe

FNAC, CT

22
Q

What is a sebaceous horn

- cx

A

Keratin outgrowth from sebaceous cyst

  • risk of malignant transformation at base of horn to SCC (10%)
  • trauma, bleeding

MBBS Surgery (18 decks)

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