melanoma

Question 1

H/P

Answer 1

length of time
comorbidities - AIDS?transplant?
previous facial surgeries/trauma
sun exposure
smoking
meds - anticoagulants

EXAM:
ulcerative, eroded, involving hair? part of body? concerncs for nerve injury? Fitzpatrick? Skin type? lymph node, facial nerve? size, color

previous biopsy? If no workup then do excision vs incional biopsy

Counseling - need resection margins then know plan, need to counsel on diagnosis, prognosis and plan

Question 2

Conservative management for SCC and BCC

Answer 2

SCC and BCC can be treated with 5FU radiation
reserved for patients who are high risk or resection is not practical

Question 3

Mohs criteria

Answer 3

all high risk BCC and SCC
incompletely excised lesions
recurrent lesions same spot
high risk areas
>2cm and rapidly growing
aggressive appearance morpheaphorm, poorly differentiated SCC
lesions in immunocompromised patients
lesions in basal cell nevus syndrome

otherwise excise yourself
BCC 4mm low risk and 6mm high risk
SCC 4mm low risk (less than 2cm), 6mm for high risk (>2cm, high risk areas, also features like perineurial invasion, deep tissue involving fat, muscle, bone,

Question 4

Melanoma MArgins

Answer 4

insitu 5mm
<1mm 1cm
1-2mm 1-2cm
>2mm 2cm

SLN - >1mm, any with ulceration, stage 3 melanoma as you may need immunotherapy

surgical margins are not reliable

Question 5

2