NMS Skin (cancer), soft tissue, hernia

Question 1

indications for excision of skin lesions (4)

Answer 1

ABCDE, ulceration, recent changes, nodularity

Question 2

tx of basal cell vs. squamous cell carcinoma of skin

Answer 2

basal cell rarely metastatic –> just need to do local excision to clear margins;
squamous cell slightly more metastatic (to LN) –> need to do local excision + LN resection if palpable LN on exam

Question 3

how to assess malignant potential of melanoma? what is mgmt

Answer 3

dangerous, malignant potential depends on depth; TREATMENT: local resection with margins = f(depth);
Lymphadenopathy = metastatic dz –> use IMMUNOTHERAPY (interferon)

Question 4

tx of dysplastic nevus

Answer 4

excision if atypia on histo

Question 5

what observable factors worsen prognosis of malignant melanoma?

Answer 5

ulceration, face/skin involvement

Question 6

implications of lymphadenopathy for malignant melanoma

Answer 6

suggests metastatic dz –> use immunotherapy (interferon)

Question 7

how to work up soft tissue sarcoma

Answer 7

MRI, bx

Question 8

cause of painful testicle (3)

Answer 8

1. ACUTE: torsion

2. SUBACUTE: orchitis, 3. epididymitis

Question 9

when to surgically treat hernia

Answer 9

if incarcerated/strangulated (URGENT); if not, essentially elective: tx if giving patient problems

Question 10

what repair in kids with inguinal hernia

Answer 10

in kids, 2/2 patent procesus vaginalis –> likely bilateral –> bilateral high ligation of the sac