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UdeM PS questions > Peau et oncologie cutanée > Flashcards

Peau et oncologie cutanée Flashcards

1
Q

What are the main functions of the skin (4)

A
  • Protection (UV, mechanical, chemical, thermal)
  • Immunologic (barrier to microorganisms)
  • Metabolic (vitamin D synthesis)
  • Thermoregulation
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2
Q

What is the embryological origin of the epidermis

A

Ectoderm

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3
Q

What is the embryological origin of the dermis

A

Mesoderm

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4
Q

What is the embryological origin of melanocytes

A

Neural crest

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5
Q

What is the embryological origin of Langerhans cells

A

Mesenchymal origin

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6
Q

How long does it take for keratinocyte differentiation to occur

A

28-45 days from basal layer to cornified layer

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7
Q

What 4 cells are found in the epidermis

A
  • Keratinocytes
  • Melanocytes
  • Langerhans cells
  • Merkel cells
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8
Q

What 3 cells are found in the dermis

A
  • Fibroblasts
  • Macrophages
  • Mast cells

aussi occasionnellement: lymphocytes

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9
Q

What appendage cells are found in the epidermis

A

None

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10
Q

What appendage cells are found in the dermis

A
  • Hair follicles
  • Sebacious glands
  • Eccrine and Appocrine sweat glands
  • Meissner’s corpuscules
  • Pacinian corpuscules
  • Ruffini endings
  • Bulb of Krause
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11
Q

What is the function of eccrine glands

A

Thermoregulation

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12
Q

What is the function of apporcine glands

A

Sweat

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13
Q

What is the function of Langerhans cells

A

Immunity (antigen response)

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14
Q

Cell for:
Light Touch
Dynamic 2-point discrimination

A

Meissner’s corposcule

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15
Q

Cell for:
Vibration
Deep pressure

A

Pacinian corpuscules

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16
Q

Cell for:
Sustained pressure
Hot temperature

A

ADD

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17
Q

Cell for:
Cold temperature

A

Bulb of Kraus

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18
Q

What are the 5 layers of the epidermis

A

Mneumonic: ‘’ Come Lets Get Sun Burned’’

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale

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19
Q

What are the 2 layers of the dermis

A
  • papillary layer
  • reticular layer
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20
Q

What type of collagen is primarily found in the papillary and reticular layers of the dermis

A

Papillary: type 3
Reticular: type 1

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21
Q

What is the primary type of collagen found in bones

A

Type 1

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22
Q

What is the primary type of collagen found in tendons

A

Type 1

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23
Q

What is the primary type of collagen found in hyalin cartillage

A

Type 2

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24
Q

What is the primary type of collagen found in arteries

A

Type 3

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25
Q

What is the ratio of type 1:3 collagen in the adult skin

A

4:1

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26
Q

What is the ratio of type 1:3 collagen in hypertrophic scars
And what is its composition

A

2:1

Well-organized collagen fibers with myofibroblast

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27
Q

What are common areas for hypertrophic scarring

A

Areas of high tension: knees, ankles

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28
Q

What is the ratio of type 1:3 collagen in keloids
and what is its composition

A

3:1

Disorganized hypocellular, hick collagen fibers, no myofibroblasts

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29
Q

Common area for keloids

A

Ches, earlobs, upper arms

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30
Q

What is the ratio of type 1:3 collagen in feotal wounds

A

1:3

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31
Q

What is the precursor of tropoelastin

A

Elastin

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32
Q

What cells confer stretch and elastic recoil to the skin

A

Elastin

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33
Q

What are the types of receptors found in the skin

A
  • mechanoreceptors
  • thermoreceptors
  • chemoreceptors
  • nociceptors
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34
Q

List 5 skin changes that occur with aging

A
  • flatenning of dermal-epidermal junction
  • less layers of keratinocytes
  • decreased melanocyte density
  • decreased number of Langerhans cells
  • dermal atrophy
  • enlargement of fibroblasts
  • increase in ground substance
  • increase in tyep 3 collagen
  • decreased elastic fibers

ADD JANIS P. 219 PICTURE

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35
Q

Actinic changes (photoaging) is clinically evidenced by?

A

Rhytids
Increased skin laxity
Pigmentary mottling

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36
Q

What is the pathophysiology of Ehlers-Danlos Syndrome

A

abnormal collagen cross linking

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37
Q

What are some clinical findings of Ehlers-Danlos?

A
  • hypermobile joints
  • thin, friable skin
  • redundant perioccular skin (epicanthal folds, wide nasal bridge)
  • increased predisposition to hypertrophic scarring
  • POOR wound healing
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38
Q

What are findings of Cutis Laxa (Elastolysis)

A
  • hypoelastic skin
  • premature aging
  • NORMAL wound healing
  • ventral hernias
  • cardiopulmonary issues
  • GI issues
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39
Q

What are findings of Pseudoxanthoma Elasticum

A
  • cobblestone yellowish plaques
  • calcification and degeneration of elastic fibers
  • NORMAL wound healing
  • occular problems
  • cardiac anomalies
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40
Q

What are findings of Progeria (Hutchinson-Gilford Syndrome)

A
  • autosomal recessive
  • premature aging
  • poor wound healing
  • baldness
  • increased skin laxity
  • loss of subcutaneous fat
  • growth retardation
  • premature death
  • craniosynostosis
  • micrognathia
  • prominent ears
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41
Q

What are findings of Werner’s Syndrome

A
  • autosomal recessive
  • premature aging
  • scleroderma-like skin
  • hyper/hypo pigmentation of skin
  • microangiopathy
  • diabetes
  • cataract
  • high pitched voice
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42
Q

Mechanism of action of silicone for scars

A

Hydration and occlusion leading to decreased fibroblast activity
Scar warming leading to increased collagenase activity

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43
Q

Injectable projects for scar treatment, + 1 side effect for each

A

Corticosteroid (depigmentation)

5-Fluorouracil (ulceration)

Bleomycin (skin and pulmonary fibrosis)

Fat grafting

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44
Q

Keloid recurrence rate after
1) Excision alone
2) excision + steroid injection
3) Excision + postop radiation therapy

A

1) Excision alone: 50-80%
2) excision + steroid injection: 40-50%
3) Excision + postop radiation therapy: 10-30%

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45
Q

What is the radiation protocol for keloid scars

A

Three fractions starting post-op day 2 with a total dose of 15-30 Gy

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46
Q

Mechanism of allograft

A

Gets vascularized and is then rejected day 10

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47
Q

Phases of skin graft take

A

1) Imbibition 24-48h
2) Inosculation 48-72h
3) Revascularisation 4-6 days

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48
Q

Common causes fo skin graft failure

A

Shear
Fluid collection: seroma/hematoma
Infection
Inadequate perfusion from recipient site

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49
Q

Explain primary contracture of skin graft

A

immediate contracture

Results of retained elastin in dermis

FTSG

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50
Q

Explain secondary contracture of skin grafts

A

Contraction in healed grafts

Result of myofibroblast activity

STSG

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51
Q

Adv and disadv of STSG

A

Adv:
Higher survival
Reharvest
Greater availability of donor

Disadv:
Secondary contracture
Poor color/texture match
Hair growth not possible

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52
Q

Adv and disadv of FTSG

A

Adv:
Can close donor site
Better color/texture match
More robust reinnervation

Disadv:
Lower survival
Need to close donor site limits size of harvest

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53
Q

Time to repeithialize donors of STSG

A

14-21 days

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54
Q

What is the most common form of skin cancer

A

Basal cell carcinoma

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55
Q

What is the most common malignancy of the eyelid

A

BCC

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56
Q

What is the predominant location of basal cel carcinomas

A

80% of BCCs are in the head and neck

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57
Q

Name 5 risk factors for basal cell carcinoma

A
  • Sun exposure (#1)
  • Fitzpatrick skin type
  • Advanced age
  • Immunosupression (AIDS, organ transplant)
  • Arsenic
  • Hydrocarbons
  • Genetic mutations (PTCH and p53)
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58
Q

What are the genetic mutations associated with BCC

A
  • PTCH (patch gene codes for SHH pathway)
  • p53 gene
  • p-450 and glutathione (in truncal BCC)
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59
Q

What is the pathogenesis of albinism

A

Defective production of melanin from tyrosine

Type 1: tyrosinase-related oculocutaneous albinism with AFFECTED tyrosinase activity

Type 2: tyrosinase-related oculocutaneous albinism with NORMAL tyrosinase activity

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60
Q

What is the inheritance pattern of Gorlin Syndrome (Nevoid basal cell syndrome)

A

Autosomal dominant
9q22.3-q31

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61
Q

What are findings associated with Gorlin’s Syndrome (Nevoid basal cell syndrome)

A

** Dx need 2 major or 1 major and 2 minors**

Major:
- multiple BCCs (>2 or 1 BCC before 20yrs old)
- odontogenic keratocysts of the jaw histologically proven
- >3 palmar and plantar pits
- calcification of falx cerebri
- bifid ribs
- 1st degree relative

Minor
- cleft lip/palate
- macrocephalie
- hypertelorism
- broad nasal root
- pectus excavatum
- scoliose
- tumeur ovaire ou médulloblastome

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62
Q

What is the inheritance pattern of Xeroderma Pigmentosum

A

Autosomal recessive

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63
Q

List 6 features of xeroderma pigmentosum

A

Dentition anormale
arthralgies
retard cognitif
télangiectasies
photosensibilité
multiple epithelial malignancies

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64
Q

Name the syndrome/disease
- impaired DNA repair
- intolerance to UV radiation
- multiple epithelial malignancies

A

altération dans la réparation de l’ADN entrainant intolérance aux rayon UV

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65
Q

What is the risk of malignant transformation of Nevus sebaceus of Jadassohn

A

10-15% risk of malignant transformation to BCC

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66
Q

Nevus sebaceus of Jadassohn predisposes to which type of malignancy

A

BCC

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67
Q

Name the lesion
- present at birth on scalp or face
- well circumscribed
- hairless yellow-ish plaque
- verrucous and nodular transformation in puberty
- malignant risk of 10-15%

A

Nevus sebaceus of Jadassohn

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68
Q

List features of Nevus sebaceous of Jadassohn

A
  • present at birth on scalp or face
  • well circumscribed
  • hairless yellow-ish plaque
  • verrucous and nodular transformation in puberty
  • malignant risk of BCC of 10-15%
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69
Q

What % of BCCs will recur within 5 years

A

30-50%

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70
Q

Define 7 criteria for high versus low risk BCC

A

Locations:
Low risk: <2cm thrunk and extremities
Hight risk: >=2cm trunk and extremities and any size for head, nack, hands, pretibial and anogenital area

Poorly (high) versus well (low) defined borders

Recurrrent (high) versus primary (low) lesion

+/- immunosuprression

Site of prior RT

Subtypes: aggressive growth pattern (high) vs nodular or superficial (low)

Perineural involvement

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71
Q

What is the overall metastasis risk of basal cell carcinoma

A

<0.1%

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72
Q

What are the main sites of metastasis for BCCs

A
  • lymph nodes
  • lungs
  • bones
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73
Q

Name the 6 types of BCC
Which is most common and most agressive

A
  • nodular (50-60%)
  • nodular ulcerative
  • spreading
  • ulcerative
  • infiltrative
  • pigmented
  • morpheaform or sclerosing (most agressive)

ADD PHOTO JANIS P.256

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74
Q

Where do basal cell carcinomas originate from

A

Pluripotent epithelial cells of the epidermis and hair follicles at the dermoepithelial junction

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75
Q

What is the most common histologic type of BCC

A

Nodular (50-60%)

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76
Q

What is the most aggressive form of BCC

A

Mopheaform (high incidence of +ve margins after excision)

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77
Q

What is the goal of treatment in management of cutaneous malignancies

A

Cure tumor with preservation of function and cosmesis

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78
Q

List 6 non-surgical treatment options for BCC

A
  • Radiation
  • Imiquimod
  • 5 F-U
  • CO2 laser
  • Photodynamic therapy (PDT)
  • Cryosurgery

superficial therapies are reserved for patients who are not candidates for surgery or radiation

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79
Q

List 3 surgical treatment options for BCC

A
  • Curretage and electrodesiccation (for low risk)
  • Mohs surgery
  • Surgical excision with margins (Gold standard)
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80
Q

% des BCC qui sont histologiquement mixte

A

40%

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81
Q

Name 4 indications for Mohs surgery in the context of BCC

A
  • reccurent tumor
  • cosmetically sensitive area (nose, eyelid, periauricular)
  • aggressive BCC (morpheaform, micronodular)
  • poorly differenciated margins
  • other tumors (ie. SCC with perineural invasion, dermatofibrosarcoma, microcystic adnexal carcinoma)
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82
Q

List 2 adjuvant therapies for management of BCC

A
  • Radiation
  • Vismodegib (SHH pathway inhibitor) - last resort, surtout si métastase
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83
Q

List adverse events associated with Vismodegib

A
  • Muscle spasms
  • Alopecia
  • Loss of taste
  • Weight loss
  • Fatigue
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84
Q

What is the cure rate of BCC using Mohs

A

99% cure rate

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85
Q

What are the recommended margins for BCC

A

4mm (small, face and other low risk)

**10mm high risk (large, trunk and extremities)

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86
Q

What is the cure rate of BCC treated with C&E

A

Overall 74%
96-100% for tumors <2mm

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87
Q

What are the contra-indications to cryosurgery in BCC management

A
  • tumors deeper than 3mm
  • cold intolerance
  • morpheaform type
  • recurrent BCC
  • cosmetically sensitive area
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88
Q

What should you warm your patients about when using cryosurgery to treat BCCs

A
  • prolonged edema (4-6 weeks)
  • permanant pigment loss
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89
Q

What are the indications for radiation in patients with BCCs

A
  • non surgical candidate
  • > 60 yrs old
  • tumor up to 15mm in high risk location
  • tumor up to 20mm in intermediate risk location
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90
Q

What are the limitations of punch biopsies

A

Cannot assess lesion dept beyond the punch

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91
Q

Why are shave biopsies not recommended in the context of melanomas

A

Cannot assess lesion dept at all

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92
Q

In which layer of the skin is melanoma in situ confined to

A

Basal Layer of Epidermis

93
Q

What is the margin of choice for a melanoma in situ of the face

94
Q

Name 3 considerations in the long term management of Gorlins

A
  • Frequent physicals exam
  • Nicotinamide (B3)
  • Sun protection
95
Q

Pour quelle pathologie cutanée la radiotx est-elle contre-indiquée et pourquoi?

A

syndrome de Gorlin
Radiotx met plus à risque de cancer de peau

96
Q

What is a sebaceous nevus

A

Naevus of Jadassohn
Hamartomatous sebaceous glands proliferation
Most commonly on scalp
Present at birth

97
Q

What is the expected evolution of neavus sebaceous during childhood

A

Growth proportional to child development until adolescence. Turns into a veracious lesion in adolescence

98
Q

Name 4 different diagnosis to neavus sebaceous

A

Epidermal naevus
Sebaceous naevus
Linear psoriasis
Sebaceous carcinoma
Cutis aplasia

99
Q

What is the most frequent malignant transformation of sebaceous naevus

100
Q

Name 2 structures that can lead to malignant transformation

A
  • Apocrine glands
  • Eccrine glands
  • Hair follicles
101
Q

Name 4 risk factors for Merkel carcinoma

A

UV radiation
Immunosupression
Advanged age
Merkel cell polyomavirus infection

102
Q

Describe Merkel carcinoma lesions characteristics

A

Painless
Firm
Shinny
Flesh colored or erythematous nodule
Rapidly growing

103
Q

What is the most appropriate treatment option for Merkel carcinoma

A

1-2cm
Down to fascia
Sentinel lymph node biopsy

104
Q

What adjuvant therapy should be used in the management of Merkels carcinoma

A

Radiation therapy
(proven to reduce recurrence rates)

105
Q

Name 2 imaging modalities that you would use to stage Merkel carcinoma

A

PET-Scan
TAP-Scan
+/- MRI

106
Q

Where do SCC arise from

A

Cellules malpighienne de la membrane basale de l’épiderme

107
Q

Types of SCC

A

Verrucous
Ulcerative
Marjolins ulcer
Subungeal

108
Q

Lifetitme risk of malignant degeneration of burn scar

A

Marjolain Ulcer: 2%

109
Q

Name 8 risk factors for squamous cell carcinoma

A

Fitzpatrick Type 1-2
Sun exposure
HPV
HSV
Immunosuppression
Prior radiation
Chronic wound
Advanced age

110
Q

Name characteristics of low risk (LR), high risk (HR) and very high risk (VHR) SCC

111
Q

5 Pre-malignant lesion of SCC and % of malignant transformation of known

A

Actinic keratosis (1-10%)
Maladie de Bowen (10%)
Leukoplakia (15%)
Érythroplasie de Queyrat (30%)
Keratoacanthoma
Papulose bowenoid

Leukoplakie: patche blanchâtre a/n muqueuse orale
Queyrat: Bowen génital ou oral
Bowen: SCC in situ

112
Q

What is Bowens disease of penis glans, vulva or oral mucosa, what is its % of malignant transformation

A

Erythroplasia of Queyrat

30%

113
Q

Name 2 premalignant lesions associated with SCC of the lip

A

Leucoplakia (15% malignant transformation)
Actinic Cheilitis

114
Q

Areas of metastasis of SCC

A

Lungs
Liver
Brain
Skin
Bone

115
Q

Name 2 elements on pathologie that would increase the risk of reccurence of SCC

A

-Adenoide, adenosquameux ou carcinosarcomateux
-Dept >2mm
-Perineural invasion
-Lympho-vascular invasion
-Poor differenciation

116
Q

Medical treatment of SCC

A

Radiation
Brachytherapy
Oral retinoids
Topical 5-FU and imiquimod (pre malignant or SCC in situ)
Chemotherapy (carbotaxol or cisplatin)
Immunotherapy (cemiplamab or pembrolizumab)

117
Q

Treatment of low risk SCC

A
  • Wide local excision with 4-6mm margins (if positive margins must do Mohs)
  • Mohs
  • Radiaton therapy (if patient refuses surgery)
118
Q

Treatment of HR and VHR SCC

A
  • Consider SLNB if multiple high risk features or if recurrent
  • Mohs
  • Standard excision wit “wider” surgical margins
  • RT for non surgical candidates
119
Q

2 Indications for SLNB SCC

A

Recurrent
OR
Multiple HR features

120
Q

Management d’un SCC sous-unguéal

A

Amputation à l’IPD

121
Q

FU pour un SCC maladie localisée (NCCN 2024)

A

Low Risk:
q3-12mois x 2 ans puis
q6-12 mois x 3 ans
puis q1 an à vie

high risk:
q3-6mois x 2 ans puis
q6-12 mois x 3 ans
puis q1 an à vie

very high risk:
q3-6mois x 2 ans puis
q6 mois x 3 ans
puis q6-12 mois à vie

122
Q

FU pour SCC avec maladie régionale (NCCN 2024)

A

q2-3mois x 1 an puis
q2-4 mois x 1 an puis
q4-6 mois pour 3 ans
puis q6-12 mois à vie

imagerie (IRM) au besoin si e/p n’est pas suffisant pour suivre l’étendu de la maladie ou si risque de récurrence gg

123
Q

Melanoma risk factors (NCCN 2024)

A

Age > 50
Homme
Prédisposition phénotypique
Nevus dysplasique
Atypical mole syndrome
Fitzpatrick 1-2
Cheveux yeux, yeux bleus

Histoire personnelle
Coup de soleil multiple
Lésion pré-maligne: KA, NMSC
Immunosuppression (VIH, transplant)
Xeroderma pigmentosum

Prédisposition génétique
Histoire familiale positive
Mutations: BRAC, PTEN, MITF

Facteurs environnementaux
Utilisation de lit de bronzage
Habiter dans un climat de soleil ou altitude près de l’équateur
Exposition chronique au soeil

124
Q

4 Lésions mélanocytaires pré-malignes

A

Névus dysplasique (10%)
Mélanome in situ
Lentigo malin (Hutchison freckle) (5%)
Névus mélanocytaire congenital (1-10%)

125
Q

Atypical mole syndrome criteria et risque de transfo maligne

autres noms: B-K mole syndrome, FAMMM familial atypical multiple mole melanoma

A
  • More than 100 nevi measuring 6-15mm
  • One or more measuring >8mm
  • One or more with atypical features

10% de transfo maligne

126
Q

Types of pigmented lesion that can be confused with melanoma

A

Junctional nevi
Compound nevi (Halo nevus is subtype)
Intradermal nevi
Blue Nevi
Spitz nevus
Lentigo
Seborrheic keratosis

127
Q

Where are melanocytes normally located

A

Basalis layer of epidermis

128
Q

nommer 2 différences entre un CMN et un nevus mélanocytaire acquis

A

CMN: invasion du derme réticulaire profond et des annexes cutanées

acquis: se limite au derme papillaire et n’envahit pas les annexes cutanées

129
Q

Where are melanocytes located in congenital melanocytic neavus

A

Deep reticular dermis (can invade appendages, nerves and vessels)

130
Q

Name 2 important prognostic findings on pathology for melanoma other than tumor depth

A

Ulceration
Mitotic rate
Microscopic satelitosis

131
Q

Melanoma growth patterns/types

A

Superficial spreading melanoma
Nodular
Lentigo maligna
Acral-lentginous melanoma
Desmoplastic melanoma
Amelanotic melanoma
Noncutaneous melanoma
Ocular melanoma

132
Q

Precursor of lentigo maligna

A

Hutchinson freckle

133
Q

Characteristic of acral melanoma

A

melanonychia
Usually flat with irregular border
Long radial growth

134
Q

Describe T1-T4 for melanoma

A

nombre de mitose n’est plus important

135
Q

Name 4 risk factors for malignant transformation in CMN (transformation to melanoma)

A

3 or more nevi
Location on the trunk
>20cm
contour irrégulier

aussi jeune âge 3-5 ans ?

janis 2022

136
Q

Name 2 characteristics of neurocutaneous melanosis

A

CNS involvement
>2 small or 1 large

137
Q

qu’est-ce que la neuromélanose cutanée

A

invasion mélanocytaire des méninges et du parenchyme cérébral associé à un CMN

138
Q

7 caractéristiques cliniques d’un CMN qui se transforme en mélanome

A

■ Rapid increase in size
■ Irregularity of border
■ Development of asymmetry
■ Variation of color within the nevus
■ Development of satellite lesions
■ Changes in texture
■ Bleeding, pain, itching

139
Q

What is the preferred diagnosis modality for neurocutaneous melanosis

A

MRI ( at 4 months of age avant que le cerveau soit myélinisé pour bien voir les dépôt de mélanine)

140
Q

Name 2 reasons why we usually proceed with surgical excision of neavus sebaceous

A

Aesthetic consideration (cause of alopecia)
Risk of malignant transformation

141
Q

Name 3 possible tumoral transformations of sebaceous neavus

A

Sebaceous carcinoma
SCC
BCC (most common)
Microcystic adnexal carcinoma

142
Q

Name 3 reconstruction options for a posterior scalp defect that cannot be closed primarily

A

2nd intension
Skin graft
Tissue expansion
Local rotation flap

143
Q

What is the significant of a melanoma recurrent a few cm away from the primary lesion?

A

Metastasis in transit

144
Q

Name 3 possible DDx for a cutaneous lesion on the finger with bony erosion?

A

Osteomyelitis
Marjolin ulcer
BCC
Osteosarcome

145
Q

What are 2 cutaneous findings associated with Gorlins other than BCCs

A
  • palmar or plantar pits
  • facial milia
  • epidermal cysts
146
Q

Name 2 squeletal findings associated with Gorlins

A
  • calcification of falx cerebri
  • bifid ribs
  • scoliosis
  • syndactylie
  • sprengel deformity (scapula)
147
Q

What is the % risk of malignant transformation in congenital melanocytic nevi

A

small = 1 %
giant = 5-10%

148
Q

Nommer 5 indications d’IRM pour les CMN

A

3 CMN ou plus
1 GCMN
CMN du midline
CMN au visage
Sx neuro

c’est indications correspondent aussi aux facteurs de risques de mélanose neurocutanée

149
Q

Name 2 surgical considerations in the management of CMN

A
  • Serial excisions (depending on size)
  • Excision at young age (before school age)
150
Q

nommer 5 arguments contre l’excision d’un CMN

A
  • Anesthésie générale délétère avant 1 an
  • Diminue pas le risque de mélanome (n’est pas restreint à la lésion)
  • Risque de déclencher transfo maligne
  • Impossible à exciser complètement
  • Peut pâlir avec les années
151
Q

Name 4 risk factors for malignant lentigo

A
  • Fitspatrick 1-2
  • Sun exposure
  • Advanced age
  • Familial hx
152
Q

Name 2 ways to have better margins during ressection for malignant lentigo

A
  • Woods lamp
  • dermoscopie
153
Q

Why are frozen sections not adequate in the context of melanoma

A

car détruit l’architecture cellulaire

154
Q

Name 3 conditions associated with congenital melanocytic nevis

A
  • neurocutaneous melanosis
  • malignant melanoma
  • neurofibromatosis (GCMN)
  • spina bifida (GCMN)
  • myelomeningocele (GCMN)
155
Q

List 3 surgical treatment options for congenital melanocytic nevi

A
  • Serial excision
  • Tissue expansion
  • Skin graft
156
Q

Name a long term sequellae of congenital melanocytic nevi

A
  • Hypertrophic scarring
  • Malignant transformation
157
Q

Mutations in melanoma

A

BRAF, cKIT, NRAS

158
Q

Syndromes qui augmentent le risqué de mélanome?

A

FAMMM/BK Mole
Albinisme
CMN, neuromélanose
XP
BRCA
PTEN

159
Q

Resection margins for melanoma

A

In situ: 0.5-1cm
B <1mm: 1cm
B 1-2mm: 1-2cm
B 2-4 mm: 2cm
B > 4mm: 2cm

160
Q

Elements to look for in melanoma biopsy, which are the 3 most important prognostic factors

A

Breslow (+)
Ulceration status (+)
Dermal mitotic rate (+)
Deep and peripheral margin status
Microsatellitosis
Desmoplasia
Lymphovascular/perineural invasion

161
Q

Melanoma workup

A

Pour Stade I-II, aucun labo ou imagerie nécessaire

Pour Stade III+ (N>1+), labo de base, hépatique, LDH, CXR, CT poumon, CT abdo-pelvien, PET

162
Q

5 DDx of mélanonychie

A
  • Hematome sous-unguéal
  • Onychomycose
  • Mélanome in situ
  • Mélanome invasif
  • Hyperplasie mélanocytaire
163
Q

Resection for subungeal melanoma

A

Amputation proximal to distal interphalangeal joint

except for in situ, possibilité d’être plus conservateur

164
Q

Indication for SLNB in melanoma

A

<0.8mm with ulceration
OR
>0.8 with/without ulceration

dès stade IB (aka T1b ou T2a)

165
Q

Indication for Therapeutic lymph node dissection melanoma

A
  • ganglion cliniquement positif
  • SLNB + ET patient incapable d’adhérés aux suivis recommendés
  • SLNB + ET fardeau tumoral entrainant une prédiction élevé d’avoir d’autres gg +

NCCN 2024: il n’est plus indiqué de faire une dissection axillaire simplement pour un SNLB positif

166
Q

Thérapies adjuvantes pour le mélanome

A

Immunothérapie : Nivolumab
Pembrolizumab
XR
Interféron (?)
Chimiothérapie

si BRAF +: Dabrafenib/trametinib

167
Q

Melanoma follow-up

A

in situ: H/P q1an

Stade IA -IIA
H/P q6-12 mois x 5 ans puis
q 1 an

Stade IIB-IV
H/P q3-6 mois x 2 ans puis
q3012 mois x 3 ans puis
q1 an
Pour screen une récurrence ou métastase:
Considérer imagerie q3-6 mois x 2 ans puis
q 6-12 mois x 3 ans puis
seulement pour sx spécifiques

imagerie à considérer pour investiguer sx spécifique

168
Q

Qu’est-ce que le Syndrome LEOPARD

A

Lentigines
EKG anomalies
Ocular hypertelorism
Pulmonary stenosis
Abnormal genitals
Retarded growth
Deaf

169
Q

List 5 DDx for bullous lesions

A
  • bullous pemphygoid
  • cicatricial pemphygoid
  • Epidermolysis bullosa
  • S/TEN
  • erythema multiform
  • graft vs host disease
  • Staphyloccocal scaled skin syndrome
170
Q

Name 4 types of Epidermolysis bullosa

A
  • simplex
  • junctional
  • dysmorphic
  • Kindler syndrome
171
Q

Name 3 findings associated with dystrophic type Epidermolysis bullosa

A
  • pseudosyndactylie
  • ungeal dystrophy
  • alopecia
  • dental caries
  • corneal ulcers
  • renal insufficiency
  • 50% risk of SCC by age 30
172
Q

What is the risk of SCC in patients with dystrophic epidermolysis bullosa

A

50% by age 30

173
Q

Describe the management components of dystrophic epidermolysis bullosa

A
  • avoid mechanical trauma
  • infection prevention
  • non adhenrant dressings
  • debride bullaes
  • avoid chronic topical antibiotics
  • frequent physical exams
  • multidisciplinary approach
174
Q

What are features of erythema multiforme

A
  • precipitated by HSV
  • target lesions
  • non painful
  • usually on palmes and soles
175
Q

What are the 2 types of erythema multiforme

A

Minor: no mucosal or systemic involvement

Major: mucosal and systemic involvement

176
Q

What other consultant should you ask for in patients with erythema multiforme

A

ophtalmology

177
Q

What is the management of erythema multiforme

A
  • Minor - supportive treatment
  • More severe - antiviral +/- immunosupression
178
Q

What is the pathophysiology of Staphylococcal Scalded Skin Syndrome

A
  • Seperation of desmosomes found int he granulosum layer of the epidermis (desmoglein-1)
  • Hematogenous dissemination of exfoliative toxins
179
Q

What are clinical findings of SSSS

A
  • SPARING OF MUCOUS MEMBRANES
  • malaise
  • fever
  • Nikolsky +
  • irritability
  • pain
  • affects whole body (head to toes)
180
Q

What is the expected evolution of SSSS

A

Resolution within 1-2 weeks

181
Q

What is the management of SSSS

A

IV antibiotics (b-lactamase + clindamycin)

182
Q

What is the mortality rate associated with SSSS

A

4% children
60% adults

183
Q

Melanoma with Breslow 11 on thigh. What are your margins?

184
Q

What are two important technical points of a biopsy for melanoma

A
  • orientation of specimen
  • excision down to fascia
185
Q

What is your management of a melanoma lesion (list 4)

A
  • WLE with 2cm margins
  • Sentinel lymph node biopsy
  • Linear reconstruction or STSG
  • Dr. B to confirm
186
Q

What are your margins for a 1.5cm SCC lesion of the cheek

187
Q

What are 3 important things to check on physical exam in the context of SCC

A
  • Evaluation of lesion characteristics
  • Adherence of the lesion to deep plains
  • Regional lymph node palpation
  • Cranial nerve exam
  • Laxity of surrounding for reconstruction
188
Q

Draw a limberg

A

Add picture in brainscape

189
Q

What are 3 things on path report that are rick factors of recurrence for SCC

A
  • Perineural invasion
  • Clark 4 or more
  • Poor differentiation
  • Lymphatic or vascular involvement
  • Desmoplastic histology
190
Q

What is the name of a SCC that arises from a chronic wound?

A

Marjolin ulcer

191
Q

What are the surgical margins for marjolin ulcers

192
Q

You are in OR and frozen sections are not available. What do you do with the deficit?

193
Q

Name 2 functional complications of cervico-facial flap with reconstruct a cheek deficit and 2 ways to mitigate this

A

Ectropion
- anchor down to periosteum
- canthopexy
- Frost sutures
- Tenzel modification

194
Q

Classification of CMN ?

195
Q

Pathologies associated with GCMN?

A
  • NF
  • Spina bifida
  • Myelomeningocele
196
Q

Most frequent localisation of CMN?

A

Trunk > Extremities > H&N

197
Q

What is a late CMN?

A

Absent at birth, but appears < 2 years of age

198
Q

What it neurocutaneous melanosis?

A

Melanocytic proliferation within the brain parenchyma + GCMN (or > 2 smaller melanocytic nevi)

Risks factors:
- >20 satellite nevi
- CMN in a midline location over trunk or calvaria

199
Q

Sx of neurocutaneous melanosis?

A

Can be Asx (50%)
Usually symptomatic by 2 years of age
Increased ICP (lethargy, headache, vomiting, photophobia) and result in hydrocephalus, seizures, developmental delay , cranial nerve palsies, bladder and bowel dysfunction

200
Q

Surgical treatments for CMN?

A

Serial excision (< 3 excisions)
Tissue Expansion
STSG/FTSG
FLAP

201
Q

What is a Nevus of Ota?

A

blue-brown unilateral periocular macula (areas follow V1-V2)
At birth or around puberty
Asians and Black especially

202
Q

What is a Nevus of Ito?

A

Same as Nevus of Ota but areas innervated by posterior supraclavicular and lateral cutaneous brachial nerves

203
Q

List 5 features of LEOPARD syndrome

204
Q

Name 4 syndromes/conditions that increase the risk of melanoma

A

Atypical mole syndrome
Neuromelanosis
Albinism
Xeroderma pigmentosum

205
Q

What are the 3 most important prognosis factors for melanoma

A

Breslow thickness
Ulceration
Mitotic rate

206
Q

Name 4 tumors associated with Gorlins

A
  • BCC
  • Medulloblasoma
  • Meningioma
  • Fibrosarcoma
  • Rhabdosarcoma
207
Q

Describe classic appearance of BCC

A

Well defined borders, flesh-colored, pearly nodule, ovelying telangiesttasia

208
Q

List 4 agressive subtypes f BCC

A

Micronodular
Basosquamous
Sclerosing/Morpheaforme
Infiltratif

209
Q

Name 4 genetic syndromes with higher risk of developping SCC

210
Q

Name 4 genetic syndromes with higher risk of developping BCC

A

Épidermolyse buleuse
XP
Albinisme
Anémie de Fanconi
Werner syndrome

211
Q

Name 4 genetic syndromes with higher risk of developing melanoma

A

FAMMM
Li-Fraumeni
Xeroderma Pigmentosum
Cowden Syndrome
Albinism
Neuromelanosis

212
Q

Risk factors for hydradenitis suppurativa?

A
  • Obesity
  • Afro American
  • Family Hx
  • Woman
  • Tobacco
213
Q

Which type of gland is involved in HS ?

A
  • Apocrine glands
214
Q

What is the classification of HS? (with their associated tx?)

A

Hurley Classification :
I: Simple, single of multiple abcesses

tx: Deroofing, topical clindamycin x 12 weeks, intralesional kenalog, consider monthly Nd-YAG or CO2 laser

II:lesions widely separated, single or multiple recurrent
abcesses
tx: Deroofing, Oral clinda +
rifampin x 10 weeks
consider monthly Nd-YAG

III: Diffuse involvement of affected region, multiple
interconnected tracts and abscesses
tx: wide surgical excision

215
Q

Non surgical tx of HS?

A
  • Diet
  • Weight loss
  • Hygiene
  • Smoking cessation
  • ATB
  • Anti-TNF, Anti- IL1
  • Laser, steroid injection
  • XRT
216
Q

Gold standard tx of HS?

A

WLE 1-2 cm margin

217
Q

What is the reccurence rate of HS after WLE?

218
Q

Criteria for neurofibromatosis grade 1

What are the criteria for neurofibromatosis type 1

A

Must have 2 or more of the following features
* 6 or more cafe au lait macules (over 5mm in diameter prepubertal) (over 15 mm in diameter postpubertal)
* Two or more neurrofibromas orr one plexiform neurrofibroma
* Frreckling int he axillary or inguinal regions
* Optic glioma
* Two or more Lisch nodules (iris hamartomas)
* Distinctive dosseous lesion: sphenoid dysplasia, thining of a long bone cortex, pseudoarthrosis
Firrst degree relative with NF1

219
Q

Gene implicated in NF type 1 + inheritance pattern

A

Damage to chromosone 17q11.2

Autosomal dominant

220
Q

Other name for NF type 1

A

Von Recklinghausen disease

221
Q

Where is located (at the cellular level) a neurofibroma

A

In peripheral nerve seath

222
Q

Risk of malignant peripheral sheath tumor in neurofibromatosis

223
Q

Criteria for NF type 2

A

Vestibular schwannomas (acoustic neuromas) in both ears
OR
Vestibular schwannoma in one ear and one or several first-degree relatives with NF2

224
Q

Do NF type 2 also have skin ttumors

A

Yes but much less extensive than NF type 1

225
Q

Dermatofibrosarcome protuberans (DFSP), clincial aspect of lesion

A

nodulaire, couleur peau, violacé, kéloide

226
Q

DFSP localisation

A

Tronc > extrémités > H&N (50-40-10%)

227
Q

Risk factor (4) for DFSP

A

Burn
Tattoo
Radiation therapy
Surgical incision

228
Q

DFSP tx + margins

A

Marge 3-4cm, incluant le fascia superficiel vs Mohs

229
Q

5 year survival rate des mélanome selon le stade

UdeM PS questions (52 decks)

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