Plastic/Soft Tissue

Question 1

What are the types of melanoma?

Answer 1

Superficial spreading: Associated w nevus, most common
Lentigo Maligna: Rarely assocaited w nevus, Typically on sun-exposed skin
Acral Lentiginous: Nevus associated, palm/sole/subungual
Nodular: Most aggressive

Question 2

What’s indication to do SLNB for melanoma?

Answer 2

> =1 mm deep

Question 3

What additional procedure is needed for scalp/facial melanoma?

Answer 3

If anterior to ear, above lip, or on ear >1 mm deep:
Superficial parotidectomy (20% mets to parotids)

Question 4

What are adjuncts to melanoma resection?

Answer 4

Dacarbazine (chemo), IL-2 and tumor vaccines

Question 5

What affects staging/prognosis of sarcoma?

Answer 5

Grade

Question 6

What’s adjunct for sarcoma resection?

Answer 6

Chemo: Doxorubicin
Radiation if high grade, close margin, tumor >5 cm
Can do neoadj rads if >10 cm to shrink it

Question 7

What are the side effects of burn wound topical agents?

Answer 7

Silvadene: Neutropenia, thrombocytopenia, sulfa allergy
Silver Nitrate: Methemoglobinemia, electrolyte imbalance (hypo-everything), discoloration
Sulfamylon: metabolic acidosis (carbonic anhydrase inhibition)
Bacitracin: Nephrotoxicity

Question 8

What margins are used for BCC/SCC?

Answer 8

BCC: 0.3-0.5 cm margin
SCC: 0.5-1 cm margin, 2 cm if Marjolin’s or penile/vulvar

Question 9

What are the stages of Hidradenitis?

Answer 9

Hurley Stage I: Localized abscesses without sinus tracts or scarring
Stage II: Recurrent abscesses with sinus tracts and scarring separated by normal skin
Stage III: Diffuse disease with multiple interconnected sinus tracts and abscesses involving entire anatomic area with scarring

Question 10

How do you treat hidradenitis?

Answer 10

Stage I: Topical clinda/antiseptic wash/lifestyle changes
Stage II: Oral Doxy +/- adalimumab
Stage III: Oral doxy, clinda/rifampin/antiandrogen, adalimumab, excision if refractory