Plastic Surgery Flashcards
Indication of surgery in moles
*Suspicious of malignancy. Like in congenital navus (controversy)
*Cosmetic reasons
*In area with repeated irritation like shaving
*Giant hairy mole as soon as possible surgical excision only
Diathermy and cautery r harmful
🌿Mc tumors in human
🌿Clinical forms of naevus cell tumors
🌿Types of melanocytic tumors
🌿Ttt of pigmented precancerous skin lesions
- Neaves cell tumor
2.superficial
Junctional
Dermal
Compound
Dysplastic
Sebaceous neavus
3 . With increase activity
Freckles
With increase number
Lentigo maligna , lentigo simplex
With dermal melanocytes
nevus of ota
Nevus of ito
Blue nevus
Mongolian spot
Cellular blue navus
- Medical ttt quinolones
Q switched laser
Surgical excision
Pfs of malignant melanoma
Prolonged exposure to sun light UV rays
In some premalignant conditions like albinism and xeroderma pigmentosa retinitis pigmentosa
On top of benign skin lesion dt chronic irritation
Giant hairy mole
Junctional and intradermal
Types of malignant melanoma
🌷Superficial spreading intermediate prognosis 50:60%
🌷Nodular 10-20% bad prognosis
🌷Acral 2-8% poor radial to vertical
🌷Amelanotic melanoma <5% worst prognosis
🌷Lentigo maligna 10% in old aged females radial growth some regress with time best prognosis
Spread of malignant melanoma
Direct radial and vertical growth
Lymphatic
Permiatiom and embolization
Blood
Mc site is lung
It has high affinity to liver
Explain clark mcgovern classification of malignant melanoma
Breslow classification TTM
🌹level 1 insitu melanoma confined to epiderms
🌹level 2 invasion of papillary dermis
🌹level 3 widening of papillary dermis junction bw papillary and reticular dermis
🌹level 4 invasion of reticular dermis
🌹 level 5 subcutaneous tissue invasion
0.75 surgically curable
0.75:1.5 low ass withe onset of vertical growth phase
1.5:4 higher risk
4 definitely high risk
Investigation of malignant melanoma
★Excisional Biopsy should include skin subcutaneous tissue with safety margin 3 mm
★LN Scintigraphy sentinel LN
★Investigation for mets chest X ray PAUS CT Scan
★Preoperative investigation KFT, LFT , ECG blood sugar, electrolytes
Ttt of malignant melanoma
★Mm is radioresistant
🌷Stage 1&1A
Sergical excision è safty margin
1cm if thickness<1mm
2cmif thickness 1-4mm
3cm if> 4 mm
🌷Stage 2 & 2B
Surgical excison + LN dissemination
+ Adjuvant therapy chemotherapy actinomycin D
Immunotherapy IL2 mainly
🌷Stage 3
Surgical excison + LN dissemination
+ Adjuvant therapy chemotherapy actinomycin D
Immunotherapy IL2 mainly
Hyperthermic regional perfusion with chemotherapeutic agent melphalan is now ttt of choice
Mention pfs of SCC & BCC
Scheme KAB³ 🧢 XERO👷 and marjolin 🧑🚀 ابيض،اسود
Radiation 🌄
Keratoacanthoma
Actinic keratosis
Bowns disease
Lupus vulgaris TB
HPV
Xeroderma pigmentosa
Marjolin ulcer
Leukoplakia
Chemicals like TAR arsenic
UV RAYS. Radiation exposure immunosuppression
Macroscopic and microscopic appearance of BCC
Macroscopic either nodule or ulcer (mc)
Nodule pearly white wih overling talengeitagia
Thin epiderms that may ulcerate dischargong serous fluid or pus
Ulcer rolled in edge LN not enlarged
Microscopic
Sheat of round prickle cells surrounded by low columnar basal cells pallisading seperated by fibrous stroma
Investigation and Ttt of BCC
The only line of spread is
★Investigations
Excisional Biopsy
Ct scan in infiltrative ulcers
★Ttt
Wide local Excisional with 5 mm safety margin
Closure of the defect by graft flap or direct closure
Radiotherapy by iridium or deep x ray surgery BCC is radiosensitive
For patient unfit for surgery
# near eye
Infiltrate or near bone
Recurrence after radiotherapy to avoid superselection
Other lines for small lesions
Cryosurgery. Topical 5 fluorouracil MOHs micrographic surgery+ frozen section
Photodynamic surgery
Local invasion
Mention types of BCC
Noduloulcerative MC type
Ulcerative
Cicatricial
Sclerosing
Infiltrative
Apparent
Polypoidal
Pigmented
Cystic
Superficial
Ttt of Scc
🌹Wide local Excision SM 1 cm
★If LN is not involved FU. Monthly
★If infiltrated or sentinel LN +ve block dissection
==>If near the 1ry tumor with excision of 1ry tumor
==>If away wait for 2- 4 wks to allow any tumor emboli to settle draining LN
🌹Radiotherapy
🌹Mohs
🌹Photodynamic surgery
🌹5 fluorouracil topical
🌹Cryosurgery especially ear ,eye lid
Indication of surgery in SCC
Recurrence after irradiation
Radioresistant
Small lesion
Near eye
Bone invasion
Marjolin ulcer
LN Dissection
Mention local complications of burn
early
Infection mostly by psedomonas and staph aures
Constricting eschar neck hand circumferential deep burn
Compartmental ś
Suffocation in face and neck burn dt laryngeal edema
Late
Hyper and hypopigmentation
Hypertrophic scar or keloid
Contracture if it over a joint
Marjolin ulcer
