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Surgery > Plastics > Flashcards

Plastics Flashcards

1
Q

What is a malignant melanoma?

A

malignant neoplasm of melanocytes

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2
Q

RFs for malignant melanoma?

A

Fitzpatrick skin type 1 and 2
pale skin, freckles, fair hair
multiple benign naevi
atypical naevi
UV exposure
FHx
personal Hx
immunosuppression

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3
Q

Presentation of melanoma?

A

ABCDE
palpable lymph nodes (may be only clinical feature)

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4
Q

Glasgow system of grading melanoma?

A

major (2 points):
change in size
irregular pigment
irregular border

minor (1 point):
diameter >7mm
inflammation
oozing, bleeding, crusting
itching, altered sensation

3 or more points needs referral

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5
Q

DDx for malignant melanoma?

A

junctional or compound naevi
cherry angioma
pigmented BCC
seborrheic keratosis
Kaposi sarcoma

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6
Q

Most important prognostic factor in malignant melanoma?

A

Breslow thickness (depth)

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7
Q

Subtypes of malignant melanoma?

A

superficial spreading melanoma
nodular melanoma
lentigo Maligna melanoma
acral lentiginous melanoma
other rare types

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8
Q

Features of superficial spreading melanoma?

A

most common type in Caucasians
70% of cases
legs for females, back for males

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9
Q

Features of nodular melanoma?

A

15-30%
more common in males on the trunk
black/brown nodule with ulceration and bleeding
poor prognosis

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10
Q

Features of lentigo maligna melanoma?

A

aka Hutchinson’s freckle
common in elderly and on face
least aggressive form
takes years before invasion occurs

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11
Q

Features of acral lentiginous melanoma?

A

5%
most common in dark-skinned population
occurs on palms and soles
can occur under nail plate (subungual)

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12
Q

Investigations for malignant melanoma?

A

excision biopsy with 2mm margin for histology
sentinel node biopsy if Breslow thickness >0.8mm
staging CT if >1mm thickness

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13
Q

Mx of melanoma?

A

WLE with margin of 1-3cm
if sentinel node biopsy positive -> lymphadenectomy

ipilimumab for mets

recurrence -> surgical excision, CO2 laser, isolated chemotherapeutic limb perfusion

radiation for palliative

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14
Q

What is a BCC?

A

basal cell carcinoma
‘rodent ulcer’
most common non-melanoma skin cancer

slow growing, mets rare, but can cause extensive local damage

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15
Q

What is SCC?

A

squamous cell carcinoma
keratin cells
second most common NMSC

higher mortality than BCC, mets more common via lymphatics
lesions on lip, ear and perineum mets early

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16
Q

RFs for BCC and SCC?

A

exposure to sunlight
fair skin
light hair
blue or green eyes
male
FHx
immunosuppression
smoking
previous BCC

17
Q

Prevention of BCC and SCC?

A

minimise sun exposure
sun cream
protective clothing

early detection and appropriate management

18
Q

Presentation of BCC?

A

shiny, translucent, pearly papule or nodule
raised edges
bleeding, oozing, crusting
ulceration
telangiectasia

19
Q

Presentation of SCC?

A

hyperkeratotic indurated crusted nodule
reddish, scaly patch or plaque
ulcerated
may bleed

20
Q

Mx of BCC?

A

depends on size, depth and location

surgical excision -> simple excision or Mohs micrographic surgery

cryotherapy/curettage
radiotherapy if unfit for surgery

topical creams (imiquimod or 5-FU for small superficial lesions)

21
Q

Mx of SCC?

A

excision of primary tumour with a 5-10mm clearance
block dissection of affected lymph nodes if lymphatic involvement

radiotherapy for unresectable tumours

cryotherapy/curettage

topical creams (5-FU) for small superficial lesions

22
Q

Prognosis of BCC?

A

previous BCC diagnosis increases risk of having recurrent BCCs within 3yrs by 40%

23
Q

Prognosis of SCC?

A

good, 95% of patients remaining disease free at 5 years in those with clear margins

24
Q

Severity of burns depends on?

A

depth
size
location
patient risk factors

25
Q

Depth of a burn?

A

epidermal (erythematous, shiny, painful, brisk cap refill)
partial thickness (dark red, blotchy, blisters, slow cap refill, may not have any sensation)
full thickness (leathery appearance, white, no cap refill, no sensation)

26
Q

Rule of Nines in burns?

A

each arm 9%
each anterior leg 9%
each posterior leg 9%
anterior trunk 18%
posterior trunk 18%
head 9%
perineum 1%

27
Q

What is the Parkland formula used for?

A

to calculate fluid replacement in patients with burns

28
Q

What is the Parkland formula?

A

4ml x kg x %TBSA

half of the fluid in first 8hrs, other half in 16hrs

29
Q

Mx of burns?

A

early aggressive fluid resuscitation
IV analgesia and sedatives
tetanus immunisation
topical ABx
PPIs
DVT prophylaxis

conservative (small superficial or mixed partial thickness burns): simple dressings changed infrequently

surgery:
burn is excised down to healthy viable tissue
reconstruction with skin graft (split thickness in most places, full thickness in hand and face)

30
Q

Complications of burns?

A

circumferential burns can act like a tourniquet
respiratory compromise
renal compromise secondary to acute tubular necrosis
infection

Surgery (10 decks)

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