Skin Flashcards
Margins needed for basal cell carcinoma?
0.5 cm
LN dissection only needed with clinically palpable nodes
SE of silver nitrate?
Electrolyte derangements and methemoglobinemia
It’s painful too
No eschar penetration
Benefits of mafenide acetate?
Great eschar penetration
Broad activity
Painful
SE of silver sulfadiazine?
Leukopenia
Cutaneous melanoma subtypes;
Management of positive SLNDBx in cutaneous melanoma?
Historically it was completion lymphadenectomy
Has changed to US surveillance to inguinal area every 3 months
Marjolin ulcers?
Cutaneous Ca that arises in area of previously injured skin, chronic wound, scar
2% of burn scars undergo malignant transformation
Squamous cell is the most common Ca identified
Highly malignant and require complete excision when identified
Precursor lesions to squamous cell?
Actinic keratosis
If single lesion, usual cryotherapy is sufficient for removal
MC skin malignancy?
Basal cell
Bowen dx?
Actinic keratosis —-> Bowen dx (carcinoma in situ)—-> Squamous cell ca
Need 4-6 mm margins with Bowen dx
Flesh colored lesion, commonly seen over trunk, extremities, head, neck and associated with translocation 17:22, with genes PDFG, COL1A1:
Dermatofibrosarcoma protuberans
Extra intestinal manifestation of inflammatory bowel dx, seen in pre-tibial region;
Pyoderma gangrenosum
Improves after colectomy
Starts chronically and progresses
MC complication after inguinal lymph node dissection?
Lymphedema
Pearly lesion with rolled edges, can be pink/brown/black?
Basal cell carcinoma
Tx for basal cell carcinoma?
Excision w/0.5 cm margins
LNs are not part of resection in absence of palpable nodes
Red crusty lesions; precursors to squamous cell ca:
Actinic keratosis
Tx is cryoabalation if few or isolated
STSG are made of what?
Epidermis and some dermis
MCC of death in pts with TEN?
Sepsis
Boundaries of femoral triangle for a superficial lymphadenectomy in the groin?
Sartorius laterally
Adductor longus medially
Inguinal ligament superiorly
How do skin grafts survive in the recipient site?
Imbibition; graft absorbs nutrients by diffusion
inosculation; by day 3, vessels on underside of dermis begin to form connections to vessels on recipient site
angiogenesis; by day 5, new blood vessels grow into the graft
4 types of necrotizing soft tissue infections:
I; polymicrobial
II: mono (GAS, staph)
III: Marine (vibrio, clostridial)
IV: fungal (candida)
MC type of cutaneous melanoma?
Superficial spreading
(Least common is acral)
Antibiotic ointment effective against gram negative organisms, easy to use, painless, and shown to increase re-epithelialization;
Bacitracin/polymyxin b/neomycin
Mupirocin?
Good for gram positive, no gram negative coverage
No eschar penetration
Good eschar penetration, very painful, broad activity;
Mafenide acetate
SE of silver sulfadiazine>
Leukopenia
SE of silver nitrate?
Methemoglobinemia and electrolyte derangements
Gradually enlarging flesh colored mass growing over the trunk, sometimes head, neck, extremities;
Dermatofibrosarcoma pertuberans
Genetics of dermatofibrosarcoma protuberans?
Translocation 17;22, 11q13
PDGF-b, COL1A1
How do we diagnose and tx dermatofibrosarcoma protuberans?
Skin biopsy in addition to an incisional biopsy (has roots underneath)
Tx is wide local excision with 2-4 cm margins or Mohs
What are the dominant cells in a wound early on?
Platelets are the first cells that come to the wound to help form a clot
Neutrophils* in first 24-48 hrs
Macrophages in first 48-72 hrs
Scaly, irregular, dark brown lesions over sun exposed areas seen in elderly people; precursor lesion to squamous cell carcinoma;
Actinic keratosis
For melanoma, when do we perform a sentinel lymph node biopsy?
For lesions >0.8 cm
For lesions < 0.8 cm but they have ulceration
Breslow and Clark staging for melanoma:
Breslow stages examine depth of tumor growth
Clark stages the depth of tumor growth by relating it to the skin layers
This skin Ca may be associated with polyomavirus;
Merkel cell
Tx for Merkel Cell Ca?
Wide local excision, sentinel lymph node biopsy and adjuvant radiation
Management of positive sentinel lymph nodes on cutaneous melanoma?
Previously a completion inguinal lymphadenectomy was done
New trials show surveillance with US every 3 months has similar outcomes with reduced morbidity
FAMM?
Dysplastic Nevus syndrome
> 50 dysplastic nevi + family member hx of melanoma
Autosomal dominant
Full-thickness skin grafts;
Contain epidermis and full dermis
Have less secondary contracture 2/2 containing all dermis
Angiosarcoma of the breast after radiation?
Rare cancer that develops after radiation for breast cancer
Dark, purple lesion (vascular tumors)
Hurley staging for Hidradenitis:
I: abscess with no tracts or sinuses
II: recurrent abscesses with tracts and sinuses
III: diffuse involvement with multiple interconnected sinus tracts and abscesses, with little normal skin left
Tx for Hidradenitis?
For stage I; PO tetracyclines, metformin, topic Linda
For stage II/III disease that has failed initial management, biological TNF inhibitors like infliximab and adalimumab are next
Gardner syndrome?
Epidermal cysts
GI polyps
Osteomas
Bowen dx?
In situ squamous cell carcinoma of penis
Need excision with 4-6 mm margins
Most common non-melanoma skin Ca?
Basal cell
MCC cancer of lower lip?
SCC
Sun exposure is greatest risk factor
MC parotid neoplasms?
Pleomorphic adenoma; benign
MC malignant parotid tumor?
Mucoepidermoid carcinoma
Initial test of choice to measure for carcinoid syndrome?
24-hr urine HIAA levels
MC location of an ectopic superior parathyroid gland?
Tracheosophageal groove
Breslow thickness;
Used for melanoma thickness staging
T1; <1 mm’
T2; 1-2 mm
T3; 2-4 mm
T4; >4 mm
Interventions for hemangiomas that are causing ophthalmic obstruction?
First line is propranolol; steroids can be considered
How do we diagnose melanoma?
Full thickness skin bx (punch, elliptical excisional, saucerization)
N staging for melanoma:
N1; 1 node
N2; 2-3 nodes
N3; >4 nodes
FDA approved adjuvant therapy for stage IIB-III melanoma following resection:
Interferon-alpha 2b
