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Skin Flashcards

1
Q

Margins needed for basal cell carcinoma?

A

0.5 cm

LN dissection only needed with clinically palpable nodes

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2
Q

SE of silver nitrate?

A

Electrolyte derangements and methemoglobinemia

It’s painful too

No eschar penetration

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3
Q

Benefits of mafenide acetate?

A

Great eschar penetration
Broad activity

Painful

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4
Q

SE of silver sulfadiazine?

A

Leukopenia

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5
Q

Cutaneous melanoma subtypes;

A
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6
Q

Management of positive SLNDBx in cutaneous melanoma?

A

Historically it was completion lymphadenectomy

Has changed to US surveillance to inguinal area every 3 months

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7
Q

Marjolin ulcers?

A

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

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8
Q

Precursor lesions to squamous cell?

A

Actinic keratosis

If single lesion, usual cryotherapy is sufficient for removal

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9
Q

MC skin malignancy?

A

Basal cell

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10
Q

Bowen dx?

A

Actinic keratosis —-> Bowen dx (carcinoma in situ)—-> Squamous cell ca

Need 4-6 mm margins with Bowen dx

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11
Q

Flesh colored lesion, commonly seen over trunk, extremities, head, neck and associated with translocation 17:22, with genes PDFG, COL1A1:

A

Dermatofibrosarcoma protuberans

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12
Q

Extra intestinal manifestation of inflammatory bowel dx, seen in pre-tibial region;

A

Pyoderma gangrenosum

Improves after colectomy

Starts chronically and progresses

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13
Q

MC complication after inguinal lymph node dissection?

A

Lymphedema

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14
Q

Pearly lesion with rolled edges, can be pink/brown/black?

A

Basal cell carcinoma

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15
Q

Tx for basal cell carcinoma?

A

Excision w/0.5 cm margins

LNs are not part of resection in absence of palpable nodes

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16
Q

Red crusty lesions; precursors to squamous cell ca:

A

Actinic keratosis

Tx is cryoabalation if few or isolated

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17
Q

STSG are made of what?

A

Epidermis and some dermis

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18
Q

MCC of death in pts with TEN?

A

Sepsis

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19
Q

Boundaries of femoral triangle for a superficial lymphadenectomy in the groin?

A

Sartorius laterally
Adductor longus medially
Inguinal ligament superiorly

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20
Q

How do skin grafts survive in the recipient site?

A

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

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21
Q

4 types of necrotizing soft tissue infections:

A

I; polymicrobial
II: mono (GAS, staph)
III: Marine (vibrio, clostridial)
IV: fungal (candida)

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22
Q

MC type of cutaneous melanoma?

A

Superficial spreading

(Least common is acral)

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23
Q

Antibiotic ointment effective against gram negative organisms, easy to use, painless, and shown to increase re-epithelialization;

A

Bacitracin/polymyxin b/neomycin

24
Q

Mupirocin?

A

Good for gram positive, no gram negative coverage

No eschar penetration

25
Q

Good eschar penetration, very painful, broad activity;

A

Mafenide acetate

26
Q

SE of silver sulfadiazine>

A

Leukopenia

27
Q

SE of silver nitrate?

A

Methemoglobinemia and electrolyte derangements

28
Q

Gradually enlarging flesh colored mass growing over the trunk, sometimes head, neck, extremities;

A

Dermatofibrosarcoma pertuberans

29
Q

Genetics of dermatofibrosarcoma protuberans?

A

Translocation 17;22, 11q13
PDGF-b, COL1A1

30
Q

How do we diagnose and tx dermatofibrosarcoma protuberans?

A

Skin biopsy in addition to an incisional biopsy (has roots underneath)

Tx is wide local excision with 2-4 cm margins or Mohs

31
Q

What are the dominant cells in a wound early on?

A

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

32
Q

Scaly, irregular, dark brown lesions over sun exposed areas seen in elderly people; precursor lesion to squamous cell carcinoma;

A

Actinic keratosis

33
Q

For melanoma, when do we perform a sentinel lymph node biopsy?

A

For lesions >0.8 cm

For lesions < 0.8 cm but they have ulceration

34
Q

Breslow and Clark staging for melanoma:

A

Breslow stages examine depth of tumor growth

Clark stages the depth of tumor growth by relating it to the skin layers

35
Q

This skin Ca may be associated with polyomavirus;

A

Merkel cell

36
Q

Tx for Merkel Cell Ca?

A

Wide local excision, sentinel lymph node biopsy and adjuvant radiation

37
Q

Management of positive sentinel lymph nodes on cutaneous melanoma?

A

Previously a completion inguinal lymphadenectomy was done

New trials show surveillance with US every 3 months has similar outcomes with reduced morbidity

38
Q

FAMM?

A

Dysplastic Nevus syndrome

> 50 dysplastic nevi + family member hx of melanoma

Autosomal dominant

39
Q

Full-thickness skin grafts;

A

Contain epidermis and full dermis

Have less secondary contracture 2/2 containing all dermis

40
Q

Angiosarcoma of the breast after radiation?

A

Rare cancer that develops after radiation for breast cancer

Dark, purple lesion (vascular tumors)

41
Q

Hurley staging for Hidradenitis:

A

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

42
Q

Tx for Hidradenitis?

A

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

43
Q

Gardner syndrome?

A

Epidermal cysts
GI polyps
Osteomas

44
Q

Bowen dx?

A

In situ squamous cell carcinoma of penis

Need excision with 4-6 mm margins

45
Q

Most common non-melanoma skin Ca?

A

Basal cell

46
Q

MCC cancer of lower lip?

A

SCC

Sun exposure is greatest risk factor

47
Q

MC parotid neoplasms?

A

Pleomorphic adenoma; benign

48
Q

MC malignant parotid tumor?

A

Mucoepidermoid carcinoma

49
Q

Initial test of choice to measure for carcinoid syndrome?

A

24-hr urine HIAA levels

50
Q

MC location of an ectopic superior parathyroid gland?

A

Tracheosophageal groove

51
Q

Breslow thickness;

A

Used for melanoma thickness staging

T1; <1 mm’
T2; 1-2 mm
T3; 2-4 mm
T4; >4 mm

52
Q

Interventions for hemangiomas that are causing ophthalmic obstruction?

A

First line is propranolol; steroids can be considered

53
Q

How do we diagnose melanoma?

A

Full thickness skin bx (punch, elliptical excisional, saucerization)

54
Q

N staging for melanoma:

A

N1; 1 node
N2; 2-3 nodes
N3; >4 nodes

55
Q

FDA approved adjuvant therapy for stage IIB-III melanoma following resection:

A

Interferon-alpha 2b

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