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Surgery > Skin And Soft Tissue > Flashcards

Skin And Soft Tissue Flashcards

1
Q

Superficial cellular layer

A

Epidermis

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2
Q

Epidermis histology

A

Stratified squamous epithelium

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3
Q

Sublayers of epidermis

A

Horny
Granular
Spinous
Basal

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4
Q

Dermal epidermal junction

Anchors dermis to epidermis

A

Basal membrane

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5
Q

Thick layer of CT
Larger blood vessels and nerves
Primarily collagen type I (70%)
Contains dermal appendages housing pluripotent cells critical in wound healing

A

Reticular layer of dermis

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6
Q

Collagen provides

A

tensile stength

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7
Q

Cells found in epidermis

A

Melanocyte
Langerhan
Merkel

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8
Q

Found in dermis

A

Hair follicle
Sebaceous gland
Apocrine gland
Nerve cell (meissner and pacinian)

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9
Q

Meissner’s function

A

light touch

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10
Q

Pacinian function

A

pressure

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11
Q 
Cafe au lait
Neurofibroma
Iris hamartoma (lisch nodule)
optic glioma 
freckling of non-sun exposed areas (axilla)
inc risk of astrocytoma 
pheochromocytome
neurofibrosarcoma

Autosomal dominant
More common than other variant

Mutation in:

A

NF1
von Recklinghausen’s

NF1 gene ch17
Involved in Ras pathway

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12
Q

Bilateral vestibular CN VIII
Schwannoma
Intracranial or intraspinal tumor (glioma, meningioma)

Autosomal dominant
Involved in cytoskeleton

Mutations:

A

NF2

NF2 ch22

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13
Q

Adenoma sebaceum
Shagreen patch
Ash leaf macule
Hamartoma (brain, lung, kidney), epilepsy, mental retardation

Autosominal dominant
Sporadic

Involved in GTPase activity

Mutation

A

Tuberous sclerosis

TSC1 and TSC2 ch9 and 16

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14
Q 
GI polyp (ampullary SI, large intestine)
Desmoid tumor
Sebaceous cyst
Osteoma
Variant of FAP

AD

Involved in cell adhesion, interaction and cystokeleton

Mutation:

A

Gardner’s

APC ch5

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15
Q

=1 first of second degree relative with melanoma
multiple atypical mole
mole with specific microscopic features
assoc with increased risk of pancreatic cancer

Autosomal dominant

Involved in cell cycle progression througg G1 S transition

Mutation:

A

Familial atypical multiple mole melanoma
FAMMM

CDKN2A p16 ch9
CDK4 ch12

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16
Q

45, F
painful 5mm subungual, bluish nodule on right index finger
exacerbated with cold

Dx?
Tx?

A

Glomus tumor

Excision lateral approach

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17
Q

Benign digital tumor composed of bv and nerves from dermal glommus body

Regulates distal perfusion

Women, painful subungual, bluish nodule exacebated by cold

Blanching blue to purple nodule usually <1cm

Mistaken for hemangioma or VM

A

Glomus body

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18
Q

Glomus body most common location

A

subungual area

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19
Q

Fair skinned Caucasian Male upon sun exposure
Premalignant
Leads to SCC

A

Actinic keratosis

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20
Q

Benign appear with equal prevalence in male and female
May inc in size with pregnancy, hormone and malignancy
Unrelated to sun exposure

A

Seborrheic keratoses

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21
Q

Actinic keratoses tx

A

Excise lesion

topical 5 FU

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22
Q

Seborrheic keratitis tx

A

observation

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23
Q

Most common benign head and neck tumor in adult

Accelerated growth during first 2 years of age but involute and do not require therapy

50% spontaneously resolves by 5 years
70% by age of 7

A

Hemangioma

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24
Q

Hemangioma tx

A

Non surgical: intralesional steroid, IFNa-2a

Invasive: surgical excision, laser or cryotherapy and embolization

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25
Q

consumptive coagulopathy due to hemangioma
thrombocytopenia
DIC
CHF
persistence into adolescence as rate of spontaneous involution decreases

A

Kasabach-Meritt

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26
Q 
Inc with sun exposure
Tender
Face, back of hands, forearm sunexposed
Elevated, scaly or warty
Red-yellow, brown, black lesion
Hyperkeratotic scale
A

Actinic keratosis

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27
Q

Inc with pregnancy, hormone therapy, malignancy
Not affected by sun exposure
Non tender, pruritic
Chest, back and abdomen
Elevated, scaly, waxy oily plaque
Yellowish brown, brownish black stuck-on macule

A

Seborrheic keratosis

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28
Q

Inflammatory nodule associated with underlying systemic disease
UC, regional ileitis, RA, dysproteinemia, leukemia, lymphoma

Rapidly enlarging, erythematous, necrotic ulcer with purple edematous border involving LE

Identification of treatment of underlying systemic disease

A

Pyoderma gangrenosum

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29
Q

Pyoderma gangrenosum skin lesion tx

bowel disease

A

steroid
cyclosporine
skin graft

resection of affected bowel

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30
Q

Necrotic ulcer with violet border

Surrounding erythematous halo

A

Pyoderma gangrenosum

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31
Q

Benign overgrowth of melanocyte

Congenital or acquired

A

Benign nevus

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32
Q

Flat, elevated, veruccous, nodular brown, black or blue

Flat, nonpalpable brown lesion on palms and soles of infants

Elevated, dome shaped, pigmented

Elevated, skin-colored contain hair

Solitary brown or pink dome-shaped nodule on face or upper extremities

Blue to black dome shaped nodule

A

Congenital lesion

Junctional nevi

Compound nevi

Intradermal nevi

Spitz nevi

Blue nevi

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33
Q

Benign nevi is confirmed with

A

skin biopsy

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34
Q

Melanocyte proliferation at epidermal junction

A

Junctional nevi

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35
Q

Melanocyte proliferation only in dermis

A

Intradermal and blue nevi

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36
Q

Melanocyte proliferation both in dermis and epidermal-dermal junction

A

Compound nevi

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37
Q

Demonstrate largr number of mitoses

A

Spitz nevi

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38
Q

65, F
Forehead lesion
Notable 8mm with rolled border and underlying telangiectasia

Mx?

A

Surgical excision with 4mm margin likely basal cell ca

39
Q

Most common skin cancer

A

Basal cell

40
Q

Basal cell rf:

A 
exposure to UV radiation
p53 mutation
Fair skinned men (Celtic)
sunexposed areas (face)
occurs at any age but after fifth decade
41
Q

Slow growing transluscent
Shiny, pearly elevated nodule
Central ulceration with rolled pearly edges, scab, telangiectasia

A

Basal cell carcinoma

42
Q

Dx of basal cell carcinoma

A

Shave or punch biopsy of basal layer

43
Q

Basal cell carcinoma tx

A

Electrodissection and curettage for small lesion <2mm

Excision via Moh’s micrographic surgery for larger

Unable or willing to undergo surgery, consider radiation, topical 5FU, imiquimod or intralesional interferon

95% cured, metastases rare

44
Q

T1 staging basal cell

A

> /= 2 cm in greatest dimension

45
Q

> 2cm and >/=5 cm greatest dimension

A

T2

46
Q

> 5cm greatest dimension

A

T3

47
Q

invasion into extradermal structure

A

T4

48
Q

Second most common cancer in fair-skinned population

Occurs in sun-exposed aread (lower lip, backs of hands)

A

Squamous cell carcinoma

49
Q

Rf for SCC of skin

A 
UV, ionizing radiation exposure
actinic keratosis
Hydrocarbon 
Tobacco
Chronic infection (HPV)
Immunosupression
Burns (Marjolin’s ulcer)
Chronic, non healing wound
50
Q

Erythematous plaque or nodule
Associated with central ulceration or indistinct margin
Pain, bleeding or pruritus

A

SCC

51
Q

Confirms dx of SCC

A

Shave, punch, incisional or excisional biopsy

biopsy: atypical keratinocyte invading dermis associated with keratin pearls

52
Q

SCC in situ

A

Bowen disease

53
Q

SCC tx

A

Excise with 1cm margin
Lymph node excision indicated for palpable nodules

Metastasizes
85%, 3 year survival and dramatically dec if metastasis is present

54
Q

Leading cause of skin cancer related deaths

A

Melanoma

55
Q

Rf for melanoma

A

UV exposure
Family hx (FAMMM)
Congenital nevi
Fair skinned male with significant hx of sun exposure during teenage

56
Q

Sun exposed area (neck, face, back of hands)
Older
Best prognosis

A

Lentigo maligna

57
Q

Anywhere but palms and soles spared
Most common
Exhibits primarily radial growth

A

Superficial spreading

58
Q

Palms
Soles
Subungual
Least common, dark skinned population

A

Acral lentiginous

59
Q

Palms, soles or subungual
Most aggressive type
Lacks radial growth

A

Nodular

60
Q

ABCDEs of melanoma

A 
Asymmetry
Border (irregular, ill defined)
Color (pigmented)
Diameter (>6mm)
Evolution
61
Q

Pruritis in melanoma is suggestive of

A

neural invasion

62
Q

Confirms dx of melanoma

A

Excisional biopsy

WLE

63
Q

WLE for <1cm lesion

A

<1mm margin

64
Q

1-2cm lesion

A

1-2mm

65
Q

2 cm lesion

A

2-4mm

66
Q

2-3cm lesion

A

> 4mm

67
Q

Sentinel lymph node biopsy is warranted in melanomas

A

> 1mm without clinically + nodes or
0.75mm high risk signs (ulceration)

Lymph node dissection for clinically + nodes
Chemo not shown to be effective

68
Q

Improves disease free and overall survival in patients stage IIB or III

A

IFNalpha-2b

69
Q

Clark staging of melanoma

Level I

A

Epidermis

70
Q

Clark level II

A

upper half of papillary dermis

71
Q

Clark Level III

A

Epidermis + papillary dermis

72
Q

Clark Level IV

A

Epidermis to reticular dermis

73
Q

Clark level V

A

Epidermis, dermis, subcutaneosu tissue

74
Q

Breslow melanoma level 1

A

0.75 mm

75
Q

Breslow level II

A

0.76-1.5mm

76
Q

Breslow level III

A

1.51-3.0mm

77
Q

Breslow level IV

A

> 4mm

78
Q

Neuroendocrine lesion of dermis
Synchronous of metachronous SCC
Red purple painless nodule of head and neck

A

Merkel cell carcinoma

79
Q

Merkel cell carcinoma is +

A

IHC for neuron specific enolase NSE

Neurofilament protein

80
Q

Merkel cell tx

A

WLE with 3cm margin

lymph node dissection for palpable nodes

81
Q

Benign tumor from muscular fascial plane
3rd to 4th decade
Etiology not clear associated with Gardner prior surgery pregnancy

Asymptomatic, signs and symptoms related to compression or invasion

Confirm with biopsy: spindle cells with collagen

IHC + for smooth muscle actin, vimentin, desmin

High level of suspicion in FAP, Gardner’s

Tx: WLE with 2-4cm margin

A

Desmoid tumor

82
Q

Injury to superior or inferior epigastric vessel
Inc pressure or shearing force to rectus sheath in coagulation
Acute tender mass evident with tensing of rectus muscle

Dx: CT

Tx: pressure to hematoma and serial Hct

A

Rectus sheath hematoma

83
Q

Tensing of rectus muscle

A

Fothergill’s sign

84
Q

Most common bone malignancy
Young adult also in >40
Rf: radiation, Paget’s, chemotherapy

Bone pain, palpable mass with lung mets

Rx: Codman’s triangle with cortical destruction (sunburst sign)

Neoadjuvant, chemo, WLE 4cm
Limb salvage or ampu

A

Osteosarcoma

85
Q

Osteosarcoma affects

A

metaphyseal region of long bones

86
Q

Primitive neuroectodermal tumor
5-15 years
Pelvis, femur or humerus (diaphysis)
Due to ch 11-22 translocation

Malaise, fever, pain, edema

Rx: onion skinning

Chemo, radiation, radical resection

A

Ewing’s sarcoma

87
Q

Most common pediatric sarcoma
2-5 years, 15-19 years
Arises as mesenchyme differentiates into skeletal muscle

Palpable mass

Incisional biopsy, CT and MRI to determine primary site extent and histology

Chemotherapy, WLE

A

Rhabdomyosarcoma

88
Q 
AIDS
Immunosupression
Chemotherapy
HHV8
Most common AIDS related malignancy

Red to purple nodule or skin or mucosa
Biopsy

Chemoradiation, resection

A

Kaposi’s sarcoma

89
Q

1 year old boy
facial hemangioma

Correct management?

A

Observation, involute and not require further therapy

90
Q

38, F

UC with necrotic ulcer with violaceous border

A

Pyoderms gangrenosum

91
Q

60 M
Third degree burn to right LE 25 years ago

Chronic lesion at site of burnt scar

Dx

A

SCC Marjolin ulcer

92
Q

44 M
Pain and palpable mass of RLE
Codman’s triangle

Mx?

A

Osteosarcoma

Neoadjuvant chemotherapy
followed by WLE

93
Q

82 F
Purple nodule or right shoulder
+ NSE and neurofilament protein

Mx?

A

Merkel cell carcinoma

WLE with 3cm margin

LN dissection if palpable

Surgery (17 decks)

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