Skin and Soft Tissue Disorders & Hernias Flashcards
Hutchinson freckle
large, macular brown lesion on the cheek, may be present for many years or decades and is a precursor for lentigo malignant melanoma
management of Hutchinson freckle
close observation looking for changes
malignant melanoma on the sole of the food
acral-lentiginous melanoma - MC in dark-skinned pts; tend to be thicker with poorer prognosis
tx. of subungual melanoma
amputation at the DIP
tx. of anal melanoma
thick lesions require abdominoperineal resection of the anorectum
- very poor prognosis
Characteristics of basal cell carcinoma (4)
Waxy, raised lesion or punched out ulcer
Indolent, slow growing
Does not metastasize - no enlarged LN
Preference for upper face
Diagnosis of basal cell carcinoma
Full thickness biopsy at edge of lesion (punch or knife)
Tx. Basal cell carcinoma
Surgical excision with clear margins (1mm; 2-4 mm for larger, more aggressive lesions)
Topical 5FU or radiation may also be used
Non-healing indolent ulcer on the lower lip that has been enlarging for 8 months
Consider squamous cell carcinoma
Diagnosis of squamous cell carcinoma of skin
Full thickness biopsy at edge of lesion
Tx. Squamous cell carcinoma
Surgical resection with wider margins (1 cm)
If palpable LN, need to do node dissection
Local radiation also an option
When can you do an incisional biopsy of melanoma?
If lesion is > 2-3 cm or if the lesion is contiguous with important structures on the face
What are the excision margins for melanoma?
1 mm for superficial melanoma
2-3 cm margin if deep melanoma
Tx of in situ melanoma
Re- excise lesion with 0.5-1 cm margin of normal tissue
What is a common presentation of melanoma mets
Mets to peritoneal cavity and viscera - common presentation is small bowel obstruction.
- exploration indicated and prognosis is poor
