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ABS > SKIN & SOFT TISSUE > Flashcards

SKIN & SOFT TISSUE Flashcards

1
Q

Which sarcomas spread to lymph nodes more often

A

rhabdomyosarcoma
epithloid sarcoma
clear cell sarcoma
synovial sarcoma
vascular sarcoma

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2
Q

Pt with 10 cm mass in the root of small bowel mesentery - desmoid tumor. Treatment?

A

Watch and reimage in 3 months. Often remain stable in size for many years or even spontaneously regress

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3
Q

Hurley stage I (no sinus tracts or scarring) tx

A

clindamycin gel

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4
Q

cephalad limit for ilioinguinal lymphadenectomy

A

bifurcation of the CIA to internal and external iliacs

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5
Q

Caudad extent of ilioinguinal lymphadenectomy

A

inguinal ligament

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6
Q

inferior extemnt of inguinal lymphadenectomy

A

apex of the femoral triangle (defiened by adductor longus mediall and sartorius muscle laterally). Superior boundary is inguinal ligament.

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7
Q

Risk factors that warrant consideration for SLN bx in SCC

A

tumor >2 cm for trunk and extremities and >1 cm for face, scalp hands and feet
[poorly differentiated tumors
angiolymphatic invasion and perineural invasion
tumor depth >6 mm or invasion beyond subcutaneous fat
immunosuppressed

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8
Q

30% of all mets to skin are of what primary origin?

A

breast

70% of skin mets in women are from primary breast tumor

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9
Q

tx of clinically localized Merkel cell ca

A

resection with 1-2 cm margins and SLN bx

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10
Q

paronychial infection MCC

A

staph aureus

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11
Q

metastatic melanoma - tx

A

Pembrolizumab is a monoclonal antibody against PD-1 and has significantly increased long-term survival, up to 40% or more, for patients with metastatic melanoma. When combined with ipilimumab, this dual immunotherapy increases survival up to 50% or more.

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12
Q

Retroperitoneal sarcoma and RT

A

Neoadjuvant radiation for resectable retroperitoneal sarcoma (RPS) has been studied in a prospective, randomized clinical trial (STRASS trial). The rationale for a neoadjuvant approach is that often the RPS has mobilized the viscera within the abdomen to a large degree, and the appropriate radiation dose can thereby be delivered without the attendant toxicity to organs that may be spared during the course of resection. Conversely, the delivery of a therapeutic radiation dose in the adjuvant setting is often precluded because of toxicity incurred by surrounding viscera, namely bowel. Biologically speaking, radiation is biologically more effective in the neoadjuvant setting due to optimal oxygen tension of the tissue relative to the postoperative setting.

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13
Q

What feature of dermatofibrosarcoma protuberans increases the metastatic potential?

A

If it has fibrosarcomatous change - usually mets to lungs

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14
Q

What is the main cell type in epidermis? Where does it originate from?

A

Keratinocytes originate from basal layer - provide mechanical barrier

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15
Q

Melanocytes are of what origin? Where are they found?

A 
Neuroectdermal origin (neural crest cells) in basal layer of epidermis
Havge dendritic processes that transfer melanin to neighboring keratinocytes via melanosomes. The density is the same among races but melanin production is different
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16
Q

Sensory nerves - pressure

A

pacinian corpuscles

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17
Q

Sensory nerves - warmth

A

Ruffinis endings

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18
Q

Sensory nerves - cold

A

Krause’s end bulbs

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19
Q

Sensory nerves - tactile sense

A

Meissner’s corpuscles

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20
Q

Which sweat glands responsible for aqqueous sweat?

A

Eccrine - thermal regulation, usually hypotonic

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21
Q

Which sweat glands responsible for milky sweat?

A

Apocrine

Highest concentration in palms and soles; most result of SNS via acetylcholine

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22
Q

TRAM flaps rely on what vessel

A

superior epigastric

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23
Q

Most impt determinant of TRAM flap viability

A

periumbilical muscle perforators

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24
Q

hypertrophic scar - which type of collagen?

A

organized type III collagen

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25
Q

keloid scar - which type of collagen?

A

disorganized I/III collagen

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26
Q

Hypertrophic or keloid scars stay within boundaries?

A

hypertrophic

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27
Q

Single beset factor for protecting skin from UYV radiation

A

Melanin

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28
Q

Responsible for chronic sun damage

A

UV B

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29
Q

Familial BK mole syndrome gives what risk for melanoma?

A

Almost 100%

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30
Q

MC location for distant melanoma mets

A

Lung

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31
Q

MC met to small bowel

A

melanoma

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32
Q

<2 cm lesion concerning for melanoma - biopsy type?

A

Excisional (Tru-Cut core needle biopsy)

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33
Q

When are 0.5 cm margins appropriate in melanoma?

A

Melanoma in situ or thin lentigo maligna (Hutchinson’s freckle) – just in the epidermis

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34
Q

Least aggressive melanoma subtype

A

lentigo maligna melanoma

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35
Q

Most aggressive melanoma subtype

A

Nodular. Most likely to have mets at time of dx. Deepest growth at time of dx. Vertical growth 1st.

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36
Q

Staging for melanoma >1 mm

A

CT C/A/P, LFTs and LDH

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37
Q

When do you excise LN in melanoma?

A

If clinically positive or if SLNBx positive

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38
Q

What do you need to include for all scalp/face melanomas anterior to the ear and above the lip >1 mm deep

A

superficial parotidectomy

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39
Q

Axillary node melanoma with no other primary - tx?

A

Complete ALND (level I-III)

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40
Q

First line chemo for metastatic melanoma

A

Dacarbazine

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41
Q

Where does BCC originate?

A

Epidermis (basal epithelial cells and hair folicles)

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42
Q

Path shows peripheral palisading of nuclei and stromal retraction - dx?

A

BCC

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43
Q

Most aggressive BCC

A

Morpheaform type. Has collagewnase production

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44
Q

Margins for BCC

A

0.3-0.5 cm

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45
Q

Margins for SCC

A

0.5-1.0 cm except in Marjolin’s ulcers (2 cm) and penile/vulvar areas)

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46
Q

MC soft tissue sarcoma

A

malignant fibrous histiocytoma

47
Q

What comes first when concern for sarcoma?

A

MRI before biopsy

48
Q

What can you give to decrease size of dermatofibrosarcoma protuberans

A

Imatinib

49
Q

Spindle cells containing CD34

A

DFS protuberans

50
Q

Margins for DFS protuberans

A

2 cm

51
Q

Excisional biopsy for sarcomas < what size?

A

<4 cm

52
Q

MC site of sarcoma met

A

Lung

53
Q

Staging of sarcomas is based on?

A

grade (tumor grade is also most important prognostic factor)

54
Q

What margins do you want for sarcoma?

A

2-3 cm and at least 1 uninvolved fascial plane. Place clips to mark site of likely recurrence

55
Q

Post op XRT for sarcoma when?

A

High grade tumors
Close margins
Tumors > 5 cm

56
Q

Chemotherapy for sarcoma

A

Doxorubicin (adriamycin) based

57
Q

What size sarcoma may benefit from pre op chemo/XRT?

A

> 10 cm

58
Q

Isolated sarcoma mets

A

Resect if no other evidence of systemic disesase

59
Q

Most impt prognostic factor in retroperitoneal sarcoma

A

Ability to completely remove tumor

60
Q

MC retroperitoneal tumor

A

Lymphoma

61
Q

Risk factor for angiosarcoma

A

PVC, arsenic

62
Q

MC sites for Kaposi’s sarcoma

A

Oral and pharyngeal mucosa

63
Q

MC malignancy in AIDS

A

Kaposi’s sarcoma

64
Q

Primary goal in tx of Kaposi’s

A

palliation

AIDS Tx shrinks AIDS related KS

65
Q

Disseminated Kaposi’s sarcoma tx

A

Interferon alpha

66
Q

Local disease tx for Kaposi’s sarcoma

A

XRT or intra lesional vinblastine

67
Q

1 soft tissue sarcoma in kids

A

Rhabdomyosarcoma

68
Q

Most common rhabdomyossarcoma in kids

A

embryonal

69
Q

Worst prognosis rhabdomyosarcoma in kids

A

Alveolar

70
Q

Rhadomyosarcoma contains what protein

A

Desmin

71
Q

Tx for childhood rhabdomyosarcoma

A

Surgery; doxorubicin based chemo

72
Q

Osteosarcoma originates from what type of cells

A

Metaphyseal cells

73
Q

Neurofibromatosis - what types of tumors

A

CNS, peripheral sheath tumors, pheo

74
Q

Li-Fraumeni syndrome - what type of soft tissue tumor?

A

rhabdomyosarcoma

75
Q

Tuberous sclerosis is assoc with what soft tissue tumor

A

angiomyolipoma

76
Q

Tx for actinic keratosis

A

Diclofenac sodium; liquid nitrogen

77
Q

Arsenical keratosis is assoc with>

A

SCC

78
Q

Merkel cell CA - what proteins?

A

neuron-specific enolase, cytokeratin, neurofilament

79
Q

What is ineffective in merkel cell cA?

A

chemo. can consider if curative sx or XRT not feasible

80
Q

MC site of glomus cell tumor

A

terminal aspect of the digit

81
Q

Tx of desmoid tumor if vital structures involved or too much bowel taken

A

chemotherapy with sulindac, tamoxifen

82
Q

Tx of Bowen’s disease

A

imiquimod, cautery ablation, topical 5-FU. AVOID WLE if possible. Regular bx to r/o CA

83
Q

Worsening nodular cellulitis often mistaken for a fungal infection - name and what bug?

A

Botryomycosis is due to local inoculation of bacteria into the wound of an immunocompromised patient. It presents as a worsening, nodular cellulitis and is often mistaken for a fungal infection (hence the “mycosis”), but it is actually most often due to S aureus.

84
Q

Sandfly byte

A

Leishmaniasis

85
Q

Touching contaminated plant matter - “rose gardener’s disease”

A

Sporotrichosis - infection due to fungus, Sporothrix schenckii. Cutaneous form usually appears as red or pink bumps but can progress to slow healing ulcer.

86
Q

LRINEC score

A 
WBC > 15
Na < 135
CRP > 150
Cr > 1.6
Glucose > 180
Hgb < 13.5
87
Q

T1 sarcoma

A

<5 cm

88
Q

T4 sarcoma

A

> 15 cm

89
Q

Stage I and II melanoma - additional workup for staging?

A

None

90
Q

MC short term complication 2/2 inguinal lymph node dissection

A

Wound infection

91
Q

MCC lymphangitis

A

S pyogenes

92
Q

Merkel cell CA a/w what virus

A

Polyomavirus

93
Q

Bridging node between deep and superficial LN basins (inguinal)

A

Cloquet

94
Q

Where can you find saphenous vein in a superficial inguinal lymphadenectomy

A

Junction of sartorius and adductor

95
Q

What nerve runs under fascia of sartorius (superficial ILND)

A

lateral femoral cutaneous

96
Q

Where does the obturator nerve run between?

A

External and internal iliac

97
Q

MC monomicrobial cause of nec fasc

A

group a beta hemolytic strep

98
Q

MCC nec fasc

A

polymicrobial

99
Q

partial thickness nuclear pleomorphism

A

AK

100
Q

DFSP commonly shows immune reactivity to CD?

A

CD34

101
Q

Hurley Stage I

A

single or multiple nodules or abscesses, absence of sinus tracts and scarring

102
Q

Hurley Stage II

A

recurrent abscesses, sinu stracts, scarring

103
Q

Hurley STage III

A

interconnections between recurring abscesses and coalesced sinus tracts
diffuse disease

104
Q

Clinical signs of subungual melanoma

ABC

A

ABCDEF
Age (40-60)
Band of brown/black color >3 mm with irregular borders
Change in size of band
Digits involved
Extension of pigmentation to nail fold (Hutchison)
Family hx of melanoma

105
Q

What is keratoacanthoma

A

Rare clinical variant of SCC which presents with painful onycholysis as well as digital erythema and swelling

106
Q

Drugs that commonly cause TEN or SJS

A

sulfonamides
aminopenicillins
anticonvulsants
NSAIDs
allopurinal

107
Q

How to treat dopamine extravasation

A

Infiltrate ASAP with 10-20 mL of NS containing 10 mg of phentolamine

108
Q

Markers for melanoma

A

HMB 45
Melan-A
S-100
MITF
SOX-100

109
Q

Merkel cell stains + for what and - for what

A

+ for CK20
- for TTF-1 (which differentiates it from small cell lung CA)

110
Q

dense proliferation of spindle shaped tumor cells from the dermis to the subcutaneous adipose tissue wit hsparing of the epidermis

A

dermatofibrosarcoma protuberans

111
Q

tumor cells stain positive for CD34 and vimentin

A

dermatofibrosarcoma protuberans

112
Q

finger like projections fo spindle cells

A

dermatofibrosarcoma protuberans

113
Q

ABCD classification is poor sensitivity for what type of melanoma

A

nodular

ABS (23 decks)

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