Skin, Soft Tissue Flashcards
MCC pedicled, or anastamosed free flap necrosis
Venous thrombosis
Tissue expansion occurs by
Local recruitment, thinning of dermis and epidermis, mitosis
TRAM flaps
Complications – flap necrosis, ventral hernia, infection, abdominal wall weakness
- Rely on superior epigastric vessesls
Pressure sore stages
I: Erythema and pain
II: Partial skin loss with yellow debris
III: Full thickness, subcutaneous fat exposure [sharp debridement]
IV: bony cortex; muscle; adipose tissue; tendon [myocutaneous flap]
Single best factor for protecting skin from UV radiation
Melanin
UV a or b is responsible for chronic sun damage
UVB
Risk factors for melanoma
Dysplastic, atypical, large congenital nevi
What syndrome results in 100% risk of malnoma
Familial BK mole syndrome
MC site of melanoma on men vs. women
Men: Back
Women: Legs
From what cell layer does melanoma originate?
Neuroal crest cells (melanocytes) in basal layer
What color melanoma is most ominous?
Blue
Most common location for distant melanoma mets
Lung
Most common mets to small bowel
Melanoma
What stains do you use for melanoma?
S-100 and HMB-45 proteins
< 2 vs > 2 cm melaoma
Excisional; incisional bx
Most aggressive type of melanoma
Nodular; most likely to have metastsized at time of diagnosis
Staging of melanoma
CAP CT; LFTs; LDH
Surgical margins for melanoma excision
In situ (0.5 cm); Thin <1mm (1 cm); Intermediate 1.1-2mm (1-2 cm); Thick >2mm (2 cm)
When do you need to resect nodes with melanoma?
Clinically positive; SLNB+
When do you perform SLNB with melanoma?
Clinically node negative disease and tumor > 1mm deep
For all scalp melanomas anterior to the ear and above the lip…
Need to include superficial parotidectomy
First-line CTX for metastatic melanoma
Dacarbazine
T/F Il-2 and tumor vaccines can be used for systemic disease
True
80% Basal Cell Ca is located…
H+N
Pearly appearance, rolled borders, slow and indolent growth is characteristic of what type of skin cancer
BCC
Pathology of basal cell carcinoma
Peripheral palisaiding of nuclei and stromal retraction
What size margins for basal cell carcinoma?
0.3-0.5 cm margins
Most aggrsesive type of basal cell carcinoma
Morpheaform type
Old burn scars can predispose to this kind of skin cancer
SCC
Margins for SCC
0.5-1cm margins
1 soft tissue sarcoma
1 malignant fibrous histiosarcoma
Do you do an MRI before biopsy of a soft tissue sarcoma?
Yes – to rule out vascular, neuro or bone invasion
How do sarcomas spread
Through blood
Post-op CTX for soft tissue sarcomas
Doxorubicin
Chronic lymphedema can pre-dispose to
Lymphangiosarcoma
Syndrome a/w childhood rhabdomyosarcoma
Li-Fraimeni
Tuberous sclerosis is a/w which sarcoma
Angiomyolipioma
Most common mesenchymal tumor
Lipoma
