Skin/Soft Tissue

Question 1

What is Toxic epidermal necrolysis (TEN)?

Answer 1

life threatening condition marked by dermoepidermal separation resulting in FULL thickness epidermis loss

Question 2

What are symptoms of toxic epidermal necrolysi (TEN)?

Answer 2

fever and URI for 1 week prior to rash –> stomatitis, conjunctivitis and pruritis 24-48 hours before rash –> painful erythema that covers epidermis that will slidde and separate from skin with light pressure (Nikolsky sign)

Question 3

What are top 3 causes of toxic epidermal necrolysis (TEN)?

Answer 3

#1) antibiotics (40%)
#2) anticonvulsants (11%)
#3 analgesics (5-23%)

Question 4

Most common cause of death for toxic epiermal necrolysis (TEN)?

Answer 4

overwhelming sepsis

Question 5

Treatment for toxic epidermal necrolysis?

Answer 5

admission o burn unit if severe
cyclosprine
cyclophosphamide
plasma exchange
immunoglobulin administration

Question 6

What are risk factors for melanoma?

Answer 6

ultraviolet light (B>A)
genetic factors (CDKN2a Mutation = 67% lifetime risk, etc)
personal history of melanoma
family history
atypical nevi
>50 common nevi
red hair
high density freckles
light eye color
albinism

Question 7

Which genetic mutations place you at increase risk for melanoma?

Answer 7

CDKN2A (67% lifetime risk)
xeroderma pigmentosum (20%)
Familial atypical multiple mole and melanoma (FAMM) syndrome (100%)

Question 8

What is the treatment for stage IV melanoma?

Answer 8

anti-CTLA-4 antibodies (ipilimumab)

Question 9

Inflamed epidermoid cyst, when and how should you excise?

Answer 9

Wait for inflammation to resolve –> then perform elliptical, punch or linear incision with excision of cyst wall.

Note: punch/linear incision is preferred for the face

Question 10

Squamous cell carcinoma of the anus –> Treatment?

Answer 10

5-FU + Mitomycin C + External beam Radiation

aka. Nigro protocol

Question 11

When is surgery indicated in squamous cell carcinoma of the anus? What procedure?

Answer 11

Surgery is indicated in local regional recurrence or persistence of the tumor after chemoradiation (10-30% of patients).

Salvage APR is the surgery

Question 12

Where does lymphatic drainage of the anal canal (distal to dentate line) drain to?

Answer 12

inguinal lymph nodes

Question 13

What is median 2-year survival rate for anal squamous cell carcinoma vs. melanoma?

Answer 13

75% (SCC) vs < 50% (melanoma)