Skin/Soft Tissue/Hernias Flashcards
What is “Bowen’s disease”?
SCC in situ
The margins required in excision of SCC are ____ cm, while for BCC it is _____ cm.
SCC: 1 cm
BCC: 0.2-0.4 cm
In the evaluation of malignant melanoma, the most significant finding in addition to histologic findings and TNM stage is the presence of
ulceration
What is the required margin for excision of MM?
if 1mm depth = 2cm
In MM with palpable lymph nodes, treatmetn with ______ may increase survival by as much as 40%
interferon
T/F: A Hutchinson freckle (what is it?) is malignant.
False! This is a large macular brown lesion on the cheek (lentigo maligna) that is not malignant in and of itself, but which may be a precursor of lentigo malignant melanoma.
T/F: Lentigo malignant melanoma has a more favorable prognosis than malignant melanoma.
True! More thick than deep
Treatment of distant metastatic melanoma?
systemic therapy with combination drugs or dacarbazine
If a subungual melanoma is found, what is the treatment?
amputation at the DIP!!!
Individuals with melanomas located on the face or trunk have a (better/worse) prognosis than those with lesions on the extremity, and (men/women) do better overall.
Women do better
face & trunk < extremity
**note, acral lesions have a poorer prognosis
Excisional biopsy is indicated for sarcomas of what size?
<3 cm (otherwise incisional biopsy)
What in the history can predispose to fibrosarcoma or lymphangiosarcoma?
hx of therapeutic radiation = fibrosarcoma
hx of axillary lymphadenectomy = lymphangiosarcoma
T/F: Neither FNA nor frozen section biopsies of a sarcoma aids diagnosis.
True. Core biopsy or excisional biopsy does.
T/F: Cell type of origin is a determinant of whether a sarcoma is low grade or high grade.
False! # of mitotic figures and degree of necrosis, as well as size (>15 cm) and if the lesion is symptomatic
Sarcomas of a muscle should be treated surgically with a total compartmental resection (radical local resection), which involves removing…
the entire length of the muscle, its origin and insertion, and its investing fascia, including the deep fascia
**not a wide excision!
WITH adjuvant radiotherapy/brachytherapy! :)
A tender area in the lateral portion of the groin and an impulse that travels down the inguinal canal while coughing:
indirect inguinal hernia
Which of the 3 groin hernias goes posterior to the inguinal ligament? Which anterior?
posterior = femoral anterior = direct and indirect
Though femoral hernias are most likely to strangulate overall, out of direct and indirect hernias, which are more likely to strangulate?
indirect > direct
What are conditions that are associated with hernia development?
obesity, COPD, ascites, BPH (causes bladder obstruction), colon or rectal obstruction, pregnancy…
What is the repair of a pediatric inguinal hernia?
high ligation of the sac (no abdominal repair is needed because there is no abdominal wall defect present). Exist because of a patent processus vaginalis (communication between the peritoneal cavity and the inguinal canal)
What are the boundaries of the femoral canal?
anterior: iliopubic tract (reflection of inguinal ligament)
posterior: Cooper’s ligament
medial: pubic tubercle
lateral: femoral vein
What is a Littre hernia?
protrusion of a Meckel diverticulum into a hernia sac
What is a Richter hernia?
protrusion of a portion of the intestine wall into the hernia sac
The most common sliding hernias in indirect hernias involve what?
bladder, cecum, or sigmoid colon
