Skin/Soft Tissue Surgery Flashcards

0
Q

What does basal cell carcinoma look like?

A

Raised waxy lesion or non-healing ulcer in upper face, doesn’t spread; tx local excision with 1 mm margins

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1
Q

What are the common skin cancers?

A

Basal cell carcinoma (50%), squamous cell carcinoma (25%), malignant melanoma (15%); management is full-thickness incisional biopsy at border of the lesion

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2
Q

What does squamous cell carcinoma look like?

A

Non-healing ulcer in lower face, spreads to LN; tx local excision with 1 cm margins and LN excision

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3
Q

What are the SCC risk factors?

A

draining fistulas, arsenic exposure

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4
Q

What is a dysplastic nevus?

A

Atypical mole, precursor of malignant melanomas, requires close observation

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5
Q

What do you see with melanomas?

A

ABCDE
A-asymmetric B- irregular borders C- colors D- diameter >5mm E-evolving
Px is related to depth, highly metastatic and will be found in weird places

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6
Q

What are the worrisome melanoma features?

A

ulcerated (1/3 reduction in survival) and depth >4 mm (pt will likely die from mets)

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7
Q

How do you treat melanoma with metastasis?

A

Tx radiation and chemotherapy (interferons)

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8
Q

What is lentigo maligna melanoma?

A

Superficial, spreading melanoma on the face, good prognosis overall, tx excision with narrow margin

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9
Q

What is acral lentiginous melanoma?

A

Melanoma on pale areas of dark-skinned patients (sole of feet, palm of hand), worst prognosis due to depth

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10
Q

How does a sarcoma present?

A

Present as a firm, painless mass; px depends on size, grade, and distant metastasis
No LN involvement since sarcomas spread hematogenously

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11
Q

What are some melanoma subtypes to be aware of?

A
subungual melanoma (under fingernail or toenail)
mucosal melanoma (bad prognosis, tx APR with palpable LN excision)
melanoma + SBO (presents as abd distention, nausea and vomiting due to metastatic melanoma in abd cavity, tx with ex lap and excision)
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12
Q

How do you manage sarcomas?

A

Dx incisional biopsy parallel to resection margins, chest CT for mets, tx resection with 1 cm negative margins
tx high-grade sarcomas with radical amputation with post-op radiation therapy
Common mets in lung and liver

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13
Q

What are the hernia surgery indications?

A

All abdominal hernias due to possibility of strangulation, except sliding esophageal hernias (tx PPIs) and umbilical hernias in pts <2 yo (simple observation)
Can cause SBO or strangulation (presents as firm/tender mass with fever, increase in WBC, metabolic acidosis)

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14
Q

How do you manage umbilical hernias?

A

2cm fix, fix if it doesn’t regress before kindergarten regardless

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15
Q

What is an indirect hernia?

A

Through internal ring lateral to inferior epigastric vessels, due to patent processus vaginalis; most common hernia overall
In kids, high incidence of bilaterality, repair is limited to high ligation of sac without abdominal wall repair

16
Q

What is a direct hernia?

A

Medial to inferior epigastric vessels, due to weakening abdominal wall; more common in elderly

17
Q

What is a femoral hernia?

A

Below inguinal ligament into femoral triangle, more common in women, highest risk of strangulation
Other types include : sliding hernia and ventral hernia

18
Q

What are the four places in the body you can bleed out?

A

Abdomen, retroperitoneal space (pelvis), pleural space (x2), and the thighs