Skin surgery

Question 1

Cancer of the skin (classic pic)

Answer 1

Blond, blue-eyed, fair ppl w/ fierce sun, who areoutside a lot. Basal cell = 50%, squam = 25%, melanoma = 15% (but rising). Dx = full-thickness incisional/punch biopsy at edge (include noral skin). Shared etiology, often co-exist, pts hav emultiple lesions

Question 2

Basal cell carcinoma

Answer 2

Raised waxy lesion or non-healing ulcer. Preference for upper part of face (above lips), no mets, but can kill by relentless local invasion. Local invasion w/ negative margins- curative but other lesions might come later

Question 3

Squam cell carcinoma

Answer 3

Non-healing ulcer, esp on lower lip (and below a line drawn across the hips, mets to lymph nodes possible. Excise w/ wider margins (.5 to 2 cm), node dissection if involved. Rads tx is an option

Question 4

Melanoma

Answer 4

Starts as pigmented lesion, Asymmetric, irregular Borders, different Colors, Diameter > .5 cm. Or changing the way it looks. Biopsy report gives dx + depth. Less than 1 mm deep only need local excision. Deeper lesion needs 2-3 cm margin. Larger than 4 mm = terrible prognosis. 1-4 mm size = aggresive therapy, node dissection

Question 5

Mets malig melanoma

Answer 5

Deep, invasive primary => mets. Bizarre, unpredictable. Mets to lymph, liver, lung, brain, bone but also WEIRD places (duodenum, LV, anywhere!). Also no predictable timetable- few months or 20 years