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QUESTION NOTES > SOFT TISSUE > Flashcards

SOFT TISSUE Flashcards

1
Q

What is Cloquet’s LN

A
  • bridging node between superficial and deep nodal basins
  • status important for pts with malignant melanoma - if positive, high possibility of deep pelvic note involvement, and operation should be extended to include deep compartment of groin
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2
Q

Where is Cloquet’s LN

A

Below inguinal ligament and medially in the femoral canal

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3
Q

Mgmt soft tissue sarcoma

A

WLE 1-2cm margin (neoadjuvant only if >10cm or high-grade tumors)

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4
Q

Most important prognostic factor for melanoma

A

Correlates to Breslow depth

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5
Q

Acral lentigenous melanoma associated with poor prognosis because…?

A

Due to delay in dx - when correlated with Breslow depth, overall survival similar to other subtypes of melanoma

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6
Q

Acral lentigenous melanoma typically found where? More common in what pts?

A

Hands, feet, digits.

MC among people of color.

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7
Q

Superficial spreading melanoma associated with vertical or radial growth?

A

Radial

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8
Q

What is the MC non-skin melanoma?

A

Eye melanoma

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9
Q

Nodula melanoma associated with good or bad prognosis?

A

Bad - bc aggressive growth and later presentation

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10
Q

Indications for deep inguinal LN dissection are…

A
  • > 4 LN positive on superficial dissection
  • positive Cloquet’s node
  • enlarged ileo-obturator LN on CT
  • clinically palpable or extracapsular invasion of femoral LN
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11
Q

Mgmt acute paronychia infection

A

If superficial - warm compress and close f/u
If unilateral abscess - corner of affected nail removed to unroof infxn
If underneath nail to c/l side - prox 1/3 nail should be removed + wound packed and allowed to drain + Abx (amox/clavulanate)

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12
Q

Mgmt lymphedema

A

compressive decongestive therapy (2-phase program of initiation and maintenance)

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13
Q

Manifestations of Marfan sydrome

A

(fibrillin-1)

  • aortic root dilation
  • dislocated lens of eye
  • long, tall body habitus
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14
Q

Defect found in Ehlers-Danlos syndrome

A

defect in type III collagen

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15
Q

Mgmt for recurrent, advanced pilonidal cysts

A

off-midline incision (reduced Cx rate, healing time, and recurrence rate than midline) + rhomboid flap reconstruction

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16
Q

Type of biopsy if concerning for soft tissue sarcoma… and if fails?

A 
core needle biopsy for >5cm.
excisional biopsy (longitudinal) for <3cm, if CNBx fails.
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17
Q

What is a felon? Mgmt?

A

severe, closed space infection of fingertip pulp; uncommon Cx of acute paronychia.
Mgmt: I&D + adj Abx

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18
Q

MC pathogen for acute paronychia

A

S.aureus

19
Q

MC soft-tissue sarcoma subtype in adults (#1, 2, 3)

A 
#1: malignant fibrohistio-sarcoma
#2: liposarcoma
#3: lipomyosarcoma
20
Q

MC soft-tissue sarcoma subtype in peds

A

rhabdosarcoma

21
Q

Rx rhabdosarcoma

A

surgery + chemoradiation

22
Q

What subtype sarcoma is somewhat responsive to chemotherapy?

A
  • rhabdosarcoma

- Ewing sarcoma

23
Q

MC site mets for soft-tissue sarcoma

A

lung

24
Q

Dx soft-tissue sarcoma

A

1: MRI
2: Bx (CNBx for >5cm, excisional only <3cm and when CNBx fails) - for RP liposarcoma can just resect bc difficult to biopsy

25
Q

Tx soft-tissue sarcoma

A
  • WLE 2-3cm
  • radiotherapy if close margins or size >5cm
  • chemo if rhabdo or Ewing sarcoma
26
Q

Dx melanoma.

When do punch biopsy?

A

excisional full-thickness biopsy w/ 1-2mm margins.

punch bx only if tumor large and will need complete excision, and for cosmetic areas

27
Q

Margins needed for melanoma excision (by Breslow depth)

A 
in situ -> 0.5-1cm margin
T1 (<1mm) -> 1cm
T2 (1-2mm) -> 1-2cm
T3 (2-4mm) -> 2cm
T4 (>4mm) -> >2cm
28
Q

Staging: melanoma

A 
1,2 = local disease, no LN
3 = regional disease, post LN
4 = distant mets
29
Q

If pos LN melanoma, then must do…?

A

complete LN dissection + PET

30
Q

Common choice Abx for acute paronychia

A

PO amox/clavulanate

31
Q

Tx Merkel Cell Carcinoma

A
  • WLE 3-5cm margins
  • SLNBx
  • adjuvant radiation therapy for >/= 2cm
  • chemoRx for stage 4
32
Q

High-risk factors of SCC and basal cell that need Mohs

A
  • location: face, ear, genitalia, hand/foot
  • > /= 6mm on high-risk areas
  • poorly diff
  • depth >/= 4mm
  • perineural invasion
  • rapid growth
  • etiology: scar, chronic ulcer or inflam, sinus tract, site of prior radiation therapy
  • immunosuppression
33
Q

Actinic keratosis

A

precursor for SCC

34
Q

Dermatofibrosarcoma protuberans (presentation, histo)

A

Presents: 30-50s; firm, flesh-colored to dull red plaques (can be mistaken for keloid)
Histo: finger-like projections of spindle cells

35
Q

Biopsies of suspicious skin lesions should be…

A

along long axis of extremity, full thickness biopsy taken from edge of lesion (with healthy tissue)

36
Q

Margin for low-risk basal cell carcinoma

A

0.3-0.5 cm

37
Q

What stage should do SLNBx for melanoma?

A

Stage 1B and above (>1mm, or <1mm with high-risk features)

38
Q

Borders of superficial groin

A

(femoral triangle)

  • lateral: sartorius
  • medial: adductor longus
  • superior: inguinal ligament
39
Q

Where is Cloquet’s LN?

A

below inguinal ligament, medial to femoral canal

40
Q

How does skin graft survive at recipient site?

A
  1. plasmatic imbibition (graft passively absorbs nutrients in wound bed by diffusion)
  2. day 3 - inosculation (cut ends of vessels on dermal underside form connection with wound bed)
  3. day 5 - angiogenesis
  4. graft is vascularized
41
Q

MC subtype melanoma

A

superficial spreading melanoma

42
Q

Melanoma subtype with best overall prognosis

A

lentigo maligna melanoma

43
Q

Melanoma subtype with worse overall prognosis

A

nodular melanoma (early vertical growth)

44
Q

Lymphedema occurs in ?% of axillary dissections

A

20%

QUESTION NOTES (28 decks)

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