SOFT TISSUE Flashcards
What is Cloquet’s LN
- 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
Where is Cloquet’s LN
Below inguinal ligament and medially in the femoral canal
Mgmt soft tissue sarcoma
WLE 1-2cm margin (neoadjuvant only if >10cm or high-grade tumors)
Most important prognostic factor for melanoma
Correlates to Breslow depth
Acral lentigenous melanoma associated with poor prognosis because…?
Due to delay in dx - when correlated with Breslow depth, overall survival similar to other subtypes of melanoma
Acral lentigenous melanoma typically found where? More common in what pts?
Hands, feet, digits.
MC among people of color.
Superficial spreading melanoma associated with vertical or radial growth?
Radial
What is the MC non-skin melanoma?
Eye melanoma
Nodula melanoma associated with good or bad prognosis?
Bad - bc aggressive growth and later presentation
Indications for deep inguinal LN dissection are…
- > 4 LN positive on superficial dissection
- positive Cloquet’s node
- enlarged ileo-obturator LN on CT
- clinically palpable or extracapsular invasion of femoral LN
Mgmt acute paronychia infection
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)
Mgmt lymphedema
compressive decongestive therapy (2-phase program of initiation and maintenance)
Manifestations of Marfan sydrome
(fibrillin-1)
- aortic root dilation
- dislocated lens of eye
- long, tall body habitus
Defect found in Ehlers-Danlos syndrome
defect in type III collagen
Mgmt for recurrent, advanced pilonidal cysts
off-midline incision (reduced Cx rate, healing time, and recurrence rate than midline) + rhomboid flap reconstruction
Type of biopsy if concerning for soft tissue sarcoma… and if fails?
core needle biopsy for >5cm. excisional biopsy (longitudinal) for <3cm, if CNBx fails.
What is a felon? Mgmt?
severe, closed space infection of fingertip pulp; uncommon Cx of acute paronychia.
Mgmt: I&D + adj Abx
MC pathogen for acute paronychia
S.aureus
MC soft-tissue sarcoma subtype in adults (#1, 2, 3)
#1: malignant fibrohistio-sarcoma #2: liposarcoma #3: lipomyosarcoma
MC soft-tissue sarcoma subtype in peds
rhabdosarcoma
Rx rhabdosarcoma
surgery + chemoradiation
What subtype sarcoma is somewhat responsive to chemotherapy?
- rhabdosarcoma
- Ewing sarcoma
MC site mets for soft-tissue sarcoma
lung
Dx soft-tissue sarcoma
1: MRI
2: Bx (CNBx for >5cm, excisional only <3cm and when CNBx fails) - for RP liposarcoma can just resect bc difficult to biopsy
Tx soft-tissue sarcoma
- WLE 2-3cm
- radiotherapy if close margins or size >5cm
- chemo if rhabdo or Ewing sarcoma
Dx melanoma.
When do punch biopsy?
excisional full-thickness biopsy w/ 1-2mm margins.
punch bx only if tumor large and will need complete excision, and for cosmetic areas
Margins needed for melanoma excision (by Breslow depth)
in situ -> 0.5-1cm margin T1 (<1mm) -> 1cm T2 (1-2mm) -> 1-2cm T3 (2-4mm) -> 2cm T4 (>4mm) -> >2cm
Staging: melanoma
1,2 = local disease, no LN 3 = regional disease, post LN 4 = distant mets
If pos LN melanoma, then must do…?
complete LN dissection + PET
Common choice Abx for acute paronychia
PO amox/clavulanate
Tx Merkel Cell Carcinoma
- WLE 3-5cm margins
- SLNBx
- adjuvant radiation therapy for >/= 2cm
- chemoRx for stage 4
High-risk factors of SCC and basal cell that need Mohs
- 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
Actinic keratosis
precursor for SCC
Dermatofibrosarcoma protuberans (presentation, histo)
Presents: 30-50s; firm, flesh-colored to dull red plaques (can be mistaken for keloid)
Histo: finger-like projections of spindle cells
Biopsies of suspicious skin lesions should be…
along long axis of extremity, full thickness biopsy taken from edge of lesion (with healthy tissue)
Margin for low-risk basal cell carcinoma
0.3-0.5 cm
What stage should do SLNBx for melanoma?
Stage 1B and above (>1mm, or <1mm with high-risk features)
Borders of superficial groin
(femoral triangle)
- lateral: sartorius
- medial: adductor longus
- superior: inguinal ligament
Where is Cloquet’s LN?
below inguinal ligament, medial to femoral canal
How does skin graft survive at recipient site?
- plasmatic imbibition (graft passively absorbs nutrients in wound bed by diffusion)
- day 3 - inosculation (cut ends of vessels on dermal underside form connection with wound bed)
- day 5 - angiogenesis
- graft is vascularized
MC subtype melanoma
superficial spreading melanoma
Melanoma subtype with best overall prognosis
lentigo maligna melanoma
Melanoma subtype with worse overall prognosis
nodular melanoma (early vertical growth)
Lymphedema occurs in ?% of axillary dissections
20%
