Summary of Essentials Ch. 36-37 (Derm)

Question 1

Skin cancer incidence (greatest to least)?

Answer 1

BCC>SCC>melanoma

Question 2

Metastatic risk (greatest to least)?

Answer 2

Melanoma>SCC>BCC

Question 3

How is melanoma staged?

Answer 3

Breslow based on depth of invasion

Question 4

Work-up of skin lesions?

Answer 4

Biopsy all suspicious lesions

• Excisional if small
• Punch if large

Question 5

Work-up of melanoma?

Answer 5

CXR, LFTs, LDH, CBC

PET and CT if clinically palpable nodes

Question 6

Management of melanoma?

Answer 6

Re-excise with margins based on breslow depth
Selective sentinal LN biopsy based on depth
Questionable value of adjuvant therapy

Question 7

Management of BCC/SCC?

Answer 7

BCC: 3-5 mm margins
SCC: 5-10 mm margins

Mohs (tissue sparing, for cosmetically sensitive areas)

Question 8

True or false - shave biopsies should be performed for suspected melanoma.

Answer 8

FALSE

Question 9

Presentation - history of traumatic injury (even a small cut), acute onset of pain, swelling, erythema, hemodynamic instability, creptius, bullae, skin necrosis

Answer 9

Necrotizing soft-tissue infection

Question 10

Dx NSTI

Answer 10

Clinical diagnosis

LRINE score can help (low serum Na, high WBC)

Question 11

Management of NSTI?

Answer 11

Immediate IV fluids, broad-spectrum ABX, emergent aggressive surgical debridement
May need multiple reoperations for further debridement