SURGERY EOR SKIN & BREAST Flashcards
Soft, large, mobile mass on a person’s body makes you think of?
lipoma
If a sebaceous cyst becomes infected, how do you treat it?
Make an incision and drain
What is the most common skin cancer?
Basal cell
What is the Tx for Seborrheic keratosis?
Leave it, could biopsy it
What is the Tx for Aktinic keratosis?
Freeze, 5-F,U cream, or excise
What’s the general Tx for all suspicious skin lesions?
Excision
What’s special about the Tx for Melanoma?
Need 1-3mm of skin surrounding + SubQ fat
If you see pearly, rolled border think?
BCC
If you see raised, ulcerated, chronic scab/non-healing wound think?
SCC
On what POD would we see a wound infection?
5-7
What are the MC causes of wound infection?
Staph aureus, E coli, and enterococcus
What type of wound would a GI or pulm (including biliary/urinary) be classified as?
Clean contaminated
If there is a GI apillage, acute inflammation, or traumatic wound how would it be classified?
Contaminated
If a 20 y/o woman comes in with concern for breast lump, and you note 1-3cm, freely moveable, firm/rubbery mass – how do you proceed? Dx?
could do an U/S first
Most likely a FNA or core biopsy
Dx: Fibroadenoma
If you see a 40y/o woman with a firm, bollotable, mobile mass – how do you proceed? Dx?
Age 40 can do a mammogram → then, with U/S + FNA
Dx: breast cyst
A pt has a breast cyst and during FNA blood is extracted – how do you proceed? What if there was no blood?
If bloody = surgical referral
Not bloody = close F/U in 2-4 months for recurrence or does not result in complete collapse → surgical referral
If a 30y/o patient has a painful, erythematous breast what should you do?
Mastitis or breast abscess
Treat with Doxy or Clinda (for staph aureus)
What if your pt with an erythematous, painful breast is 58y/o?
Not normal to have mastitis or breast abcess in a post-menopausal woman
[if !supportLists]⇒ [endif]GET A MAMMOGRAM
What are some risk factors to breast cancer?
> 55; no children/breastfeeding; exogenous estrogen exposure; family Hx; overweight
How does breast cancer present?
lumps, bumps, skin changes, dimpling, red/hot, pain/no pain, regional node enlargement
When do we start mammograms?
Age 40 annually or every 2 years
Age 50 annually or every 2 years
if you have a post-menopausal woman with a new mass, discharge, or asymmetry what should you always think about?
Presumed cancerous until proven otherwise
What is the GOLD STANDARD of breast mass diagnosis?
Aspiration/biopsy = superior to imaging
What’s the most common type of breast cancer?
Infiltrating ductal carcinoma = spreads
What sxs make you think of infiltrating ductal carcinoma?
redness, scaling, dimpling, thickening of the nipple
How do you treat infiltrating ductal carcinoma?
Lumpectomy (if <2cm) or mastectomy
Sentinel node biopsy
What type of breast cancer does not metastasis but has a high incidence of recurrence?
Ductal carcinoma insitu
What are the systemic treatment options for breast CA?
Chemo, hormonal therapy, estrogen receptor downregulators (Tamoxifen) for pre-menopausal
If breast CA were to metastasize, where does it most likely go?
obvi lymph nodes/muscle/fat/skin around the breast
But vertebral pedicles & ribs
What does the F/U involve after breast CA?
every 3-6 months x 3 years
Every 6-12 months years 4 & 5
Every year after year 5
*Yearly mammogram + pelvic exams (some drugs can increase uterine cancer)
If a pt has itching, burning, pain, scales/thickening of the nipple – what should you think?
Not just eczema but possible breast CA!
Paget’s
