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Minor Surgery > week 8 > Flashcards

week 8 Flashcards

1
Q

squamous cell carcinoma

  • dx how
  • eti
  • if over what age, high risk
  • where on body?
  • mets?
  • what color skin risky
  • location on dark skin ppl
A
  • skin biopsy to dx
  • UVB sun exposure
  • 75
  • exposed areas of skin CUTANEOUS SURFACE … head, neck, trunk, extrem, oral mucoas, periungal skin, anogen.
  • low rate of mets
  • white ppl … if in dark-skin, cSCCs on non sun-exposed areas and freq assoc w inflamm.
  • legs, anus, areas of chronic inflamm/scarring
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2
Q

UVA light exposure

A
  • penetrates deeply
  • UVA radiation -> DNA damage
  • p53 tumor suppressor gene point mutations
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3
Q

Other risks for sSCC

A

ionizing radiation, grenz-rays, gamma rays

- basal layer of epidermis more affected by radiation at higher risk of BCC than cSCC

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4
Q

what percent of cutaneous skin CA arise in chronically inflamed skin

A

1% …. most are squamous (95%)

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5
Q

when does cSCC appear after skin damage?

A

can be super early 6 wks or 60 yrs later

- be suspicious if it’s not healing

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6
Q

Arsenic exposure is assoc w …

A

cSCC, BCC

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7
Q

chemo protection w

A

vitamin A

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8
Q

Bowen’s Dz is…

presents as…

A

SCC in situ

- well-demarcated, scaly patch/plaque, often erythematous, grow slowly, usu asx

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9
Q

Invasive cSCC

A

often Asx, but mb painful, pruritic

- looks gross

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10
Q

well-differentiated SCC

A
  • indurated, firm, hyperkeratotic, papules, plaques or nodules
  • usu 0.5-1.5cm
  • mb ulcerated
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11
Q

poorly differentiated SCCS

  • looks like
  • sxs
  • bad sign if invasion into?
A

fleshy, soft, granulomatous, papules, nodules

  • mb ulceration, hemorrhage, areas of necrosis
  • NEURO SXS
  • perineural
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12
Q

Oral SCC

  • looks like
  • lesion arise in sites of…
  • assoc w..
A
  • ulcer, nodule, or indurated plaque
    floor of mouth, lateral, ventral tonuge
  • erythroplakia or leukoplakia
  • assoc w tobacco heavy alc abuse
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13
Q

keratoacanthoma

  • cSCC?
  • usu found where?
  • what makes it different from cSCC
A

resembles cSCC
controversial whether it is
- usu found on ACTINICALLY-DAMAGED SKIN
- RAPID initial growth, dome-shaped or crateriform nodules w central keratotic core

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14
Q

verrucous carcinoma

  • looks like
  • location
A

well defined, exophytic, cauliflower-like

- oral, anogenital, epithelioma cuniculatum (plantar foot)

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15
Q

cSCC

  • location
  • looks like
A

lower lip
nodules, ulcers, indurated white plaques
- lesion on vermillion border is cSCC until proven otherwise!

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16
Q

where to SCC mets?

A
  • 5-10%
  • regional lymph nodes
  • lr, lu, brain, skin, bones
  • to skin can look looks like erythematous papule, nodule
17
Q

histopath examine looks for?

A
  • perineural invasion, tumor depth, differentiation
18
Q

if you think SCC, remove by….

A

full thickness excisional, or punch biopsy

19
Q

Tx SCC

A
  • cryotherapy, etc
20
Q

most common fatal form of skin CA

A 
malign melanoma (5 yr survival rate)
- can mb get a cure if thin stage l
21
Q

if you have atypical nevi risk to develop…

how many put you at risk for melanoma

A

malign melanoma .. at 2-20 fold

- 25

22
Q

malig melanoma risk

A

sun, uv exposure, tanning bed, white ppl, etc

23
Q

malig melanoma growth phases

- dangerous?

A

HORIZONTAL “radial” phase
most superficial confined to epidermis
at this stage, can cure w surgery

24
Q

malig melanoma “vertical” growth

A

have met potential

NODULAR.. no identifiable radial growth phase… enter vertical growth from their inception

25
Q

4 types of malig melanomas in order of prevalence

A
  1. superficial spreading
  2. nodular
  3. acral lentiginous
  4. lentigo maligna
26
Q

superficial spreading melanoma

  • pop.
  • growth
  • curable
A
  • mc type
  • young ppl
  • grows slowly … long time before penetrating deep
  • if
27
Q

Nodular melanoma

A 
most aggressive
2nd mc
most diff. to dx at an early stage
when dx usu > 2 mm thick, so bad news
all diff colors, amelanotic variants
28
Q

Lentigo Maligna Melanoma
pop.
looks like

A

remains close to skin surface for a while
usu elderly…. face ears arms upper trunk… sun exposed
flat or mildly elevated, tan, brown, dark brown
common in hawaii

29
Q

acral lentiginous

  • location
  • pop.
  • spread…
  • caution bc likelihood of invasion
A

trunk, legs, arms

  • mc in asians, african
  • palmar, planta, subungual
  • spread superficially
  • raised, develops ulceration, > 5 mm in diameter
30
Q

most importatn Melanoma prognostic factors

A
  • thickness!, mitotic rate, ulceration
31
Q

stage l, ll survival rate of how long

A

10 yrs

32
Q

Dx Checklist

A

ABCDE

asym, border, color, diameter, evolution

33
Q

Glasgow seven-point checklist… use mc in europe

A

major: size
minor: >7mm, inflam, crusting, bleeding,

34
Q

biopsy to r/o malign. melanoma

- best method

A
  • excisional biopsy
  • 1-3 mm margins of normal skin and layer of subq fat
  • “narrow-margin” excision
35
Q

why superficial shave bx is never approp.

A
  • leaves residual tumor, underestimates thickness
  • cause fibrosis, scarring
  • can’t identify tumor bc no depth
36
Q

definitive “initial” surgical tx

A

wide local excision

- no difference than narrower margin - doesn not alter recurrence rate

37
Q

Mohs micrographic surgery for melanoma

A

ensure complete removal

Minor Surgery (3 decks)

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