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2A week 4,7 - skin cancer, hair and nail disorder > wound healing > Flashcards

wound healing Flashcards

1
Q

what is a wound

A

loss of integrity of skin tissue

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2
Q

what causes chronic wounds (2)

A
  1. disruption in normal healing process;
  2. slowed/incomplete healing
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3
Q

3 phases of wound healing (post fibrin plug formation)

A
  1. inflammatory phase (0-48hrs);
  2. proliferative phase;
  3. maturation and remodelling phase (3+ weeks)
    all over lapping, not clearly separated from each other
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4
Q

clinical signs of the inflammatory phase (4)

A

rubor, tumor, dolour, calor

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5
Q

3 main steps in the inflammatory phase

A
  1. wound cleaning (phagocytosis - monocytes, macrophages, lymphocytes);
  2. chemo-attraction (growth factors, cytokines, fibroblasts/immune cells);
  3. structural framework development (temporary matrix)
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6
Q

3 main stages of the proliferative phase

A
  1. net collagen synthesis (GFs, ECM molecules etc.);
  2. increased wound tensile strength (epidermal cells proliferate and move to wound edge/granulation tissue, mylofibroblasts generate force to contract and close wound);
  3. scar formation (apop of immune cells, fibroblasts etc.; remaining fibroblasts lay down collagen)
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7
Q

what happens in the maturation/remodelling phase

A

reorganisation of collagen - Type 1 and 3

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8
Q

2 types of wound healing

A

primary intention; secondary intention

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9
Q

6 things that can affect wound healing

A
  1. size of wound;
  2. blood supply to area;
  3. presence of foreign bodies or microorganisms;
  4. age/health of a pt;
  5. nurtitional status;
  6. drugs (e.g. steroids)
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10
Q

primary intention vs secondary intention

A

primary - e.g. surgical incision; immediate closure of wound edges when no loss of tissue has occured -> rapid epithelial coverm faster healing, better cosmetic result;
secondary - e.g. trauma; spontaneous healing of wound without direct closure -> granulation, slow epithelial cover, wound contraction, compromised cosmetic result

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11
Q

2 types of wound healing

A

primary intention; secondary intention

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12
Q

primary intention healing pathway (4)`

A
  1. wound edges joined by fibrin plug;
  2. regrowth of basal layer of epidermis;
  3. lysis of fibrin and re-epithelialisation;
  4. restoration to intact skin
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13
Q

secondary intention healing pathway (4)

A
  1. large defect filled by fibrin clot;
  2. new blood vessels and fibroblasts (granulation tissue) grow from the dermis into fibrin;
  3. collagen laid down by granulation tissue fibroblasts to restore integrity;
  4. maturation of collagen achieves structural integrity and allows regrowth of epidermis
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14
Q

what is tertiary intention healing

A

healing after traumatic injury, dirty surgery, delayed primary intention etc. -> initially left open after removal of all non-viable tissue, wound edges brought together after a few days when it appears clean and well vascularised

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15
Q

examples of treatments for skin lesions (8)

A
  1. cryotherapy;
  2. creams/ointments;
  3. photodynamic treatment;
  4. curretage
  5. shave excision
  6. excision
  7. RT
  8. chemo
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16
Q

how does cryotherapy cauuse cell death (4)

A
  1. ice crystal formation;
  2. osmotic differences -> cell disruption;
  3. ishaemic damage
  4. immunological stimulation
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17
Q

what is usually used for cryotherapy

A

liquid nitrogen

18
Q

4 contraindications for cryotherapy

A
  1. pigmented lesions;
  2. malignant lesions (needs histology);
  3. cold urticaria;
  4. lesion of uncertain diagnosis
19
Q

what is 5-flurouracil cream and when is it used

A

an anti-metabolite that inhibits pyrimidine metabolism and DNA synthesis; used for multiple AKs (too many for cryo), BCCs, Bowen’s disease

20
Q

what condition is cryotherapy most commonly used for

A

actinic keratosis

21
Q

what is aldara (imiquimod 5%) and when is it used

A

an iminazoquinolone that acts as an immune response modulator -> stimulates release of cytokines;

used for genital warts, superficial basal cell carcinoma, and actinic keratosis

22
Q

what is photodynamic therapy

A

the activation of topical porphyrin cream (psorelin) to destroy cancer/pre-cancer -> scale removed, cream applied and then light shone onto sensitised area

23
Q

3 contraindications for photodynamic therapy

A
  1. pigmented lesions;
  2. non-histologically sampled malignant lesions;
  3. patients unable to tolerate pain
24
Q

what is curretage/cautery and when is it used

A

lesion is scraped off and heat is applied to skin surface;
used for pyogenic granuloma, cutaneous horn (AK), seborrhoeic wart, small nodular BCCs

25
Q

5 contraindications of cutterage/cautery

A
  1. pigmented lesions;
  2. BCCs (morphoeic, infiltrating, ill-defined)
  3. poor cosmetic result (vermillion boarder, nose tip, chin);
  4. BCC on site w high recurrence rate (nose, eye, scalp etc.);
  5. SCCs (most of them)
26
Q

what is a shave excision

A

lesion is shaved off and heat applied to skin

27
Q

2 indications for shave excision

A

usually benign lesions
1. chrondrodermatitis nodularis helicis - painful nodule which develops on ear due to side sleeping;
2. benign naevi;

28
Q

2 contraindications for shave excision

A
  1. keratoacanthoma;
  2. melanomas!
29
Q

what is an excision

A

removal of lesion with adequate margin

30
Q

4 contraindications to excision biopsy

A
  1. no valid consent;
  2. INR too high;
  3. underpreparation with antplatelets/anticoagulatns;
  4. pacemaker check
31
Q

indications for excision biopsy (2)

A
  1. suspected tumours;
  2. pigments lesiosn
32
Q

5 factors to consider when determining suitability for RT

A
  1. type of lesion (is it radiosensitive e.g. BCC, SCC etc; whats the morphology e.g. nodular);
  2. site (areas where surgery may be difficult);
  3. previous radiotherapy;
  4. suitability of other treatments
  5. patient’s preference
33
Q

what is micrographic surgery

A

excision of horizontal sections cut from the periphery of an excision specimin -> microscope needed

34
Q

why is micrographic surgery used

A

to maximise the confidence of tumour clearance with minimal loss of surrounding normal tissue -> time consuming and expensive tho

35
Q

when might Moh’s surgery (micrographic) be indicated

A

for tumours that are recurrent, in high risk zones and have agressive growth

36
Q

what lesions are biopsies not done in

A

pigmented lesions - the area biopsied may not be a true representation of the whole cancer

37
Q

when is chemo indicated (derm -4)

A

metastatic malignant melanoma; localised advanced mealomas (isolated limb perfusion); SCCs; rare BCCs

38
Q

what targeted therapies are available for cancers (3)

A
  1. BRAF inhibitors
  2. MEK inhibitors
  3. C-KIT
39
Q

adjuvant vs neo-adjuvant therapy

A

adjuvant - used after primary procedure to help reduced the recurrance of the tumour
neo adjuvant - used to reduce the size of the tumour prior to the primary tumour

40
Q

example of adjuvant therapy

A

IF-alpha

2A week 4,7 - skin cancer, hair and nail disorder (5 decks)

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