Fiser ABSITE Ch. 18 Plastics, Skin, Soft Tissues Flashcards Preview

Surgery > Fiser ABSITE Ch. 18 Plastics, Skin, Soft Tissues > Flashcards

Flashcards in Fiser ABSITE Ch. 18 Plastics, Skin, Soft Tissues Deck (88):
1

What is the main cell type in the epidermis?

keratinocytes

2

What is the origin of melanocytes?

neuroectodermal origin (neural crest cells)

3

What is the skin cell type that act as antigen presenting cells (MHC class II) originate from bone marrow. Have a role in contact hypersensitivity reactions (type IV)

Langerhans cells

4

Name the sensory nerve that handles pressure.

pacinian corpuscles

5

Name the sensory nerve that handles warmth.

Ruffini's endings

6

Name the sensory nerve that handles cold.

Krause's end-bulbs

7

Name the sensory nerve that handles tactile sense.

Meissner's corpuscles

8

What type of seat glands provide aqueous sweat for thermal regulation? What type produces milky sweat as a result of sympathetic nervous system with highest concentration in palms and soles?

Eccrine, Apocrine

9

What type of collagen is the predominant type in the skin, 70% weight of dermis, gives tensile strength?

Type I

10

With split thickness skin graft donor sites, what 2 places is the skin regenerated from?

hair follicles and skin edges

11

With skin grafts, imbibition (osmotic) blood supply to skin for days __-___. What starts after that?

0-3, neovascularization

12

What vessels does a TRAM flap rely on? Which perforators are most important determinant of TRAM flap viability?

superior epigastric vessels, periumbilical perforators

13

What does TRAM stand for in TRAM flap reconstruction?

transverse rectus abdominus reconstruction

14

Name the pressure sore stage:
Erythema pain, no skin loss

Stage I

15

Name the pressure sore stage:
Partial skin loss with yellow debris. Tx: local tx, keep pressure off

Stage II

16

Name the pressure sore stage:
Full-thickness skin loss subcutaneous tissue exposure. Tx: sharp debridement; will likely need myocutaneous flap.

Stage III

17

Name the pressure sore stage:
Usually involves bony cortex. Tx: myocutaneous flaps

Stage IV

18

What is the single best factor for protecting skin from UV radiation?

melanin

19

What type of ultraviolet radiation is responsible for chronic sun damage?

UV-B

20

What represents only 3-5% of skin CA bu accounts for 65% of the deaths?

Melanoma

21

Familial BK mole syndrome carries an almost 100% risk of what?

melanoma

22

What percentage of melanoma is familial?

10%

23

What is the most common melanoma site in men and in women?

men back, women legs

24

What do the following represent in melanoma? men, ulcerated lesions, ocular and mucosal lesions

worse prognosis

25

What color in melanoma is most ominous?

blue

26

What is the most common location for distant melanoma metastasis?

lung

27

What is most common CA to metastasize to the small bowel?

melanoma

28

In the diagnosis of melanoma, what is the difference in a less than 2 cm lesion and a > 2 cm lesion or cosmetically sensitive area?

Less than 2 cm excisional bx - need resection with margins if positive; >2 cm or cosmetically sensitive do incisional (or punch) bx - need resection with margins if positive

29

Name the type of melanoma:
Least aggressive, minimal invasion, radial growth 1st usual; elevated nodules

lentigo maligna

30

Name the type of melanoma: most common, intermediate malignancy; originates from nevus/sun-exposed areas

superficial spreading melanoma

31

Name the type of melanoma:
most aggressive; most likely to have metastasized at time of diagnosis; deepest growth at time of diagnosis; vertical growth 1st; bluish black with smooth borders; occurs anywhere on the body

Nodular

32

Name the type of melanoma:
very aggressive; palms/soles of African Americans

Acral lentiginous

33

Name 3 things that need to be done to stage melanoma.

CXR, LFTs, examine all possible draining lymph nodes

34

____, ____ and tumor vaccines can be used for melanoma with systemic disease.

Alpha-interferon, IL-2

35

Perform sentinel lymph node bx with melanoma if nodes clinically negative and tumor >___ deep.

1 mm

36

Are involved nodes in melanoma usually tender?

no

37

What stage melanoma tumors need full lymph node dissection?

III

38

What additional procedure is needed for anterior head and neck melanomas?

superficial parotidectomy

39

What is the tx for axillary node melanoma with no other primary?

complete axillary node dissection

40

Should resection be performed of an isolated melanoma metastases (ie lung or liver) that can be resection with a low-risk procedure?

probably

41

What is the level classification system for melanoma based on level of invasion called?

Clark's levels (I-V)

42

List the margins needed in melanoma with depth:
Less than 1 mm
1-4 mm
>4 mm

1 cm
2 cm
2-3 cm

43

What is the most common malignancy in the US?

Basal Cell carcinoma

44

Pearly appearance, rolled borders. Pathology shows peripheral palisading of nuclei and stromal retraction.

Basal cell carcinoma

45

Tx for clinically positive nodes in basal cell carcinoma or squamous cell carcinoma?

regional adenectomy

46

What type of basal cell carcinoma is most aggressive and has collagenase production?

Morpheaform type

47

What size margins for basal cell carcinoma?

0.3-0.5 cm

48

■ Overlying erythema, papulonodular with crust and ulceration ■ May have surrounding induration and satellite nodules ■ Usually red-brown; can have a pearly appearance ■ Metastasizes more frequently than basal cell CA but less common than melanoma

squamous cell carcinoma

49

What are the margins for low risk squamous cell carcinoma? What is the tx for high risk?

0.5-1.0, Mohs surgery

50

Is Mohs used for melanoma?

no

51

What are the first and second most common soft tissue sarcomas?

malignant fibrous histiosarcoma, liposarcoma

52

What is the most common presentation of a soft tissue sarcoma?

painless mass

53

What to imaging modalities are used in soft tissue sarcoma and why?

CXR to r/o lung mets, MRI before bx to r/o vascular, neuro or bone invasion

54

How do you bx a soft tissue sarcoma that is 4cm?

excisional bx, longitudinal incisional bx (may need to eventually resect bx skin site if bx shows sarcoma)

55

What route does sarcoma mets? and what is the most common site?

hematogenous, lungs

56

What are the rules for margins in resection of sarcoma?

3 cm margins and at least 1 uninvolved fascial plane

57

Why do you place clips at site of likely recurrence in excision of sarcoma?

will XRT these later

58

List 3 indications for XRT in sarcoma?

high-grade tumors, close margins, tumors > 5 cm

59

Chemotherapy for sarcoma is based on what drug?

doxorubicin

60

Sarcoma tumors greater than what size may benefit from preop XRT and chemotherapy -> may allow limb sparing resection

> 10 cm

61

Isolated sarcoma mets without evidence of systemic disease, resection or palliation with XRT?

resection (systemic disease - palliate with XRT)

62

What is the 5 year survival rate with complete resection of sarcoma?

40%

63

Head and neck sarcomas can occur in the pediatric population, what is the usual type? Negative margins may be impossible to obtain due to close proximity to vital structures. What additional tx?

rhabdomyosarcoma, XRT

64

What are the two most common types of visceral and retroperitoneal sarcomas?

leiomysoarcoma and liposarcoma

65

Tx for Kaposi's sarcoma is XRT or intralesional ___ for local disease; systemic chemo for disseminated dz

vinblastine

66

What is the #1 soft tissue sarcoma in kids? what subtype is most common? worst prognosis?

rhabdomyosarcoma, embryonal, alveolar

67

Tx for childhood rhabdomyosarcoma is surgery and ___-based chemo.

doxorubicin

68

What location has increased incidence of osteosaroma?

around the knee

69

From what cells does osteosarcoma originate?

metaphyseal

70

Are neuroendocrine • Aggressive regional and systemic spread; patients have red to purple papulonodule/indurated plaque • Have neuron-specific enolase (NSE), cytokeratin, and neurofilament protein

Merkel cell carcinoma

71

Painful tumor composed of blood vessels and nerves. Benign; most common in the terminal aspect of the digit. Tx: tumor excision

Glomus cell tumor

72

In elderly, often on face; premalignant, not aggressive.

Hutchinson's freckle

73

In lip lacerations it is important to line up what?

vermillion border

74

What is the most common location for desmoid tumors?

anterior abdominal wall (pregnancy, trauma, surgery)

75

Intra abdominal desmoids associated with retroperitoneal fibrosis and ___ syndrome.

Gardner's

76

Tx for desomoid tumors includes surgery and ___ if vital structures involved.

chemo/XRT

77

SCCA in situ; 10% turn into invasive SCCA. Tx: excision with negative margins usual (exception includes peri-anal region)

Bowen's disease

78

• Rapid growth, rolled edges, crater filled with keratin • Is not malignant but can be confused with SCCA • Involutes spontaneously over months • Always biopsy these to be sure • If small, excise; if large, biopsy and observe

Keratoacanthoma

79

Hyperhydrosis - ↑ sweating, especially noticeable in the palms. What is the tx?

sympathectomy if refractory

80

Infection of the apocrine sweat glands, usually in axilla and groin regions • Staph/strep most common organisms • Tx: antibiotics, improved hygiene 1st; may need surgery

hidradenitis

81

Most common benign cyst? what does it contain?

epidermal inclusion cyst, creamy keratin material

82

Epidermal inclusion cysts have completely mature epidermis. What other cyst is on the scalp and has no epidermis?

trichilemmal cyst

83

What type of benign cyst is found over tendons, usually over the wrist, filled with collagenous material?

ganglion cyst

84

Midline abdominal and sacral lesions, occiput and nose; found along body fusion planes.

dermoid cyst

85

Congenital coccygeal sinus with ingrown hair; gets infected and need to be excised.

pilonidal cyst

86

What is the inheritance of keloids?

autosomal dominant

87

What is the difference in keloids and hypertrophic scar tissue?

in keloids the collagen goes beyond original scar, in hypertrophic scar collagen stays within confines of scar

88

Which can be treated with XRT Keloids or hypertrophic scar tissue? and what are the other 3 treatments that are common to both?

keloids can be treated with XRT; steroids, silicone and pressure garments can treat both