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Skin And Soft Tissue Flashcards

(93 cards)

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1
Q

Superficial cellular layer

A

Epidermis

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2
Q

Epidermis histology

A

Stratified squamous epithelium

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3
Q

Sublayers of epidermis

A

Horny
Granular
Spinous
Basal

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4
Q

Dermal epidermal junction

Anchors dermis to epidermis

A

Basal membrane

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5
Q

Thick layer of CT
Larger blood vessels and nerves
Primarily collagen type I (70%)
Contains dermal appendages housing pluripotent cells critical in wound healing

A

Reticular layer of dermis

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6
Q

Collagen provides

A

tensile stength

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7
Q

Cells found in epidermis

A

Melanocyte
Langerhan
Merkel

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8
Q

Found in dermis

A

Hair follicle
Sebaceous gland
Apocrine gland
Nerve cell (meissner and pacinian)

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9
Q

Meissner’s function

A

light touch

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10
Q

Pacinian function

A

pressure

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11
Q 
Cafe au lait
Neurofibroma
Iris hamartoma (lisch nodule)
optic glioma 
freckling of non-sun exposed areas (axilla)
inc risk of astrocytoma 
pheochromocytome
neurofibrosarcoma

Autosomal dominant
More common than other variant

Mutation in:

A

NF1
von Recklinghausen’s

NF1 gene ch17
Involved in Ras pathway

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12
Q

Bilateral vestibular CN VIII
Schwannoma
Intracranial or intraspinal tumor (glioma, meningioma)

Autosomal dominant
Involved in cytoskeleton

Mutations:

A

NF2

NF2 ch22

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13
Q

Adenoma sebaceum
Shagreen patch
Ash leaf macule
Hamartoma (brain, lung, kidney), epilepsy, mental retardation

Autosominal dominant
Sporadic

Involved in GTPase activity

Mutation

A

Tuberous sclerosis

TSC1 and TSC2 ch9 and 16

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14
Q 
GI polyp (ampullary SI, large intestine)
Desmoid tumor
Sebaceous cyst
Osteoma
Variant of FAP

AD

Involved in cell adhesion, interaction and cystokeleton

Mutation:

A

Gardner’s

APC ch5

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15
Q

=1 first of second degree relative with melanoma
multiple atypical mole
mole with specific microscopic features
assoc with increased risk of pancreatic cancer

Autosomal dominant

Involved in cell cycle progression througg G1 S transition

Mutation:

A

Familial atypical multiple mole melanoma
FAMMM

CDKN2A p16 ch9
CDK4 ch12

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16
Q

45, F
painful 5mm subungual, bluish nodule on right index finger
exacerbated with cold

Dx?
Tx?

A

Glomus tumor

Excision lateral approach

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17
Q

Benign digital tumor composed of bv and nerves from dermal glommus body

Regulates distal perfusion

Women, painful subungual, bluish nodule exacebated by cold

Blanching blue to purple nodule usually <1cm

Mistaken for hemangioma or VM

A

Glomus body

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18
Q

Glomus body most common location

A

subungual area

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19
Q

Fair skinned Caucasian Male upon sun exposure
Premalignant
Leads to SCC

A

Actinic keratosis

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20
Q

Benign appear with equal prevalence in male and female
May inc in size with pregnancy, hormone and malignancy
Unrelated to sun exposure

A

Seborrheic keratoses

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21
Q

Actinic keratoses tx

A

Excise lesion

topical 5 FU

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22
Q

Seborrheic keratitis tx

A

observation

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23
Q

Most common benign head and neck tumor in adult

Accelerated growth during first 2 years of age but involute and do not require therapy

50% spontaneously resolves by 5 years
70% by age of 7

A

Hemangioma

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24
Q

Hemangioma tx

A

Non surgical: intralesional steroid, IFNa-2a

Invasive: surgical excision, laser or cryotherapy and embolization

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25
consumptive coagulopathy due to hemangioma thrombocytopenia DIC CHF persistence into adolescence as rate of spontaneous involution decreases
Kasabach-Meritt
26
``` Inc with sun exposure Tender Face, back of hands, forearm sunexposed Elevated, scaly or warty Red-yellow, brown, black lesion Hyperkeratotic scale ```
Actinic keratosis
27
Inc with pregnancy, hormone therapy, malignancy Not affected by sun exposure Non tender, pruritic Chest, back and abdomen Elevated, scaly, waxy oily plaque Yellowish brown, brownish black stuck-on macule
Seborrheic keratosis
28
Inflammatory nodule associated with underlying systemic disease UC, regional ileitis, RA, dysproteinemia, leukemia, lymphoma Rapidly enlarging, erythematous, necrotic ulcer with purple edematous border involving LE Identification of treatment of underlying systemic disease
Pyoderma gangrenosum
29
Pyoderma gangrenosum skin lesion tx bowel disease
steroid cyclosporine skin graft resection of affected bowel
30
Necrotic ulcer with violet border | Surrounding erythematous halo
Pyoderma gangrenosum
31
Benign overgrowth of melanocyte | Congenital or acquired
Benign nevus
32
Flat, elevated, veruccous, nodular brown, black or blue Flat, nonpalpable brown lesion on palms and soles of infants Elevated, dome shaped, pigmented Elevated, skin-colored contain hair Solitary brown or pink dome-shaped nodule on face or upper extremities Blue to black dome shaped nodule
Congenital lesion Junctional nevi Compound nevi Intradermal nevi Spitz nevi Blue nevi
33
Benign nevi is confirmed with
skin biopsy
34
Melanocyte proliferation at epidermal junction
Junctional nevi
35
Melanocyte proliferation only in dermis
Intradermal and blue nevi
36
Melanocyte proliferation both in dermis and epidermal-dermal junction
Compound nevi
37
Demonstrate largr number of mitoses
Spitz nevi
38
65, F Forehead lesion Notable 8mm with rolled border and underlying telangiectasia Mx?
Surgical excision with 4mm margin likely basal cell ca
39
Most common skin cancer
Basal cell
40
Basal cell rf:
``` exposure to UV radiation p53 mutation Fair skinned men (Celtic) sunexposed areas (face) occurs at any age but after fifth decade ```
41
Slow growing transluscent Shiny, pearly elevated nodule Central ulceration with rolled pearly edges, scab, telangiectasia
Basal cell carcinoma
42
Dx of basal cell carcinoma
Shave or punch biopsy of basal layer
43
Basal cell carcinoma tx
Electrodissection and curettage for small lesion <2mm Excision via Moh’s micrographic surgery for larger Unable or willing to undergo surgery, consider radiation, topical 5FU, imiquimod or intralesional interferon 95% cured, metastases rare
44
T1 staging basal cell
>/= 2 cm in greatest dimension
45
>2cm and >/=5 cm greatest dimension
T2
46
>5cm greatest dimension
T3
47
invasion into extradermal structure
T4
48
Second most common cancer in fair-skinned population Occurs in sun-exposed aread (lower lip, backs of hands)
Squamous cell carcinoma
49
Rf for SCC of skin
``` UV, ionizing radiation exposure actinic keratosis Hydrocarbon Tobacco Chronic infection (HPV) Immunosupression Burns (Marjolin’s ulcer) Chronic, non healing wound ```
50
Erythematous plaque or nodule Associated with central ulceration or indistinct margin Pain, bleeding or pruritus
SCC
51
Confirms dx of SCC
Shave, punch, incisional or excisional biopsy biopsy: atypical keratinocyte invading dermis associated with keratin pearls
52
SCC in situ
Bowen disease
53
SCC tx
Excise with 1cm margin Lymph node excision indicated for palpable nodules Metastasizes 85%, 3 year survival and dramatically dec if metastasis is present
54
Leading cause of skin cancer related deaths
Melanoma
55
Rf for melanoma
UV exposure Family hx (FAMMM) Congenital nevi Fair skinned male with significant hx of sun exposure during teenage
56
Sun exposed area (neck, face, back of hands) Older Best prognosis
Lentigo maligna
57
Anywhere but palms and soles spared Most common Exhibits primarily radial growth
Superficial spreading
58
Palms Soles Subungual Least common, dark skinned population
Acral lentiginous
59
Palms, soles or subungual Most aggressive type Lacks radial growth
Nodular
60
ABCDEs of melanoma
``` Asymmetry Border (irregular, ill defined) Color (pigmented) Diameter (>6mm) Evolution ```
61
Pruritis in melanoma is suggestive of
neural invasion
62
Confirms dx of melanoma
Excisional biopsy | WLE
63
WLE for <1cm lesion
<1mm margin
64
1-2cm lesion
1-2mm
65
2 cm lesion
2-4mm
66
2-3cm lesion
>4mm
67
Sentinel lymph node biopsy is warranted in melanomas
>1mm without clinically + nodes or >0.75mm high risk signs (ulceration) Lymph node dissection for clinically + nodes Chemo not shown to be effective
68
Improves disease free and overall survival in patients stage IIB or III
IFNalpha-2b
69
Clark staging of melanoma | Level I
Epidermis
70
Clark level II
upper half of papillary dermis
71
Clark Level III
Epidermis + papillary dermis
72
Clark Level IV
Epidermis to reticular dermis
73
Clark level V
Epidermis, dermis, subcutaneosu tissue
74
Breslow melanoma level 1
0.75 mm
75
Breslow level II
0.76-1.5mm
76
Breslow level III
1.51-3.0mm
77
Breslow level IV
>4mm
78
Neuroendocrine lesion of dermis Synchronous of metachronous SCC Red purple painless nodule of head and neck
Merkel cell carcinoma
79
Merkel cell carcinoma is +
IHC for neuron specific enolase NSE | Neurofilament protein
80
Merkel cell tx
WLE with 3cm margin | lymph node dissection for palpable nodes
81
Benign tumor from muscular fascial plane 3rd to 4th decade Etiology not clear associated with Gardner prior surgery pregnancy Asymptomatic, signs and symptoms related to compression or invasion Confirm with biopsy: spindle cells with collagen IHC + for smooth muscle actin, vimentin, desmin High level of suspicion in FAP, Gardner’s Tx: WLE with 2-4cm margin
Desmoid tumor
82
Injury to superior or inferior epigastric vessel Inc pressure or shearing force to rectus sheath in coagulation Acute tender mass evident with tensing of rectus muscle Dx: CT Tx: pressure to hematoma and serial Hct
Rectus sheath hematoma
83
Tensing of rectus muscle
Fothergill’s sign
84
Most common bone malignancy Young adult also in >40 Rf: radiation, Paget’s, chemotherapy Bone pain, palpable mass with lung mets Rx: Codman’s triangle with cortical destruction (sunburst sign) Neoadjuvant, chemo, WLE 4cm Limb salvage or ampu
Osteosarcoma
85
Osteosarcoma affects
metaphyseal region of long bones
86
Primitive neuroectodermal tumor 5-15 years Pelvis, femur or humerus (diaphysis) Due to ch 11-22 translocation Malaise, fever, pain, edema Rx: onion skinning Chemo, radiation, radical resection
Ewing’s sarcoma
87
Most common pediatric sarcoma 2-5 years, 15-19 years Arises as mesenchyme differentiates into skeletal muscle Palpable mass Incisional biopsy, CT and MRI to determine primary site extent and histology Chemotherapy, WLE
Rhabdomyosarcoma
88
``` AIDS Immunosupression Chemotherapy HHV8 Most common AIDS related malignancy ``` Red to purple nodule or skin or mucosa Biopsy Chemoradiation, resection
Kaposi’s sarcoma
89
1 year old boy facial hemangioma Correct management?
Observation, involute and not require further therapy
90
38, F | UC with necrotic ulcer with violaceous border
Pyoderms gangrenosum
91
60 M Third degree burn to right LE 25 years ago Chronic lesion at site of burnt scar Dx
SCC Marjolin ulcer
92
44 M Pain and palpable mass of RLE Codman’s triangle Mx?
Osteosarcoma Neoadjuvant chemotherapy followed by WLE
93
82 F Purple nodule or right shoulder + NSE and neurofilament protein Mx?
Merkel cell carcinoma WLE with 3cm margin LN dissection if palpable

Surgery (17 decks)

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