skin and subcutaneous Flashcards
(23 cards)
Following caustic injury to the skin with an alkaline agent, the effected area should be initially be
Treated with running water or saline for 2 hours
- treatment for both types of injuries is based on neutralization of the inciting solution
- for acidic = 30 minutes
- for 2nd degree burns
- debridement, silavadene, protective petroleum gauze
- severe cases
- within 24 hours by liposuction with a small catheter and then saline injection
The treatment for a hydrofluoric acid skin burn
Application of calcium carbonate gel
- IV calcium repletes resorbed calcium stores
- mitigates the leasching og calcium and magnesium ions by the hydrofluoric acid from theaffected tissues abd prevents potentially sevre hypocalcemia and hypomagnesemia
The most amenable to salvage by resuscitative and wound management techniques following thermal injury
Zone of stasis
- Zone of coagulation = epicenter of the injury with varying extent of necrosis
- Zone of stasis = marginal perfusion and questionable viability
- Zone pf hyperemia = outermost area
Tissue ischemia resulting in wounds are characterized as a partial-thickness injury with a blsiter is considered
Stage 2
- Stage 1 = nonblanching erythema over intact skin
- Stage 2 = partial thickness injury (epidermis or dermis)-blisteror crater
- Stage 3 = full thickness injury extending down to, but not including fascia and without undermining of adjacent tissue
- Stage 4 = full thickness skin injury with destruction or necrosis of muscle, bine, tendon, or joint capsule
Tissue pressures that exceed the pressure of the microcirculation (30 mmHg) result in tissue ischemia
- ischial tuberosity (28%)
- trochanter (19%)
- sacrum (17%)
- heel (9%)
The presence of sulfur granules in a draining wound should lead to the use of _________
Penicillin
- Actinomycosis
- cervicofascial form = most common
- acute pyogenic infection in the submandibular or paramandibular area
- can spread beyond boundaries of tissue planes
Initial treatment of nonpurulent, complicated cellulitis
B-lactam
- Treatment of nonpurulent, complicated cellulitis can begin B-lactam with MRSA coverage
- vancomycin
- clindamycin is also approved for s. aureus however, resistance may develop, and diarrhea can occur in up to 20% (clostridium difficile related)
A 3mm basal cell carcinoma of the skin should be treated with
excision with 2 to 4 mm normal margin
- BCC arises from the basal layer of non keratinocytes
- UVB > UVA
- immune suppresion
- xeroderma pigmentosa, unilateral basal cell nevus syndrome and nevoid BCC syndrome
Trichilemmal cysts
typically found on the scalp of females
Three types of cutaneous cysts
-
Epidermal - most common
- mature epidermis complete with granular layer
-
Dermoid - congenital found between forehead to nose tip
- squamous epithelium, eccrine glands, pilosebaceous units
-
Trichilemmal - seocnd most common
- scalp on females
- distinct odor when ruptured
More than half of patients treated for BCC will experience a recurrence within
3 years
- 60%
- the remaining will recur within 5 years after initial treatment
- A 2nd primary BCC may develop after treatment in 40% cases, presents within the first 3 years
The primary risk factor for the development of squamous cell carcinoma (SCC)
UV exposure
- Squamous cell carcinoma is the 2nd most common
- Riskfactors
- UV exposure
- Chemical agents
- HPV 16 and 18
- Smoking
- Heritable conditions
- xeroderma pigmentosa
- epidermolysis bullosa
- occulocutaneous albinism
in the ABCDE of melanoma, the D stands for Diameter greater than ________
6 mm
- Asymmetric outline
- Borders - irregular
- Color varations
- DIameter >6mm
- Elevation.
Amelanotic lesions appear as raised pink, purple, or normal colored skin papules and are often diagnosed late
The most common site for distant metastasis for melanoma?
Lungs
- Common sites
- Lungs and liver
- brain
- GI tract
- distant skin
- subcutaneous tissue
- Liver mets are better dealt without surgical resection unless they arise from an ocular primary
The most common subtype of melanoma
Superficial spreading
Melanoma growth most commonly starts as a localized, radial growth phase followed by a vertical growth phase that determines metastatic risk
Other types
- lentigo melanoma
- acral lentiginous
- mucosal
- nodular
- polypoid
- desmoplastic
- amelanotic
- soft tissue
Ocular melanoma
Exclusively metastasizes to the liver
- most common noncutaneous disease site
- Treatment
- photocoagulation
- partial resection
- radiation
- enucleation
- liver resection
Merkel cell carcinoma
- Recurrence is common
- Commonly found in white men with a median age of 70 years
- Characterized by a rapidly growing, flesh-colored papule
- Treatment should begin with examination of nodal basins
- regional lymph node disease is common
What is the msot common melanoma in patients with dark skin?
Acral lentiginous
- Nodular melanoma = 15 to 30%
- vertical growth
- Lentigo maligna = older individuals primarily located in the head and neck region
- Acral lentiginous = 29 to 72% of melanomas in dark skinned
- palmar, plantar, and subungual surfaces
Kaposi sarcoma
Excision is the treatment of choice
- Diagnosed after the fifth decade of life
- skin
- immunocompromised individuals
- multifocal, rubber blue nodules
- AIDS associated Kaposi sarcoma
- systemic antiviral therapy
Prognostic indicators for patients with a sentinel node containing metastatic melanoma
- Patient age
- Number of positive nodes
- Thickness, ulceration, and mitotic rates
The site of metastasis is strongly associated with prognosis for Stage IV disease, and elevated LDH is associated with a worse prognosis
A patient with a 5mm deep melanoma of the thigh and no clinically positive nodes should undergo
Resection of the primary only
- Nonmetastatic in-transit disease should undergo excision to clear margins when feasible
- If not feasible
- Isolated limb perfusion (63% response)
- Isolated limb infusion (31% response)
- commonly use is melphalan
A 65 year old patient who spends winters in florida present with a painless, ulcerated lesion on his right cheek. The lesion has been presented for 1 year. Physical examination of the patient’s neck reveals no lymph node enlargement. The most likely diagnosis
BCC
- The most common form of BCC (60%) is the nodular variant
- raised, pearly pink papules and occasionally a depressed tumor center with raised borders “rodent ulcer”
- Superficial BCC (15%)
- pink or eythematous plaque with thin pearly border mostly in the trunk
- Morpheaform variant (3%)
- indistinct borders with yellow hue, and fibroepithelioma of Pinkus
The chronic inflammatory disease presenting as painful subcutaneous nodules is
Hiradenitis suppurativa
- multiple abscess, internetworking sinus tracts, foul-smelling exudate from darining sinuses, inflammation in the dermis, both atrophic and hypertrophic scars, ulceration, and infection, which may extend deep into the fascia
Toxic epidermal necrolysis
- Immunologic problem
- lesions are similar in appearance to aprtial thickness burns
- The process develops ar the dermoepidermal junction
- Nikolsky sign
Rare adenocarciconoma of the apocrine gland that appears as a nonpigmented plaque
Extramamamry paget disease
- perianal and axillary regions
- ezcema like appearance
- high incidence of concomitant other malignancies
- genitourinary malignancies
- gastrointestinal malignancies
