Flashcards in Skin/Soft Tissue Surgery Deck (19):
What are the common skin cancers?
Basal cell carcinoma (50%), squamous cell carcinoma (25%), malignant melanoma (15%); management is full-thickness incisional biopsy at border of the lesion
What does basal cell carcinoma look like?
Raised waxy lesion or non-healing ulcer in upper face, doesn't spread; tx local excision with 1 mm margins
What does squamous cell carcinoma look like?
Non-healing ulcer in lower face, spreads to LN; tx local excision with 1 cm margins and LN excision
What are the SCC risk factors?
draining fistulas, arsenic exposure
What is a dysplastic nevus?
Atypical mole, precursor of malignant melanomas, requires close observation
What do you see with melanomas?
A-asymmetric B- irregular borders C- colors D- diameter >5mm E-evolving
Px is related to depth, highly metastatic and will be found in weird places
What are the worrisome melanoma features?
ulcerated (1/3 reduction in survival) and depth >4 mm (pt will likely die from mets)
How do you treat melanoma with metastasis?
Tx radiation and chemotherapy (interferons)
What is lentigo maligna melanoma?
Superficial, spreading melanoma on the face, good prognosis overall, tx excision with narrow margin
What is acral lentiginous melanoma?
Melanoma on pale areas of dark-skinned patients (sole of feet, palm of hand), worst prognosis due to depth
How does a sarcoma present?
Present as a firm, painless mass; px depends on size, grade, and distant metastasis
No LN involvement since sarcomas spread hematogenously
What are some melanoma subtypes to be aware of?
subungual melanoma (under fingernail or toenail)
mucosal melanoma (bad prognosis, tx APR with palpable LN excision)
melanoma + SBO (presents as abd distention, nausea and vomiting due to metastatic melanoma in abd cavity, tx with ex lap and excision)
How do you manage sarcomas?
Dx incisional biopsy parallel to resection margins, chest CT for mets, tx resection with 1 cm negative margins
tx high-grade sarcomas with radical amputation with post-op radiation therapy
Common mets in lung and liver
What are the hernia surgery indications?
All abdominal hernias due to possibility of strangulation, except sliding esophageal hernias (tx PPIs) and umbilical hernias in pts <2 yo (simple observation)
Can cause SBO or strangulation (presents as firm/tender mass with fever, increase in WBC, metabolic acidosis)
How do you manage umbilical hernias?
2cm fix, fix if it doesn't regress before kindergarten regardless
What is an indirect hernia?
Through internal ring lateral to inferior epigastric vessels, due to patent processus vaginalis; most common hernia overall
In kids, high incidence of bilaterality, repair is limited to high ligation of sac without abdominal wall repair
What is a direct hernia?
Medial to inferior epigastric vessels, due to weakening abdominal wall; more common in elderly
What is a femoral hernia?
Below inguinal ligament into femoral triangle, more common in women, highest risk of strangulation
Other types include : sliding hernia and ventral hernia