SOFT TISSUE Flashcards by Jackie Zhang

What is Cloquet’s LN

bridging node between superficial and deep nodal basins
status important for pts with malignant melanoma - if positive, high possibility of deep pelvic note involvement, and operation should be extended to include deep compartment of groin

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Where is Cloquet’s LN

Below inguinal ligament and medially in the femoral canal

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Mgmt soft tissue sarcoma

WLE 1-2cm margin (neoadjuvant only if >10cm or high-grade tumors)

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Most important prognostic factor for melanoma

Correlates to Breslow depth

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Acral lentigenous melanoma associated with poor prognosis because…?

Due to delay in dx - when correlated with Breslow depth, overall survival similar to other subtypes of melanoma

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Acral lentigenous melanoma typically found where? More common in what pts?

Hands, feet, digits.

MC among people of color.

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Superficial spreading melanoma associated with vertical or radial growth?

Radial

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What is the MC non-skin melanoma?

Eye melanoma

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Nodula melanoma associated with good or bad prognosis?

Bad - bc aggressive growth and later presentation

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Indications for deep inguinal LN dissection are…

> 4 LN positive on superficial dissection
positive Cloquet’s node
enlarged ileo-obturator LN on CT
clinically palpable or extracapsular invasion of femoral LN

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Mgmt acute paronychia infection

If superficial - warm compress and close f/u
If unilateral abscess - corner of affected nail removed to unroof infxn
If underneath nail to c/l side - prox 1/3 nail should be removed + wound packed and allowed to drain + Abx (amox/clavulanate)

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Mgmt lymphedema

compressive decongestive therapy (2-phase program of initiation and maintenance)

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Manifestations of Marfan sydrome

(fibrillin-1)

aortic root dilation
dislocated lens of eye
long, tall body habitus

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Defect found in Ehlers-Danlos syndrome

defect in type III collagen

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Mgmt for recurrent, advanced pilonidal cysts

off-midline incision (reduced Cx rate, healing time, and recurrence rate than midline) + rhomboid flap reconstruction

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Type of biopsy if concerning for soft tissue sarcoma… and if fails?

core needle biopsy for >5cm.
excisional biopsy (longitudinal) for <3cm, if CNBx fails.

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What is a felon? Mgmt?

severe, closed space infection of fingertip pulp; uncommon Cx of acute paronychia.
Mgmt: I&D + adj Abx

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MC pathogen for acute paronychia

S.aureus

MC soft-tissue sarcoma subtype in adults (#1, 2, 3)

#1: malignant fibrohistio-sarcoma
#2: liposarcoma
#3: lipomyosarcoma

MC soft-tissue sarcoma subtype in peds

rhabdosarcoma

Rx rhabdosarcoma

surgery + chemoradiation

What subtype sarcoma is somewhat responsive to chemotherapy?

rhabdosarcoma

- Ewing sarcoma

MC site mets for soft-tissue sarcoma

lung

Dx soft-tissue sarcoma

1: MRI
2: Bx (CNBx for >5cm, excisional only <3cm and when CNBx fails) - for RP liposarcoma can just resect bc difficult to biopsy

Tx soft-tissue sarcoma

- WLE 2-3cm - radiotherapy if close margins or size >5cm - chemo if rhabdo or Ewing sarcoma

Dx melanoma. | When do punch biopsy?

excisional full-thickness biopsy w/ 1-2mm margins. | punch bx only if tumor large and will need complete excision, and for cosmetic areas

Margins needed for melanoma excision (by Breslow depth)

``` in situ -> 0.5-1cm margin T1 (<1mm) -> 1cm T2 (1-2mm) -> 1-2cm T3 (2-4mm) -> 2cm T4 (>4mm) -> >2cm ```

Staging: melanoma

``` 1,2 = local disease, no LN 3 = regional disease, post LN 4 = distant mets ```

If pos LN melanoma, then must do...?

complete LN dissection + PET

Common choice Abx for acute paronychia

PO amox/clavulanate

Tx Merkel Cell Carcinoma

- WLE 3-5cm margins - SLNBx - adjuvant radiation therapy for >/= 2cm - chemoRx for stage 4

High-risk factors of SCC and basal cell that need Mohs

- location: face, ear, genitalia, hand/foot - >/= 6mm on high-risk areas - poorly diff - depth >/= 4mm - perineural invasion - rapid growth - etiology: scar, chronic ulcer or inflam, sinus tract, site of prior radiation therapy - immunosuppression

Actinic keratosis

precursor for SCC

Dermatofibrosarcoma protuberans (presentation, histo)

Presents: 30-50s; firm, flesh-colored to dull red plaques (can be mistaken for keloid) Histo: finger-like projections of spindle cells

Biopsies of suspicious skin lesions should be...

along long axis of extremity, full thickness biopsy taken from edge of lesion (with healthy tissue)

Margin for low-risk basal cell carcinoma

0.3-0.5 cm

What stage should do SLNBx for melanoma?

Stage 1B and above (>1mm, or <1mm with high-risk features)

Borders of superficial groin

(femoral triangle) - lateral: sartorius - medial: adductor longus - superior: inguinal ligament

Where is Cloquet's LN?

below inguinal ligament, medial to femoral canal

How does skin graft survive at recipient site?

1. plasmatic imbibition (graft passively absorbs nutrients in wound bed by diffusion) 2. day 3 - inosculation (cut ends of vessels on dermal underside form connection with wound bed) 3. day 5 - angiogenesis 4. graft is vascularized

MC subtype melanoma

superficial spreading melanoma

Melanoma subtype with best overall prognosis

lentigo maligna melanoma

Melanoma subtype with worse overall prognosis

nodular melanoma (early vertical growth)

Lymphedema occurs in ?% of axillary dissections

20%