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Flashcards in Surgery - Skin Deck (22):
1

Where are melanocytes?

Epidermis

2

Staging of melanoma

- T represents how thick the melanoma is, this will tell you prognostic factor
- Breslow was only depth (in mm) before (no ulceration or mets)
- Clark has lower predictive value and was used with Breslow’s depth but described where in anatomical invasion of skin
o 1 = epidermis; 2 = papillary dermis; 3 = papillary-reticular dermis junction; 4 = reticular dermis; 5 = subQ fat

3

Melanoma Stage IA

T1a, N0, M0

< 1mm, (-) ulceration

4

Melanoma Stage IB

T1b, N0, M0 OR
T2a, N0, M0

< 1 mm + ulceration
OR
1-2 mm (-) ulceration

5

Melanoma Stage IIA

T2b, N0, M0
OR
T3a, N0, M0

1-2 mm + ulceration
OR
2-4 mm (-) ulceration

6

Melanoma Stage IIB

T3b, N0, M0
OR
T4a, N0, M0

2-4 mm + ulceration
OR
> 4 mm (-) ulceration

7

Melanoma Stage IIC

T4b, N0, M0

> 4mm + ulceration

8

Melanoma Stage III

+ nodes

9

Melanoma Stage IV

Distant mets (lung, liver, bone, heart, brain…..loves small bowel mucosa)

10

Dx SCC or Basal cell

Full thickness incisional bx done at edge of lesion including normal skin

11

Preferred adjuvant systemic therapy for metastatic melanoma?

IFN beta

12

Tx basal cell carcionma

Local excision

+ margins - reexcise to clear margins

Margins should be 2-4 mm

+ topical 5-FU or radiation

13

Tx squamous cell carcinoma

More dangerous than basal

Excision w/ 1cm tumor-free margins
Lymph node excision is palpable

+ 5-FU or radiation

14

What is most significant finding in addition to histo findings + TNM stage for melanoma?

Ulceration

Ulcerated lesions have 1/3 reduction in survival

15

Lentigo maligna melanoma

Usually on face

Superficial spreading (not as invasive)

Favorable prognosis

16

Hutchinson freckle

Precursor of lentigo malignant melanoma

17

Acral melanoma

Usually in dark skinnier ppl

Tend to be thicker lesion

Assoc w/ poorer prognosis

18

When do you bx or excise a soft tissue sarcoma?

Excisional bx for masses < 3cm

19

Bx technique for sarcoma

Core biopsy

NOT FNA

20

Sarcoma grading

Based on # of mitotic figures and degree of necrosis

21

Mets of sarcomas to...

liver
lung
bone
brain

22

If have recurrence of sarcoma, what is prognosis?

If have pulm mets, and excise, can have significant long term disease free intervavl