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73 Cards in this Set
- Front
- Back
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Def:
main cell type in epidermis; originate from basal layer; provide mechanical barrier |
Keratinocytes
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Def:
neuroectodermal origin (neural crest cells); in basal layer of epidermis Have dendritic processes that transfer melanin to neighboring keratinocytes via melanosomes |
Melanocytes
• Density of melanocytes is the same among races; difference is inproduction |
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Def:
primarily structural proteins for the epidermis |
Dermis
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Def:
Act as antigen- presenting cells (MHC class II) • Originate from bone marrow • Have a role incontact hypersensitivity reactions (type IV) |
Langerhans cells
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Def
Highest concentration of glands in palms and soles; most sweat is the result of sympathetic nervous system via acetylcholine |
Apocrine sweat glands
- milky sweat |
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Sensory nerves
pressure |
Pacinian corpuscles
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Sensory nerves
warmth |
Ruffini's endings
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Sensory nerves
cold |
Krause's end-bulbs
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Sensory nerves
tactile sense |
Meissner's corpuscles
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Produces aqueous sweat (thermal regulation, usually hypotonic)
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Eccrine sweat glands
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Def
70% weight of dermis; gives tensile strength predominant type of collegen |
Type I collagen
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Def
resistance to stretching (collagen ) |
Tension
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Def
ability to regain shape (branching proteins that can stretch to 2X normal length) |
Elasticity
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pathophysiology of Cushing's striae
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caused by loss of tensile strength and elasticity
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What type of skin graft?
Include all of the epidermis and part of the dermis • Donor site skin regenerated from hair follicles and skin edges |
Split-thickness skin grafts (STSGs)
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What skin graft is more likely to survive?
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Split-thickness skin grafts
graft not as thick so easier for imbibition and subsequent revascularization to occur |
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What skin graft is less likely to contract?
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Full-thickness skin grafts
have less wound contraction good for areas such as the palms and back of hands |
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Define Imbibition (osmotic)
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blood supply to skin graft for days 0-3
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When does Neovascularization start?
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Day 3
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What is the most common cause of Pedicled or anastomosed free flap necrosis
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venous thrombosis
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How does tissue expansion work?
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occurs by local recruitment, thinning of the dermis and epidermis, mitosis
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Transverse rectus abdominus myocutaneous (TRAM) flap reconstruction.
List complications |
Complications - flap necrosis, ventral hernia, bleeding, infection, abdominal wall
weakness |
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Transverse rectus abdominus myocutaneous (TRAM) flap reconstruction.
Main blood supply? |
Rely on superior epigastric vessels
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What UV is responsible for chronic sundamage?
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UV-B
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Represents only 3%-5% of skin CA but accounts for 65% of the deaths
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MELANOMA
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What is the % of lifetime Risk for melanoma?
Dysplastic, atypical, or large congenital nevi |
10%
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What is the % of lifetime Risk for melanoma?
Familial BK mole syndrome |
100 %
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Most common melanoma site on skin?
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back in men, legs in women
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What is the orgin of melanocytes?
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neural crest cells
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What is the most common location for distant melanoma metastases?
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Lung
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where does melanoma most commonly metastasize?
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small bowel
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Possible melanoma
<2 cm lesion What type of biopsy? |
excisional biopsy (tru-cut core needle biopsy)
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Possible melanoma
>2 cm lesions or cosmetically sensitive area What type of biopsy? |
incisional biopsy (or punch biopsy)
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Type of melanoma?
least aggressive, minimal invasion, radial growth 1st; elevated nodules |
Lentigo maligna
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Type of melanoma?
most common, intermediate malignancy; originates from nevus/sun -exposed areas |
Superficial spreading melanoma
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Type of melanoma?
most aggressive; most likely to have metastasized at time of diagnosis; deepest growth at time of diagnosis; vertical growth 1st; bluish black with smooth borders; occurs anywhere on the body |
Nodular
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Type of melanoma?
very aggressive; palms/soles of African Americans |
Acral lentiginous
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What is the tx for all stages of melanoma?
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Tx: for all stages, resection of primary tumor with appropriate margins
• Alpha- interferon, IL- 2 , and tumor vaccines can be used for systemic disease |
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List rules for nodes in melanoma.
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Always need to resect clinically positive nodes with melanoma
• Perform sentinel lymph node biopsy if nodes clinically negative and tumor >1mm deep • Involved nodes usually nontender,round ,hard ,1 -2cm •All stage Ill tumors need full lymph node dissection •Need to include superficial parotidectomy for anterior head and neck melanomas • Axillary node melanoma with no other primary - Tx: complete axillary node dissection |
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Margin needed for melanoma?
< 1 mm |
1 cm
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What Clark's Levels for Melanoma?
Epidermis basement membrane intact |
Level 1
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What Clark's Levels for Melanoma?
Papillary dermis through basement membrane |
Level 2
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What Clark's Levels for Melanoma?
Junctional dermis between papillary and reticular dermis |
Level 3
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What Clark's Levels for Melanoma?
Reticular dermis |
Level 4
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What Clark's Levels for Melanoma?
Fat |
Level 5
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Margin needed for melanoma?
1-4 mm |
2cm
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Margin needed for melanoma?
> 4 mm |
2-3cm
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Most common malignancy in United States
Pearly appearance, rolled borders Pathology - peripheral palisading of nuclei and stromal retraction |
BASAL CELL CARCINOMA
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Most agrressive form of basal cell carcinoma
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Morpheaform type- has collagenase production
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actinic keratoses, xeroderma pigmentosum, Bowen's disease, atrophic epidermis are all risk factors for what type of skin ca?
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SQUAMOUS CELL CARCINOMA
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Most common soft tissue sarcomas?
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#1 Malignant fibrous Histosarcoma
#2 Liposarcoma |
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SOFT TISSUE SARCOMA
Mass < 4cm What type of biopsy? |
Excisional biopsy
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SOFT TISSUE SARCOMA
Mass > 4cm What type of biopsy? |
Longitudinal incisional biopsy
(may need to eventually resect biopsy skin site if biopsy shows sarcoma) |
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How does SOFT TISSUE SARCOMA metastisize?
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Hematogenous spread
not to lymphatics metastasis to nodes is rare |
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Most common site of metastisis for soft tissue sarcoma?
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Lung
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Tx for SOFT TISSUE SARCOMA
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3-cm margins and at least 1 uninvolved fascial plane
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Chemotherapy for SOFT TISSUE SARCOMA
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doxorubicin based
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Staging of SOFT TISSUE SARCOMA
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Staging based on grade, not size or nodes
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#1 soft tissue sarcoma in kids
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rhabdomyosarcoma
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Most common subtype of rhabdomyosarcoma
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• Embryonal subtype - most common
• Alveolar subtype - worst prognosis • Tx: surgery; doxorubicin -based chemotherapy |
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Where do Osteosarcoma originate from?
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metaphyseal cells
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Genetic syndrome for soft tissue tumors
CNS tumors, peripheral sheath tumors, pheochromocytoma |
Neurofibromatosis
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Type of keratosis
Premalignant, in sun-damaged areas; need excisional biopsy |
Actinic keratosis
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Type of keratosis
not premalignant found on trunk on elderly; can be dark |
Seborrheic keratosis
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Type of keratosis
associated with squamous cell carcinoma |
Arsenical keratosis
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neuroendocrine tumor
• Aggressive regional and systemic spread; patients have red to purple papulonodule / indurated plaque • Have neuron-specific enolase NSE cytookeratin and neurofilament protein |
merkel cell carcinoma
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Painful tumor composed of blood vessels and nerves
• Benign; most common in the termina l aspect of the digit • Tx: tumor excision |
Glomus cell tumor
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are cytologically bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body
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Desmoid tumors
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Intra-abdominal desmoids are associated with what dz?
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Gardner's syndrome
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Most common location for Desmoid tumors?
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Anterior abdominal wall
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infection of the apocrine sweat glands, usually in axilla and groin regions
• Staph/strep most common organisms • Tx: antibiotics, improved hygiene 1st; may need surgery |
Hidradenitis
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Collagen goes beyond original scar
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Keloids
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Collagen stays with in confines of scar
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Hypertrophic scar tissue
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