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88 Cards in this Set

  • Front
  • Back
What is the main cell type in the epidermis?
keratinocytes
What is the origin of melanocytes?
neuroectodermal origin (neural crest cells)
What is the skin cell type that act as antigen presenting cells (MHC class II) originate from bone marrow. Have a role in contact hypersensitivity reactions (type IV)
Langerhans cells
Name the sensory nerve that handles pressure.
pacinian corpuscles
Name the sensory nerve that handles warmth.
Ruffini's endings
Name the sensory nerve that handles cold.
Krause's end-bulbs
Name the sensory nerve that handles tactile sense.
Meissner's corpuscles
What type of seat glands provide aqueous sweat for thermal regulation? What type produces milky sweat as a result of sympathetic nervous system with highest concentration in palms and soles?
Eccrine, Apocrine
What type of collagen is the predominant type in the skin, 70% weight of dermis, gives tensile strength?
Type I
With split thickness skin graft donor sites, what 2 places is the skin regenerated from?
hair follicles and skin edges
With skin grafts, imbibition (osmotic) blood supply to skin for days __-___. What starts after that?
0-3, neovascularization
What vessels does a TRAM flap rely on? Which perforators are most important determinant of TRAM flap viability?
superior epigastric vessels, periumbilical perforators
What does TRAM stand for in TRAM flap reconstruction?
transverse rectus abdominus reconstruction
Name the pressure sore stage:

Erythema pain, no skin loss
Stage I
Name the pressure sore stage:

Partial skin loss with yellow debris. Tx: local tx, keep pressure off
Stage II
Name the pressure sore stage:

Full-thickness skin loss subcutaneous tissue exposure. Tx: sharp debridement; will likely need myocutaneous flap.
Stage III
Name the pressure sore stage:

Usually involves bony cortex. Tx: myocutaneous flaps
Stage IV
What is the single best factor for protecting skin from UV radiation?
melanin
What type of ultraviolet radiation is responsible for chronic sun damage?
UV-B
What represents only 3-5% of skin CA bu accounts for 65% of the deaths?
Melanoma
Familial BK mole syndrome carries an almost 100% risk of what?
melanoma
What percentage of melanoma is familial?
10%
What is the most common melanoma site in men and in women?
men back, women legs
What do the following represent in melanoma? men, ulcerated lesions, ocular and mucosal lesions
worse prognosis
What color in melanoma is most ominous?
blue
What is the most common location for distant melanoma metastasis?
lung
What is most common CA to metastasize to the small bowel?
melanoma
In the diagnosis of melanoma, what is the difference in a <2 cm lesion and a >2 cm lesion or cosmetically sensitive area?
<2 cm excisional bx - need resection with margins if positive

>2 cm or cosmetically sensitive do incisional (or punch) bx - need resection with margins if positive
Name the type of melanoma:

Least aggressive, minimal invasion, radial growth 1st usual; elevated nodules
lentigo maligna
Name the type of melanoma:

most common, intermediate malignancy; originates from nevus/sun-exposed areas
superficial spreading melanoma
Name the 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
Name the type of melanoma:

very aggressive; palms/soles of African Americans
Acral lentiginous
Name 3 things that need to be done to stage melanoma.
CXR, LFTs, examine all possible draining lymph nodes
____, ____ and tumor vaccines can be used for melanoma with systemic disease.
Alpha-interferon, IL-2
Perform sentinel lymph node bx with melanoma if nodes clinically negative and tumor >___ deep.
1 mm
Are involved nodes in melanoma usually tender?
no
What stage melanoma tumors need full lymph node dissection?
III
What additional procedure is needed for anterior head and neck melanomas?
superficial parotidectomy
What is the tx for axillary node melanoma with no other primary?
complete axillary node dissection
Should resection be performed of an isolated melanoma metastases (ie lung or liver) that can be resection with a low-risk procedure?
probably
What is the level classification system for melanoma based on level of invasion called?
Clark's levels (I-V)
List the margins needed in melanoma with depth:

<1 mm
1-4 mm
>4 mm
1 cm
2 cm
2-3 cm
What is the most common malignancy in the US?
Basal Cell carcinoma
Pearly appearance, rolled borders. Pathology shows peripheral palisading of nuclei and stromal retraction.
Basal cell carcinoma
Tx for clinically positive nodes in basal cell carcinoma or squamous cell carcinoma?
regional adenectomy
What type of basal cell carcinoma is most aggressive and has collagenase production?
Morpheaform type
What size margins for basal cell carcinoma?
0.3-0.5 cm
■ Overlying erythema, papulonodular with crust and ulceration ■ May have surrounding induration and satellite nodules ■ Usually red-brown; can have a pearly appearance ■ Metastasizes more frequently than basal cell CA but less common than melanoma
squamous cell carcinoma
What are the margins for low risk squamous cell carcinoma? What is the tx for high risk?
0.5-1.0, Mohs surgery
Is Mohs used for melanoma?
no
What are the first and second most common soft tissue sarcomas?
malignant fibrous histiosarcoma, liposarcoma
What is the most common presentation of a soft tissue sarcoma?
painless mass
What to imaging modalities are used in soft tissue sarcoma and why?
CXR to r/o lung mets, MRI before bx to r/o vascular, neuro or bone invasion
How do you bx a soft tissue sarcoma that is < 4cm? >4cm?
excisional bx, longitudinal incisional bx (may need to eventually resect bx skin site if bx shows sarcoma)
What route does sarcoma mets? and what is the most common site?
hematogenous, lungs
What are the rules for margins in resection of sarcoma?
3 cm margins and at least 1 uninvolved fascial plane
Why do you place clips at site of likely recurrence in excision of sarcoma?
will XRT these later
List 3 indications for XRT in sarcoma?
high-grade tumors, close margins, tumors > 5 cm
Chemotherapy for sarcoma is based on what drug?
doxorubicin
Sarcoma tumors greater than what size may benefit from preop XRT and chemotherapy -> may allow limb sparing resection
> 10 cm
Isolated sarcoma mets without evidence of systemic disease, resection or palliation with XRT?
resection (systemic disease - palliate with XRT)
What is the 5 year survival rate with complete resection of sarcoma?
40%
Head and neck sarcomas can occur in the pediatric population, what is the usual type? Negative margins may be impossible to obtain due to close proximity to vital structures. What additional tx?
rhabdomyosarcoma, XRT
What are the two most common types of visceral and retroperitoneal sarcomas?
leiomysoarcoma and liposarcoma
Tx for Kaposi's sarcoma is XRT or intralesional ___ for local disease; systemic chemo for disseminated dz
vinblastine
What is the #1 soft tissue sarcoma in kids? what subtype is most common? worst prognosis?
rhabdomyosarcoma, embryonal, alveolar
Tx for childhood rhabdomyosarcoma is surgery and ___-based chemo.
doxorubicin
What location has increased incidence of osteosaroma?
around the knee
From what cells does osteosarcoma originate?
metaphyseal
Are neuroendocrine    • Aggressive regional and systemic spread; patients have red to purple papulonodule/indurated plaque    • Have neuron-specific enolase (NSE), cytokeratin, and neurofilament protein
Merkel cell carcinoma
Painful tumor composed of blood vessels and nerves. Benign; most common in the terminal aspect of the digit. Tx: tumor excision
Glomus cell tumor
In elderly, often on face; premalignant, not aggressive.
Hutchinson's freckle
In lip lacerations it is important to line up what?
vermillion border
What is the most common location for desmoid tumors?
anterior abdominal wall (pregnancy, trauma, surgery)
Intra abdominal desmoids associated with retroperitoneal fibrosis and ___ syndrome.
Gardner's
Tx for desomoid tumors includes surgery and ___ if vital structures involved.
chemo/XRT
SCCA in situ; 10% turn into invasive SCCA. Tx: excision with negative margins usual (exception includes peri-anal region)
Bowen's disease
• Rapid growth, rolled edges, crater filled with keratin    • Is not malignant but can be confused with SCCA    • Involutes spontaneously over months    • Always biopsy these to be sure    • If small, excise; if large, biopsy and observe
Keratoacanthoma
Hyperhydrosis – ↑ sweating, especially noticeable in the palms. What is the tx?
sympathectomy if refractory
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
Most common benign cyst? what does it contain?
epidermal inclusion cyst, creamy keratin material
Epidermal inclusion cysts have completely mature epidermis. What other cyst is on the scalp and has no epidermis?
trichilemmal cyst
What type of benign cyst is found over tendons, usually over the wrist, filled with collagenous material?
ganglion cyst
Midline abdominal and sacral lesions, occiput and nose; found along body fusion planes.
dermoid cyst
Congenital coccygeal sinus with ingrown hair; gets infected and need to be excised.
pilonidal cyst
What is the inheritance of keloids?
autosomal dominant
What is the difference in keloids and hypertrophic scar tissue?
in keloids the collagen goes beyond original scar, in hypertrophic scar collagen stays within confines of scar
Which can be treated with XRT Keloids or hypertrophic scar tissue? and what are the other 3 treatments that are common to both?
keloids can be treated with XRT

steroids, silicone and pressure garments can treat both