Term
| Pacini corpuscle function |
|
Definition
deep pressure
high freq vibration |
|
|
Term
| Meissners corpuscle function |
|
Definition
light pressure
tactile sensation |
|
|
Term
| highest conc of apocrine sweat glands? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| MCC pedicle/free flap necrosis? |
|
Definition
|
|
Term
|
Definition
*trans rectus abdominal myoplasty*
sup eipgastrics |
|
|
Term
| Most important determinant of TRAM flap viability? |
|
Definition
| peri-ubmo perforators to skin |
|
|
Term
|
Definition
|
|
Term
|
Definition
90% from free radical formation (indirect)
-10% direct DNA break up
*is a promotor and initiator* |
|
|
Term
|
Definition
melanin
-absorbs UV and dissipates it as heat |
|
|
Term
| UV light types and significance? |
|
Definition
UVA = only indirect damage
UVB = most damaging
UVC = filtered by atm |
|
|
Term
| MC met location for melanoma |
|
Definition
lung
(SB mets are most commonly from melanoma) |
|
|
Term
|
Definition
5% of all skin CA
70% of all skin CA deaths |
|
|
Term
| Factors for worse survival w/melanoma |
|
Definition
Inc nodes
BANS
(Back, post Arms, Neck, Scalp)
mucosal
ulcerated
men
mitotic rate |
|
|
Term
|
Definition
|
|
Term
| Signs of melanoma transformation |
|
Definition
ABCD
-Asym, irreg borders, color change, diameter>6 |
|
|
Term
| List the melanoma syndromes |
|
Definition
Dysplastic nevus syndrome
Xeroderma pigmentosa
Giant congenital nevus
Familial BK mole syndrome |
|
|
Term
| Dysplastic nevus criteria |
|
Definition
*100% risk of melanoma*
> 100 moles, 1+>8 cm, 1+ atypical histo |
|
|
Term
Xeroderma pigmentosa
-pphys |
|
Definition
| defective nucleoside repair enzyme |
|
|
Term
Giant congenital nevus
-melanoma risk |
|
Definition
|
|
Term
| list the types of melanoma |
|
Definition
Lentigo maligna
Superficial spreading
Nodular
Acral lentigo |
|
|
Term
Lentigo maligna
-definition |
|
Definition
melanoma in situ
-least aggressive, radial growth |
|
|
Term
|
Definition
|
|
Term
| Most aggressive melanoma type |
|
Definition
|
|
Term
| Melanoma w/inc incidence at palms/soles |
|
Definition
|
|
Term
|
Definition
Punch commonly used
<2cm, non-cosmetic location -->excisional bx |
|
|
Term
| Melanoma distant met work up |
|
Definition
All intermediate/thick (>1mm), or any clinical nodes
-CT CAP
-LFTs
-LDH (metastatic marker)
*if Met +ve or clinical node +ve, get PET* |
|
|
Term
|
Definition
| > 1 mm gets SLNBx unless clinically +ve |
|
|
Term
| when do melanoma < 1 mm need SLNBx? |
|
Definition
ulcerated
regression on path
growth into reticular dermis
inc mitotic rate |
|
|
Term
|
Definition
1: < 1 mm OR 1-2 mm w/out ulceration
2: > 1 mm
3: +ve regional nodes, in-transit mets, satellite lesion
4: distant mets (lung MC) |
|
|
Term
| Breslow depth and margins |
|
Definition
In situ = 0.5 mm margin
< 1 mm = 1 cm
1-4 mm = 2 cm
> 4 = 2 cm |
|
|
Term
| LN dz w/melanoma location? |
|
Definition
Truncal/extremity:
above line of sappey (2cm above umbo) = ax nodes
below = inguinal
Ax: take level 1-3 |
|
|
Term
| Ilioinguinal node anatomy/dissection levels? |
|
Definition
SF (fem triangle)
-cloque node inside fem sheath = node btwn sf and deep
Deep: obturator/iliacs
-take if SF nodes clinically +ve, +ve cloquet, CT adenopathy |
|
|
Term
| LN spread of head/neck melanoma based on location? |
|
Definition
Salp/face ant to pinna, superior to lip = parotid nodes
inferior to lip commissure = ant. cervical chain
post to pinna = post cervical chain |
|
|
Term
head/neck melanoma
-when to do MRND? |
|
Definition
at anterior or inferior lesions with clinically +ve nodes or +ve SLNBx (requires re-op)
*for posterior lesions, can do just posterior node dissection* |
|
|
Term
| source of skin for cosmetic skin graft? |
|
Definition
FTSG
-behind ear
-above clav |
|
|
Term
|
Definition
Thumb: DIP amputation
Other finger: PIP amp
Toe: MTP amp |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Dacarbazine vs nodes/mets
XRT at multiple node dz, palliation
*some role for IL2, tumor vaccines* |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most aggressive basal cell type |
|
Definition
morpheaform
-collagenase production |
|
|
Term
|
Definition
peripheral palisading of nuclei
stromal reaction |
|
|
Term
basal cell tx
-margins
-nodes |
|
Definition
0.3 to 0.5 cm margins
-LN dissection @ clinically pos nodes (rare mets/node +ve) |
|
|
Term
|
Definition
0.75 cm margins
*Skin flap if > 1/3 lip resected* |
|
|
Term
|
Definition
-1 cm for most
-2 cm @ marjolins, penile/vulvar CA
-MOHS for cosmetic or high risk location |
|
|
Term
Squamous cell CA
-indication for prophy node dissection |
|
Definition
1. >2 cm circumf
2. > 4 mm deep
3. Parotid basin lesions
(ear, face, ant scalp)
get SF parotidectomy
*if +ve, get total parotid + MRND* |
|
|
Term
| Mgmt Squamous cell CA @ parotid basin |
|
Definition
ear, face, anterior scalp, temple = 20% parotid LN involvement
-all lesions get SF parotidectomy. If +ve, get total parotid + MRND |
|
|
Term
Squamous cell CA
-role for CXRT? |
|
Definition
| used @ neuro, vascular, nodal invasion OR positive margins |
|
|
Term
Soft tissue sarcoma
-MC sarcoma type
-MC sacroma site |
|
Definition
malig fibrous histiosarcoma (#2 = liposarcoma)
Extremitiies (MC thigh) |
|
|
Term
Soft tissue sarcoma
-% occurring in kids |
|
Definition
|
|
Term
Soft tissue sarcoma
-RF and type of CA |
|
Definition
1. Asbestos (mesothelioma)
2. PVC, arsenic (angiosarcoma)
3 Chronic lymphedema (lymphangiosarcoma)
4. XRT |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| most important sarcoma prognostic factor? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-MRI before bx to r/o neuro/bone/vascular invasion
-Pan scan, LFTs,
-Bx |
|
|
Term
|
Definition
1. CNBx
If not possible...
2. Longitudinal EXCISIONAL bx if < 4 cm
*go back to OR if +ve*
3. longitudinal INCISIONAL bx if > 4 cm
**Bx along long axis of future incision* |
|
|
Term
Sarcoma tx
-margins
-CXRT role |
|
Definition
-2 cm
-Pre-op CXRT (MAID = Mesna, doxo(adria), isosfamide, dacarb)
-Post-op CXRT @ high-grade, close margins, tumors > 5 cm |
|
|
Term
| indications for post op CXRT vs sarcoma |
|
Definition
high grade
close margins
tumors > 5 cm
**Doxorubicin based** |
|
|
Term
| 5YSR with complete resection of sarcoma |
|
Definition
|
|
Term
Soft tissue sarcoma
-pres w/primary sarcoma and lung met |
|
Definition
1. take primary first. Then met 6 wk later
2. UNLESS met is difficult to resect, then OK to take met first |
|
|
Term
| MC pop for head and neck sarcoma |
|
Definition
|
|
Term
| MC type of Retroperitoneal sarcoma |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
NOT surgery (unless causing GI hem)
-HAART if AIDS related
-INF alpha,
-XRT |
|
|
Term
Rhabdomyosarcoma
-MC subtype
-Worst subtype |
|
Definition
MC = embryonal
Worst = alveolar |
|
|
Term
|
Definition
vaginal rhabdomyoarcoma
-p/w bleeding |
|
|
Term
Osteosarcoma
-MC location
-MC pop |
|
Definition
MC loc = knee
MC pop = children |
|
|
Term
Genetic syndromes
-Neurofibromatosis types |
|
Definition
NF1: Neurofibromin mutaiton
a. CNS (optic n, acoustic neuroma)
b. periph nerve sheath
c. pheo
NF 2 (merlin gene (cytoskeletal protein)
a. acoustic neuroma only |
|
|
Term
|
Definition
type 1 = neurofibromin (GTPase inhibitor normally)
type 2= merlin (cytoskeletal protein |
|
|
Term
|
Definition
neural crest cells
-cafe au lait, ax frecling
*< 10 % get CA* |
|
|
Term
|
Definition
|
|
Term
Hereditary retinoblastoma
-% retrinoblastoma sporadic vs inherited |
|
Definition
55% sporadic
-overall best outcome of childhood CA (98% 5YSR) |
|
|
Term
Tuberus Sclerosis
-features
-% inherited vs sporadic |
|
Definition
-hamartomas (brain, kidneys, heart, eyes, lung, skin)
-hypomelanotic macules
-70% sporadic |
|
|
Term
|
Definition
TSC1 = hamartin
TSC2 = tuberin
*tumor suppressor genes, suppress mTOR* |
|
|
Term
Gardners syndrome
-features |
|
Definition
FAP +
abd desmoid tumors,
skull osteoma,
thyroid CA,
epidermoid cysts, |
|
|
Term
|
Definition
-impacted and supranumery teeth
-jaw osteomas (cotton-wool appearance)
-odontomas
-hypertrophy of retinal pigment epithelium |
|
|
Term
|
Definition
APC gene
-binds glycogensynthasekinase (GSK) |
|
|
Term
Merkle cell carcinoma
-MC mets |
|
Definition
bone (and LN)
*Highly aggressive w/early mets* |
|
|
Term
Merkel cell carcinoma
-associated finding |
|
Definition
| 80% w/merkel cell polyomavirus |
|
|
Term
|
Definition
Neuron-specific enolase (NSE)
cytokeratin
Neuofilament protein staining
-perinuc staining w/keratin Ab |
|
|
Term
|
Definition
2-3 cm margins
SLNBx
post op CXRT |
|
|
Term
Dermatofibrosarcoma protuberans
-RF
-translocation? |
|
Definition
-arsenic
-chromosome 17;22 (PDFG gets expressed in place of collagen) |
|
|
Term
| types of keratosis and CA risk |
|
Definition
Actinic = premalig @ sun damaged areas
Seborrheic = NO CA risk. Trunk of elderly pts
Arsenical = a/w SCCa |
|
|
Term
|
Definition
Diclofenac sodium, liq nitrogen, 5FU cream, laser
surgery |
|
|
Term
Glomus tumor
-MC location
-pres
-CA risk |
|
Definition
-tip of digit near nail
-painful tumor of blood vessels/nerves
-benign
-tx excision |
|
|
Term
Paraganglioma
-cell origin
-MC location |
|
Definition
-Neural crest (glomus cells). Secrete NE.
-abdoman = MC overall
-carotid body = MC ENT location
-aortic arch body = MC thoracic location |
|
|
Term
|
Definition
from glomus body
(NOT glomus cells, which are chemo-receptors that regular BP and blood flow (paragangliomas)) |
|
|
Term
Desmoid tumors
-location
-RF |
|
Definition
-occur in fascial planes
-RF trauma, estrogen, surgery, preg, women |
|
|
Term
|
Definition
painless mass,
bowel obstruction |
|
|
Term
|
Definition
anterior abd wall
-a/w garderns and PR fibrosis when intra-abd desmoids |
|
|
Term
|
Definition
WLE
CXRT
*NSAIDs, anti-estrogens, Imatinib (gleevac) |
|
|
Term
|
Definition
squamous cell ca in-situ
-10% turn invasive |
|
|
Term
Bowens dz
-mc pt / location |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
apocrine sweat gland infection
-staph / strep MC |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 50% recurrence w/aspiration |
|
|
Term
|
Definition
|
|
Term
| DDx keloid vs hypertrophic scar |
|
Definition
keloid goes beyond original scar
-2/2 failure of collagen breakdown |
|
|
Term
|
Definition
| intra-lesional steroid injection after excision |
|
|
Term
| Sacral decub ulcer staging |
|
Definition
1 = erythema
2 = partial skin loss
3 = full thickness skin loss (subQ exposed)
4 = bony cortex |
|
|
Term
|
Definition
| IV pyelogram (trapped ureters) |
|
|
Term
|
Definition
-Steroids + immunosupp (tamox, inflix)
+/- surg if ureter trapped (vs perc tube) |
|
|
Term
Mesenteric tumors
-location of malig vs benign |
|
Definition
malig = closer to root of mesentery
benig = peripheral |
|
|
Term
Mesenteric tumors
-MC types |
|
Definition
malig = liposarcoma
benign = lipoma |
|
|
Term
|
Definition
|
|
Term
Retroperitoneal tumors
-MC types |
|
Definition
MC malig = Lymphoma
(MC malig solid tumor = liposarcoma) |
|
|
Term
|
Definition
Cutaneous lesions
Cystic hygroma
Lymphangioma Cavernosum |
|
|
Term
Cystic hygroma
-MC location |
|
Definition
Lateral posterior neck triangle (MC Left)
-can get infected (Tx rsxn) |
|
|
Term
Lymphangio Cavernosum
-lcation |
|
Definition
|
|
