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SB82 Plastics & Skin

SB82 Plastics, Skin and Soft Tissue - Loosely taken from Fiser's ABSITE review

The main cell type in the epidermis ___________ Keratinocyte
Origin of melanocytes ______________ Neuroectoderm
Location of melanocytes ____________ Basal layer of the epidermis
Melanocytes have dendritic processes that transfer melanin to neighboring keratinocytes via ______________ Melanosomes
Density of melanocytes is the same among races; the difference is in _____________ Production of melanin
Langerhans cells are part of the MHC class __________ Two
Langerhans cells originate from this location ____________ Bone marrow
These dermal structures provide pressure sensation ________________ Pacinian corpuscles
These dermal structures provide the sensation of warmth ________________ Ruffini
These dermal structures provide the sensation of cold ________________ Krause
These dermal structures provide tactile sensation ________________ Meissner’s corpuscles
These sweat glands produce aqueous sweat ___________ Eccrine
These sweat glands produce milky sweat _____________ Apocrine
Most apocrine sweat is produces due to stimulation of the __________________ Sympathetic nervous system
Type I collagen comprises ___________ % of dermis weight Seventy
What molecule gives tensile strength to the dermis? ___________ Type I collagen
Elastins are branching proteins that allow the dermis to stretch to _________ times normal length Two
These skin deformities are caused by loss of tensile strength and elasticity in some disease processes ______________ Cushing’s striae
This process brings nutrients to and waste away from skin grafts in post-graftin days 0-3 _____________ Imbibition
In split-thickness skin grafts, skin is regenerated from these structures Hair follicles and skin edges
What is the benefit of full-thickness skin grafts? Less wound contraction
Blood supply to skin grafts after day 3 occurs through _____________ Neovascularization
What is the most common cause of necrosis of pedicled or anastomosed free-flaps? __________ Venous thrombosis
TRAM flaps rely on what vessels for blood supply? ________ Superior epigastric vessels
The most important determinant of TRAM flap viability __________ Periumbilical perforators
The best natural factor in protecting the skin from UV radiation ___________ Melanin
Melanoma only comprises 3-5% of all skin cancer, but causes __________ % of skin-cancer deaths 65
You have a patient with familial BK mole syndrome. What is the lifetime risk of melanoma for this patient? ~100%
What percentage of melanomas are familial? 10%
Most common site of melanoma in men and women, respectively _________ Back and legs
Melanoma originates from ______________ cells in the basal layer of the epidermis Neural crest
The most common location for metastases from melanoma __________ Lung
You have a patient who has and SBO. CT scan reveals a metastatic-appearing lesion on the small bowel. What is the likely cause? _____________ Melanoma
A patient has a skin lesion suspicious for melanoma, which measures > 2 cm in width. What is the appropriate initial management? Incisional biopsy for lesions > 2 cm diameter, or in a cosmetically-sensitive area
The least aggressive form of melanoma _________ Lentigo maligna
Most common form of melanoma ____________ Superficial spreading
Type of melanoma most likely to have metastasized at diagnosis _________ Nodular
Melanoma type found on palms and soles ___________ Acral lentiginous
Margins for melanoma Clear margins if < 0.5 mm in depth; 1 cm margins if 0.5-1.0 mm in depth; 2 cm margins if > 1.0 mm in depth
Your patient with biopsy-proven 1.1 mm-deep melanoma is scheduled for excision. There are no clinically-positive lymph nodes. What is the appropriate management? Sentinel lymph node biopsy
The pathology report on your patient with a 1.1 mm-deep melanoma and clinically-negative lymph nodes shows margins > 2 cm and positive sentinel lymph node. What is the appropriate management? Formal lymph node dissection
A patient comes to clinic with a palpable, non-tender axillary lymph node. Biopsy reveals melanoma. On examination, no primary lesion is detectable. What is the appropriate management? Complete axillary node dissection
The most common malignancy in the United States ____________ Basal cell carcinoma
Pathology of basal cell carcinoma Peripheral palisading of nuclei, and stromal retraction
What is the most aggressive form ofr basal cell carcinoma? ____________ Morpheaform
What enzyme is produced by morpheaform basal cell carcinomas? _____________ Collagenase
Margins for BCC ____________ 0.5 cm
Name for squamous cell carcinoma that develops on the rim of a burn wound or non-healing wound/scar _____________ Marjolin’s ulcer
A patient with SCC has clinically positive nodes. What is the appropriate management? Regional lymphadenectomy
Margins for SCC 0.5-1cm
Most common soft tissue sarcoma _____________ Malignant fibrous histiocytoma
Second most common sot tissue sarcoma ___________ Liposarcoma
What percentage of sarcomas arise from extremities? ___________ 50%
Most common presentation of a soft-tissue sarcoma _____________ Painless mass
Sarcomas spread through this route ___________ Hematogenous
Your patient has a suspected soft-tissue sarcoma of his leg measuring 4.1 cm. What is the appropriate management? Longitudinal incisional biopsy for sarcomas > 4.0 cm; otherwise may perform excisional biopsy
Most common site for sarcoma metastasis ____________ Lung
Staging of sarcomas is based on ___________ Grade (not stage or nodes)
Type of chemotherapy for sarcoma _____________ Doxorubicin
Margins for sarcoma excision _________ At least 3 cm and no involved fascial planes
Post-operative radiation therapy is indicated for sarcomas with these characteristics High-grade, close margins, greater than 5 cm
Why is hemostasis important after sarcoma excision? Hemostasis helps avoid hematomas, which can disseminate tumor cells through normal tissue planes.
5-year survival rate after complete sarcoma resection 40%
Cause of death in patients with retroperitoneal sarcomas Local recurrence (rarely due to metastasis)
Sarcoma related to asbestos exposure _____________ Mesothelioma
Sarcoma related to PVC or arsenic exposure _________ Angiosarcoma
Sarcoma related to chronic lymphedema __________ Lymphangiosarcoma
Treatment for local Kaposi sarcoma XRT or intralesional vinblastine
Most common soft tissue sarcoma in children ________ Rhabdomyosarcoma
Most common rhabdomyosarcoma subtype ______________ Embryonal
Subtype of rhabdomyosarcoma with the worst prognosis ___________ Alveolar
Treatment for childhood rhabdomyosarcoma Surgical excision and doxorubicin-based chemotherapy (as with most sarcomas)
Osteosarcoma originates from the _______________ cells, usually at the knee _____________ Metaphyseal
Treatment for osteosarcoma Resect joint, followed by reconstruction vs. amputation
Xanthomas are yellow in color, contain this cell type ___________, and require excision Histiocytes
Initial treatment for verruca vulgaris ___________ Liquid nitrogen
Your patient presents with a reddish-purple papulonodular plaque with surrounding induration. What is the likely diagnosis? _________ Merkel cell carcinoma
You biopsy a reddish-purple papulonodular plaque. If it is a Merkel cell carcinoma, what substances do you expect it to stain for? Neuro-specific enolase, cytokeratin, neurofilament protein
Your patient presents with a painful swelling at the tip of her finger. Biopsy shows intertwined blood vessels and nerves within the specimen. What is the diagnosis? _________ Glomus cell tumor
Intra-abdominal desmoid tumors are associated with what conditions? Gardner’s syndrome and retroperitoneal fibrosis
Treatment for refractory hyperhidrosis ________ Sympathectomy
Most common organisms in hidradenitis suppurativa Staph and strep
Type of sweat gland infected in hidradenitis suppurativa ____________ Apocrine
Definition of keloid vs. hypertrophic scar In keloids, the collagen goes beyond the original scar; in hypertrophic scars, the collagen stays within the confines of the scar tissue
You may use steroids, silicone, and pressure garments but NOT radiation therapy for this type of scar malformation ___________ Hypertrophic scar
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