Non-melanoma Skin cancer
What is the precursor lesion for SCC and what cells does it originate from?
actinic keratoses, cutaneous horn, originates from keratinocytes of epidermis
How should extremity sarcoma be diagnosed?
Tissue biopsy- core needle biopsy, if non-diagnostic and less than 3cm then do exisional biopsy, if greater than 3cm then incisional biopsy longitudinally
What is this?
Ganglion cyst
What are the ABCDE and ugly duckling sign of melanoma?
Asymmetry
Border irregularity
Color variation
Diameter
Evolution
Ugly duckling- a mole that looks different than those surrounding is suggestive of melanoma
What tracer should be using in pregnant patients for SLNB?
Radiolabeled colloid (can't use isosulfan blue)
What are the margins for BCC and what do you do if margins are not clear on final pathology?
At least 4mm (4-10), radiation therapy
What two site of sarcoma metastasis can be considered for metastectomy?
Liver/Lung
What is this?
Herpetic Whitlow
When do you need to perform an SLNB?
T1b - anything deeper than 0.8mm or ulceration
What is Cloquet's Node?
the most superficial deep inguinal node beneath the inguinal ligament, just superficial to external iliac nodes
What gene deformity is often associated with BCC?
hedgehog pathway mutation
What two tumor markers should be assessed in patients with RP sarcomas to distinguish from other tumors? What else can be used to distinguish RP sarcomas from other masses?
AFP,B-HCG to r/o germ cell tumors, could also be lymphoma (distinguish by labs/imaging), can do FNA or core needle biopsy if unclear
What is this called? What bug causes this?
Fournier's Gangrene- often polymicrobial, E. coli (most common aerobe), Bacteroides (most common anaerobe), Proteus, Klebsiella, Enterococcus, Staph, Strep
Treatment for metastatic melanoma and mechanism of action?
PD1 monoclonal antibodies (Nivolumab/Pembrolizumab)
Key elements in preventing SSI? Name 4.
avoid hyperglycemia, maintain normothermia, prophylactic abx within 60 min of incision, discontinue abx within 24 hours of surgery end time, use a clipper (not razor), remove urinary catheters within first 2 post op days
Treatment for Merkel Cell Carcinoma
WLE, 2cm margins down to fascia/pericranium, SLNB, XRT to excision site and regional nodes (if >2cm or lymph node metastasis)
What is the #1 and #2 most common extremity sarcomas in adults? In kids?
Adult- malignant fibrous histiocytoma, leiomyosarcoma
Pediatric- rhabdomyosarcoma, fibrosarcoma
What is this? Surgical treatment?
Felon, volar longitudinal incision starting 3-5mm from DIP
Melanoma T staging and corresponding margins.
Tis (0.5-1cm)
T1<1mm (1cm)
T2 1-2 (1-2cm)
T3 2-4 (2cm)
T4 > 4 (2cm)
b= ulceration
What separates superficial and deep inguinal lymph nodes? What are the borders of a superficial vs. deep lymphadenectomy?
Fascia lata
Superficial Inguinal Lymph Node Dissection
-femoral triangle -superior border is inguinal ligament, medially adductor longus, laterally is sartorius
Deep Lymphadenectomy
-bifurcation of common iliac artery to inguinal ligament, medially to bladder/ureter, laterally to pelvic sidewall, deep to obturator nerve
A patient has a skin mole concerning for squamous cell carcinoma with palpable lymphadenopathy. What is the next best step? And what should you do if nodes are positive? (3 parts)
FNA of suspicious nodes, if positive patient should get whole Body PET and CT CAP for metastatic workup, referral to medical oncology for potential neoadjuvant immunotherapy
Name 3 types of sarcoma that metastasize to lymph nodes.
epithellioid sarcoma, clear cell sarcoma, angiosarcoma, synovial sarcoma, rhabdomyosarcoma
What is this? What bug most commonly causes this?
Erysipelas, Group A Strep
What did MSLT-1 and 2 find?
MSLT1- SLNB increased disease free survival but did not affect survival.
MSLT2- no difference in survival when doing nodal basin ultrasounds vs. completion lymphadenectomy in SLN positive patients
Surgical approach for an RP sarcoma.
most often wide midline laparotomy, left/right medial visceral rotation (Mattox/Cattell-Braasch), do not rupture/partially remove/piecemeal removal, goal is R0, resection of involved organs/structures en bloc (commonly nephrectomy/colectomy)