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ABSITE Plastic and Reconstructive Surgery Exam With Complete Solutions
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ABSITE Plastic and Reconstructive Surgery ExamWith Complete Solutions
What type of UV radiation has been associated with skin cancer?
UVB
What is the most common skin cancer in the US?
basal cell carcinoma
PreviousPlayNextBack 10 secondsForward 10 secondsMute0:01/0:15Full
screenBrainpowerRead MoreWhat are the classic physical findings of basal cell
carcinoma?
pearly appearance with rolled edges +/- telangiectasia
What subtype of basal cell carcinoma is considered to be the most aggressive?
morpheaform type, as it produces collagenase
What is acceptable margin for basal cell carcinoma treatment?
3-mm margins are acceptable
frozen section can be used intraoperatively
What is the most common physical finding of squamous cell carcinoma?
scaly appearance
papulonodular
ulceration
,What is the name of the cancer associated with a previous burn injury?
Marjolin ulcer
- Eponym for SCC arising in an old burn injury
-Ulcer that fails to heal: Granulation tissue, bleeding, everted wound margins
- can also develop in areas of chronic inflammation/enteric fistula
- Poor Prognosis (Mets after tx 40%)
Require Wide Excision with 1 cm Margins
What are appropriate margins for cutaneous SCC?
low-risk lesions (well differentiated, <2 cm): 4-mm margins
high-risk lesions (face, hands, genitalia; >2 cm): >6-mm margins
What are risk factors for development of SCC?
actinic keratosis
arsenics
atrophic dermatitis
Bowen disease
chlorophenols
fair skin
HPV
immunosuppression
nitrates
previous skin cancer
radiation exposure
sun exposure
xeroderma pigmentosum
,What is the natural history of SCC?
actinic keratosis → Bowen disease (SCC in situ) → SCC
Besides sun exposure, what classically is a risk factor for SCC?
history of organ transplant or any other immunocompromised state, including biologic
drugs for autoimmune conditions
Can SCC metastasize?
yes (uncommon) - can metastasize to lymph nodes
- regional adenectomy should be performed
- parotid gland is most frequent site of mets for lesions of cheek or temple
For which of the following scenarios can Mohs surgery be used for BCC or SCC?
sensitive areas: perioral, periocular, perinasal, ears, hands, genitalia
high risk or recurrent lesions
What is the most common site of melanoma on the skin in males? In females?
Male: back
Female: legs
What is the most common site for a distant metastasis of melanoma?
lung: surgery may palliate pain associated with metastatic melanoma to the lung, but it
is not curative
What is the most common metastasis to the small bowel?
, melanoma
What margins are recommended for a melanoma skin lesion with thickness of 1mm?
1-mm thickness: 1-cm margins
>2 mm thickness: 2-cm margins
Lentigo maligna/melanoma in situ: 0.5-cm margins
Can electrocautery be used for excisional biopsy of melanoma?
No, cold knife excision should be used to not disturb the deep margin with burn artifact
What types of melanoma are there?
- superficial spreading
- lentigo maligna melanoma
- acral lentiginous
- nodular
What is the most common type of melanoma?
superficial spreading
What is the least aggressive type of melanoma?
lentigo maligna
What is the most aggressive type of melanoma?
nodular, but acral lentiginous is also aggressive and presents late because of location
on feet/hands
If a melanoma lesion is <1 mm thickness and no lymphadenopathy is palpated, does any
additional workup need to be performed?
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