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INTRODUCTION

Test Taking Tips

  • Review innervation and blood supply to the pectoralis major, pectoralis minor, serratus, and latissimus dorsi.

  • There is always a question about topical antimicrobials such as silver nitrate or sulfamylon. Review their side effects and what organisms they best cover.

  • Review the necessary margins for melanoma excision and indications for sentinel lymph node biopsy.

SKIN

What type of UV radiation is linked with skin cancer?

  • UVB

What is the most common skin malignancy in the United States?

  • Basal cell carcinoma

What are the classic physical findings of basal cell carcinoma?

  • Pearly appearance with rolled edges +/− telangiectasia

What type of basal cell carcinoma is the most aggressive?

  • Morpheaform type (produces collagenase)

What margins are appropriate for basal cell carcinoma?

  • 3-mm margins are acceptable, and 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, an eponym for squamous cell carcinoma arising in an old burn injury; can also develop in areas of chronic inflammation, that is, enteric fistula

What are appropriate margins for cutaneous squamous cell carcinoma?

  • Low-risk lesions (well differentiated, <2 cm) take 4-mm margin; high-risk lesions (face, hands, genitalia, >2 cm), take >6-mm margin

What are risk factors for the development of squamous cell carcinoma?

  • 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 squamous cell carcinoma?

  • Actinic keratosis, Bowen disease (squamous cell carcinoma in situ), squamous cell carcinoma

Aside from sun exposure, what is classically a risk factor for squamous cell carcinoma?

  • History of organ transplantation or any other immunocompromised state, including biologic drugs for autoimmune conditions

Can squamous cell carcinoma metastasize?

  • Yes, it is uncommon, but it can metastasize to lymph nodes. Regional adenectomy should be performed. Parotid gland is most frequent site of metastasis for lesions of cheek or temple.

When can Mohs surgery be used for basal cell or squamous cell carcinoma?

  • Delicate areas that include perioral, periocular, perinasal, ears, hands, and genitalia, high risk or recurrent lesions

What is the most common melanoma site on the skin in men? In women?

  • Men—back

  • Women—legs

What is the most common location for distant melanoma metastasis?

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