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13.02.15 Plastics notes

Hilton's Law
  • Nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles
  • For example, musculocutaneous nerve:
    • Supplies biceps brachii + brachialis
    • Also supplies the elbow joint with pain and proprioception fibres
    • Also supplies the forearm skin around the elbow (close to the insertion of each of those muscles)


Melanoma history

  • Age
  • Occupation
    • Outside work?
  • Country of birth
  • Past sun exposure
    • Sunburnt?
  • Skin type / Response to sun
  • History of lesion
    • When noticed
    • When GP consulted
    • Referrals
  • Any other moles
  • PMH
  • FHx of skin or other cancer


Fungating man

  • Differentials
    • SCC / MM
    • BCC never look like that
  • Smell
    • Farty smell = Anaerobes
      • => Metroniazole


Melanoma staging

  • Breslow thickness => 5-year survival
    • <1 mm => 95-100% 
    • 1 - 2 mm => 80-96% 
    • 2 - 4 mm => 60-75% 
    • >4 mm => 50%
  • Ulceration is bad
  • Nodes
  • CT for haematogenous spread


Skin types (Fitzpatrick Scale)

  • Type I
    • Light, pale white
    • Always burns, never tans
  • Type II
    • White; fair.
    • Usually burns, tans with difficulty
  • Type III
    • Medium, white to light brown.
    • Sometimes mild burn, gradually tans to a light brown
  • Type IV
    • Olive, moderate brown
    • Rarely burns, tans with ease to a moderate brown
  • Type V
    • Brown, dark brown
    • Very rarely burns, tans very easily
  • Type VI
    • Black, very dark brown to black
    • Never burns, tans very easily, deeply pigmented

Seborrheic keratosis
  • Noncancerous benign skin growth
  • Originates in keratinocytes
  • Seen more often as people age
  • Appearance:
    • "Pasted on"
    • Various colors, from light tan to black
    • Round or oval
    • Feel flat or slightly elevated (like the scab from a healing wound)
    • Range in size from very small to more than 2.5 centimetres across
  • Resemble
    • Warts
    • Melanoma

Gastrointestinal stromal tumor (GIST)
  • Definition
    • Common GI mesenchymal tumor
      • 1-3% of all gastrointestinal malignancies
    • Defined as tumors whose behavior is driven by mutations in the Kit or PDGFRA genes
    • Sarcomas (connective tissue)
      • cf Most other GI tumours
    • 70-80% are benign
  • Signs and symptoms
    • Vague abdo pain
    • Trouble swallowing
    • GI bleed
    • Mets
    • Intestinal obstruction is rare, due to the tumor's outward pattern of growth
  • Location
    • 70% stomach
    • 20% small intestine
    • 10% oesophagus
  • Therapy
    • All GIST tumors should be considered to have malignant potential and no GIST tumor can be correctly classified as "benign."
    • Surgery is mainstay
    • c-kit tyrosine kinase inhibitor imatinib => 40-70% response rate in metastatic/inoperable cases
      • Initially marketed for CML
      • Also useful in dermatofibrosarcoma protuberans (DFSP)

Notes

  • Charcot joint
  • Eccrine porocarcinoma
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